Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 00533
Date Issued: 11/23/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S111CA14500
Jurisdiction: Tigard
Site address: 9825 SW SATTLER ST
Project: Starkey Subdivision: ALDERBROOK FARM Lot: 8
Project Description: Install freestanding gas stove and venting.
Contractor: GO SALES INC. Owner: STARKEY, WILLIAM
14210 SE STARK ST 9825 SW SATTLER ST
PORTLAND, OR 97233 TIGARD, OR 97223
PHONE: 503 - 256 -3473 PHONE: 503 - 620 -7646
FAX: 503 - 254 -1011
FEES
Specifics: Description Date Amount
Gas Fireplace 11/23/2011 $33.39
Type of Use: SF Other, ExhaustNentilation 11/23/2011 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/23/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/23/2011 $33.29
Stories:
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: Permittee Signature: /°L,
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.
Nov.22.2011 18:19 PAGE. 1/ 2
Mechanical Permit Applicati4k
RECEIVED . 1.014 OFFICE 1 SI:: MI.)
City of Tigard
, ,--- I 13125 SW Hall Blvd., Tigard, OR 97223
II FEirriargligiji - Permit No iy
'et illif ' . /
, I Phone: 503.718.2439 Fax: 503,598. !q? V 2 3 2011 ESIIIIIMMICIII
.,,.,„,, Inspection line: 503.639.4175 Data Ready/By: FM El See Page 2 ror
Internet: www,ligard-ongov
CITY OF TIGARD Non floct/Ivietliod:
Suppkmental Information
' - " . • '' • ' ' nowi DIVISION ,, . _ .
' . '..01001ACIAP 0.00' :000.01.0 SkCiit444ST. ,.-.
Mechanical permit fees* are based on the value of the work
Ej New construction El Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
D Demolition 0 Other: mechanical riaterials, equipment, labor, overhead, and profit
•• ...,:••.' . .•'•,. .. . • • • ..- • '..• cotwity. or. coNotat01011. , ' ,.... ' ' '''.-.''' '' ' ':' ' ' ' ' ' tiS - • ' , . .,,,-. ,, ..... . . ,.•
: , ' . '.. ' ..,. • ',' -• ,'. ' .• ; . . ','._;L, - ,, • - . , .... 1.,.._■ • • '' ' '' '' ' - . • ], - :' PoRp Pfri49.i /14VOMPYT SYSTEMS ERE6".•.:'.:
El 1 - and 2-family dwelling 0 Conunercial/industrial 0 Accessory building For special Wormation use checidist
E Multi-family 0 Master builder 0 Other: Description ' Qty. FA, r Total -
— • - • • 14eatIng/ewillnit:
. ' • :•'''''•:• ''' c•% :'''': .ill.0**0 ,.:'': ',!:'',,,.'. '.. • . -4.
•• • ;.: • Air conditi ung
lob site address: 9825 SW Saltier St (requires site rae showing placement) .. ........
- - '- -- Furnace 1,(8,,000 FM (ducts/vents) l(;.75
City/Slate/ZIP: Tigard, OR 97224 ---
Furnace 10iCi 000+ BTU (duots/vents) 54.91
---:- ,
Suite/bldg./apt, no,: Project name: Starkey Heat pump
.• „ ...._ -- . ironainis site plan showing placsmuna 61.06 _...„...
Cross street/directions to job site: Ouct work i 23.32
Elydronio ht water system 23.32
_ Residential holler (radiator or
•
hydronic) 23.32
Unit heater (finil.type, not electric),
ii-wall, irKluct, auspended, etc. 46,75
-- Flue/vent fO any of above 23.32
Subdivision: Lot no,: --
Other: , 23.32
Tax map/parcel no.: Other fuel appliances:
.
2332
Fax firepluqe 1 33.39 33.39
Install freestanding gas stove and venting Flue vent fcs• water heater or gas
fireplace 23.32 -
Log lighter 02.tis) 23.32 .
Wood/pellfil stove 33.39
Wood fireplace/insert 23,32
Chimney/liaer/flue/vent 1 23.32 23.32
'N ...,•• ! ,., • • .:. 121PIANT ,, - ..; ,:. .
21.32
Name: D..„1.1 \ Si ( V_P 9 Envirottm 'ntal exhaust and ventilation: —
Address: 0 i 5. - .) SLA 5a-ifie 5ii , Range ho othor kitchen
equipment 1 33.39
City/State/ZIP: "1 • cv i oe e=7.7c2,2-4 Clothes dryfir exhaust _ 33.39
y• ,.• t
____-...,-- --- Single m
lexhaust dinthloos,
Phone! (3 ) C.x) — 7.., t/61 Fax: ( ) toilet oolrtinents, utility rooms) 23.32 ,
' .:.;, si 40■1,40*rot,:'i:,i .,;.,','...'.. ', :i' - Attic/crawl p ace Sins 23,32
_-..,-„„.._____„_
Other: . 23.32
Business name: i ---
Fuel piping:
Contact name: S14.15 for first tour; 54.03 tbr each additional
Address: Furnaco, ote. _. ..... ,.„ ..._
--- (ins hetitEV2
City/State/Z1P: WalUsuspeadedAmit heater
Phone: ( ) Fax: : ( ) Water heater ,
— Fireplace i
E —
Range
, . ..
. . . . .
• ;,'''''; ::,' :;'-:•....,';'?,''•••:;. .;.:•:';,, ''.: ;'' : • ; :.• : •:';:.'•,•. ':(-,:,',',‘•••.. ' .,:..•'-.: Barbecue
Business name: CO Sales Inc. GO Clothes do7 (gas)
.......... Other:
Address: 14210 SE Stark St •..: . . ,', .'::,‘!,.-' I. . :1001,4i1404■040014,441 ''',•... .'....',...:':', '.•':•:•' •
-.
City/State/ZIP: Portland, OR 97233 . S ubtotal 56.71
• • • - Minimum permit fee ($90.00) 90.00
Phone: (503) 256-3473 Fax: (503) 2541011
Plan review (25% of permit tee)
1
194285 , i i .. State surcharge (12% of pormit fee) 10.50
TOTAL PERMIT FEE 100,80 .."'..-
__. .-____,--
Authorized signature: dr. ---- This wag application expires it st permit is not obtained within 180
! days after it has been accepted as complete.
[Print --- name: Kristin Gentry rate: 11/22/11 1 . Yee methodology net by 'frit-County Building Industry Service !Scud
IMnittratirOttontilteheltrt•PormitApodu, 09/09/10 4464611V (II /02/CoM/WP II)