Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00590
T GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2011
Parcel: 1S133CD14400
Jurisdiction: Tigard
Site address: 11889 SW TALLWOOD DR
Project: RODEMAN Subdivision: PEBBLECREEK NO.2 Lot: 35
Project Description: Gas insert installation.
Contractor: NW GAS LINES Owner: RODEMAN, STEVEN PATRICK &
16731 NE WASCO ST LINDA J
PORTLAND, OR 97230 11889 SW TALLWOOD DR
TIGARD, OR 97223
PHONE: 503 - 256 -2436 PHONE:
FAX: 503 - 256 -2245
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 12/21/2011 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 12/21/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/21/2011 $66.68
Occupancy Grp:
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: • •
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.
Dec 20 11 08:44a Tony Young 503 - 256 -2245 p.1
Mechanical Permit Application FOR of FICE USE ONLV
City of Tigard NV Received
IN •
13125 SW Hall Blvd., Tigard, OR 97. A•' �A D y: / ,, // i1v '
Phone: 503.7182439 Fax: 503.598.', a 1 Plan Review
Date/By: Other Permit
ITI.GA RD Inspection Line: 503.639_4175 ®ti %11 Date Ready/By: See Page 2 for
Internet: 't ww.tigard- or.gov -C NotitiedNethod: Supplemental Information
r
TYPE OF WOIt�Ii a F C p S�C COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
kg ❑ New construction ddition /alterari 1T ace rn enl Mechanical permit fees* are based on the value of the work
. 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*
on 2- family dwelling ❑ Commercial /industrial ❑Accessory building For special information asechecklbx
❑ Multi- family ❑Master builder 0 Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
O Air conditioning
' Job site address: A/ 1, J �� /l j�J)O, n ✓� (requires site plan showing placement) 46.75
� -¢
CityiStateIZfP: �� /J / s
,,i Op 97��3
/ s / Furnace 100.000 BTIJ (ducts/vents) 46.75
� / Cf i Furnace 100.000+ BTU (ducts/venrs) 54.91
Suite/bldg.lapt. no.: 1 Project name: 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.: Flueivent for any of above 23.32
Other. 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
ksAi/ l J�, Gas fireplace 33.39
94s 1 � �LI�T f il /u �!g s &,ke. &k
Flue vent for water heater or gas
fi replace 23.32
I.og lighter (gas) 23.32
Wood/pellet stove i-- 33.39
\151 Wood fireplace /insets ((S� ` 23.32 A3 ,
-PROPERTY OWNER ❑ TENANT Chimney /liner /flue /ve C - ° ' - \ 23.32
jp �`� ��f ,2 Other: 0 /90 20 23.32
Name:
c tr /�,4 �� `L / / Environmental exhaust an n:
Address: /��} Range hood /other kitchen
/ J Q / J f �! /1 ( •'(,/ equipment 33.39
City /State /Z1 -- ,d C /A) Or" q -7;7.,:,2 -7;7.,:,2 3 Clothes dryer exhaust 33.39 ��
r Single -duct exhaust (bathrooms,
Phone: t et : i 0 °l. Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT ❑ CONTACT PERSON Attic /crawlspacefans 23.32
[
Business name: ,(� /�J Other: _ 23.32
,�' g /fin �- " ass /Y/[� 45 -/ / ,/ S Fuel piping:
Contact name: /I y yN44 ' 7
� y)4 7 /
C��, S14.15 for first four; $4.03 for each additional
Address: /4 7 y l d
, r, S 1 ./ Furnace etc.
l Gas heat pump
City/State /ZIP:
�`lf�`.ii ! ' Fax : LT r -3C' Wall /suspendedlunitheater
Phone: } sia + (�/ : (3) s 4.A -Ij,S Water heater
J r /�,�}4 t ` Fireplace
E -mail: i t /j ! f Altos G� (iG Cf/ S t 4 cif Range
J CONTRACTOR Barbecue
Business name: ! / ,) � ' i Clothes dryer (
Other: Address: )!
MECHANICAL PERMIT FEES'
City/State/ZEP: Subtotal . 3 2.
Phone: ( ) Fax: (' ) / / � Minimum permit fee ($90.00) GI U,I/0
��J L 7 S Plan review (25% of permit fee)
CCB tic.: (j
/ State surcharge (12% of permit fee) /died
r /may' TOTAL PERMIT FEE /pa, v
Authorized signature: liaiid -7` - This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: f uj o 96 n om, Date: f j..4 /// • Fee methodology set by Tri -County Building Industry Service Board
I:\ Building \PemrtslMEC- PcrmitApp.d, 999;10 �JJJ J 440 -t61 (I1 /O21COM WEB)