Permit CITY OF TIGARD MECHANICAL PERMIT
''� COMMUNITY DEVELOPMENT Permit #: MEC2011 -00462
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 10/19/2011
Parcel: 1 S 133DB00300
Jurisdiction: Tigard
Site address: 11566 SW SHEFFIELD CIR
Project: Anderson Subdivision: BRITTANY SQUARE NO.2 Lot: 27
Project Description: Install gas insert with associated gas piping and venting.
Contractor: EVERGREEN GAS INC. Owner: ANDERSON, JILL M
PO BOX 388 11566 SW SHEFFIELD CIR
WEST LINN, OR 97068 TIGARD, OR 97223
PHONE 503 - 407 -9542 PHONE. 503 - 702 -8612
FAX 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 10/19/2011 $33.39
Type of Use: SF Chimney /Liner /FlueNent 10/19/2011 $33.39
Class of Work: ALT Type of Const: Fuel Piping 10/19/2011 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 10/19/2011 $10 80
Stories: Minimum Fee Adjustment - Mechanical 10/19/2011 $9.07
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 No ion -r. Thos- rules are set forth in OAR 952 - 001 -0010 through OAR 952 -08 ! 890 You may obtain a copy of the rules
or dire questions to OUN. b alli t 03 232 1987 or 1 800.332 2344.
Issue By: / / Permittee Si. ature: ,,.,,
Call 503.639.4175 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 -17 -2011 04:23 FROM: TO:5035981960 P.2
Mechanical Permit Applic ' en 1 FOROFFiCE USE ONLY ,
City of Tigard r _. Received �, tie c p� y ' io . la
P
,t 1, / Permit No. • DatefRy: [ �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone' 503 639.4171 Fax 503 598 1960 OCT a kr t y i V'a Date/lily Other Permit:
— �
Inspection Line: 503 639.4175 U l� I A l'* ' Date Ready/By: June 0 See Page 2 for
Internet. www.ci.tigard.or.us ", Notified/Method. Supplemental Information
CITY OF TICR iD
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❑ New construction ddition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
CI Demolition Other: mechanical materials, equipment, labor, overhead, and profit,
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` .:ll F15IDEIITIO,,,- .IRT,li..''1V,IENT /SYSTO4S'Eggs*
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
12 Multi- family ❑ Master builder ❑ Other: For special information use checklist
Description Qty L Es I Total
Mili'yii 1 .1 4∎;r!;' i = 414 01.1,EjF -4 (? f'Tl 1A_ DtiNO}1'7 * ';i• ; ∎;IH'; Heatin coolin
Job site address: / /(� ' I / Air conditioning or heat pump
//5 6 6 _ s SV ti 7/ ` ,. / " It (requires site plan showinµ placement) 14 00
City /State /ZIP: , ...-1 ' J 7 Z23 Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no • Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14 -00
Hydrontc hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in-wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
ennt, ,L 1�,• *n� 4? '. i 1 =dds ° ' r ''' +«s' , :s,'•. ,u„ ''''...r'' , ', i:4.1 IMF n' N ' ; V9l, • Water heater 10.00
i'�i � a 1'° , a, ,
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.
,f 4 f / / / Gas fireplace 1 10 00
, / 4 // 4( I�i,S', 1 i tie.,-/,/ , Flue vent for water heater or gas
fireplace 10 00
Log lighter (gas) 10 00
_ Wood /pellet stove 10.00
Wood fireplace /insert 10.00
a t A r il , 1' I R l# ,;9, e V , nRd, l ..,i, ,,” , Ik i'. >�` ' 4,kM,.:j n ''•.3 i :• v ;- X Other neyJliner /flue/vent 10 -00
Name: ) t / /t f 7 / /���,Jef� in Environmental exhaust and ventilation
Address: C� Range hood /other kitchen
( sL�S�I e 1t'f eJL� 2
equipment 10 00
City/ State/ZiP: ., ! 4i-d o it ' 772-_3 Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms,
Phone: (50) -'7 ` L 8 6 / ^7 F ax: ( ) toilet compartments, utility rooms) 6.80
(•\ 1 ` Rj� +ia``z ill-j1M1,s,- z v ti - sti MPOlkiglil S ^ , A'' II A .f an'� nv Pt' »,• •,.., , i.;�:, .
,1 � .i , 1 it s NM i ' Attic /crawlspace fans 10.00
( ;I:t`';v „. • rrY a$ � i` Y' PL�i, �s! �`�..�y�,'4ul�laidk��! t 1 ` �p"1 ;wr:�� „' ,'�' p� .+Q•w,a. � , :�Ir ';tq; ,,•p,
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall /suspended/unit heater
Phone: ( ) ! Fax: : ( ) Water heater
Fireplace li
E -mail:
Range
7s veg , r; 4.,;,w gtfi fit” Y",n , 's 1 4+ u r9t ` If • '"" w ' ,. . .. ; , ': 1.77 1 , - , , r2/.: , 7 � , ',. ,. ,
I'1',M:. _•Iti•4'„ :, thx . "k; s"t `l `, 1r:,,,r.Z ; ., t�;..,A.. ,. . . • _ r Barbecue
Business name: Clothes dryer (gas)
Cf4ireb -t 444 �NL Other:
Address: {7'c, 3zx _]_ ST, t '� f v } C1 r ]CCA' k1. `'r T tS i .
Ci / State/ZIP: ,) &'5t L N N . d 9) v L 5 Subtotal 9"
ne: / 7Sila -- Fax: � j d� y Minimum permit fee ($ _ < 3�S Plan review (25% of permit fee) ------
CCB lic.: `Ss 0 3 j State surcharge (8% of permit fee) 'O • �f O
/ TOTAL PERMIT FEE I / op. Vd
Authorized signature: This permit application expires it a permit is not obtained withi3iC�"
f days after It han been accepted as complete.
Print name: � i 1 I !1 W'� \p / e41 Date: �/ J 74/ ' Fee methodology act by Tti- County Building Industry Service Eta
i.\➢ uilding\Pernuts \MEGPemdtApp.doc 12/03 44 4617T ( OM/WEB)