Permit CITY OF TIGARD MECHANICAL PERMIT
2 ''' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00440
Date Issued: 10/04/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 parcel: 2S111 D609900
Jurisdiction: Tigard
Site address: 15495 SW OAKTREE LN
Project: McRivette Subdivision: SUMMERFIELD NO.10 Lot: 587
Project Description: Extend gas line, install logs & (1) gas fireplace insert.
Contractor: NW GAS LINES Owner: MCRIVETTE, WILLIAM RUSSELL
16731 NE WASCO ST MCRIVETTE, KATHLEEN TACK
PORTLAND, OR 97230 15495 SW OAKTREE LN
TIGARD, OR 97224
PHONE: 503 - 256 -2436 PHONE: 503 - 713 -7591
FAX: 503 - 256 -2245
FEES
Specifics: Description Date Amount
Gas Fireplace 10/04/2011 $33 39
Type of Use: SF Other, Fuel Appliances 10/04/2011 $23.32
Class of Work: ALT Type of Const: Fuel Piping 10/04/2011 $14 15
Occupancy Grp: 12% State Surcharge - Mechanical 10/04/2011 $10 80
Stories: Minimum Fee Adjustment - Mechanical 10/04/2011 $19.14
Fuel
Fuel Types: Natural Gas
Gas Pressure
Total $100 80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503 232 1987 or 1 800 332.2344
Issued By: � 'a Permittee Signature:
Call 503.. •4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Oct 04 11 11:35a Tony Young 503- 256 -2245 p.1
Mechanical Permit Appli F OR OFFICE USE oNLa
tY Tigard , :
13125 SW Hall
VI Ci of Ti and I 97223 s Pen ult No
al Blvd , Tigard, OR Date/ By: ! D ' o+ /
0 2011 Plan Review
Phone: 503.718.2439 Fax: 503.59$. Other Permit:
Inspection Line: 503.639.4175 e
Date/By
GAIiD Date i e d /meth H Sec Page 2 for
Internet wwu•,tigazd- or.gov Ploufid/Meth Supplemental Information
CITY OF TIGARD
BJ j11� p
y p DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alteration replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit,
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES'
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building X
/ Far special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
/ Air conditioning I
Job site address: /54,95 S /'v 7/f / / / / /// � ' -1'I/_ / /, r „, Z /j s. (requires site plan showing placement) 46.75
[� w �!/I Furnace 100.000 BTU (ducts/sents) I 46 75
City /State /ZIP: r f i- l
T/ if �i 7ji2� Furnace 100,000+ BTU (ducts'vents) 54 91 .
Suite/bldg. /apt. no.: ✓ Project name: Ha 4 ( i rr t Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23 32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in-duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 2.3.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
'0 / Gas fireplace / 33.39
7)dj / -- C / 116 J //I ) f /L 7/ /j-C / / /?.5 ('� Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
5 PROPE TY OWNER 0 TENANT Chimney/liner/fine/vent 23.32
Nye' / /� �t Other: f c / 23.32
Address:
Y �' /! ! i” _ EnvironmentaYexbaust and ventilation:
!� �� n/1 f , �� p equipment 33.39
Range hood /other kitchen
�j 9 �`T,t Nit lat e"
City /State /ZIP: -7 x id / ,- 7 7 V Clothes dryer exhaust 33.39
/ Single -duct exhaust (bathrooms,
Phone: (4;73 i 3 -A- z Fax: ( ) toilet compartments, utility rooms) 23.32 '
g APPLICANT / ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name. ,hiy 61,/ ) , 7 fi/� c ,( / � � . 3 Other 23.32
Es�f Y �!/�'I /V /��Z Fuclpipint;:
Contact name: �,�
,� �, r y tt ( J ` $14.75 fpr firsl four; 54.03 for each additional
Address: / ,73/ / ) 3LO Jr-- Furnace, etc.
City/State/ZIP: { Gas heat pump
Cit
y �/i .f / or g7 WalUsuspended/unit heater
Phone: 93),2c Fax:: (93) S',- a y Water heater
j� / C Fireplace /
E -mail:
1 1 �� �-�! {1 su/t�iiCst ; i ' 7 Range
CONTRACTOR Barbecue
Business name: i Clothes dryer (gas)
1 �,�i Other:
ddress: MECHANICAL PERMIT FEES"
City /State /Z[P. Subtotal
/-� � - a, y y5---
Minimum permit fee (590.00) %) .0
Phone: ( ) Fax: (93 ) �G O
/5 6/ Plan review (25 %of permit fee)
CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE / Or C•
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name: � a 4f e/2 7 c r Date: /.//' ! " Fee methodology set by Tr - County Building Industry Sere ee Board
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