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Permit
CITY OF TIGARD MECHANICAL PERMIT 2 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00589 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2011 Parcel: 2S114BA02000 Jurisdiction: Tigard Site address: 16100 SW GRIMSON CT Project: GEORGE Subdivision: PICK'S LANDING NO.2 Lot: 119 Project Description: Gas log and gas piping for fireplace. Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: GEORGE, JANET PO BOX 80607 14695 SW CABERNET CT PORTLAND, OR 97280 TIGARD, OR 97224 PHONE: 503 - 233 -1779 PHONE: FAX: 503 - 651 -3345 FEES • Specifics: Description Date Amount Gas Fireplace 12/20/2011 $33.39 Type of Use: SF Fuel Piping 12/20/2011 $14.15 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/20/2011 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/20/2011 $42.46 Stories: Fuel Fuel Types: 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. 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. e 01/15/2007 00:24 FAX 5036513345 BENS - HEATING &AIR Z002/002 Mechanical Permit Application 1-ttie t 1.1..1:i tlsi: o w 111 City of Tigard R ° °eivaa V � �� Date/By: +A L.I:/ Whin pr min Nu : /� t 'l d(� r o f 1312.5 SW Hall Blvd., Tigard. OR 9722 YYY Oc 1 Phone' 503 (,39.4171 Fax: 503.598. & Q> , 4�1 Ins ection Line: 503.639.4175 Y once Read /B I ti; n tz I l p Ready /By: Iii See pate a for Internet: www,ligard of.gov 4 / % ‘i9 � O Notified/Method: Supplemental Inrormniion P -- TYPE OF WdRK , - COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ Nov construction ridilion /ttlternt'�` cet4cmcnt Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all © k)cmol(tion C)ther: in\ VV mechanical materials equipment, labor, nvcrhead, ad }t nrir{il, -- Value,: $ . . CATEGORY OF CONSTRUCTION 1� RESIDENTIAL EQUIPMENT / SYSTEMS FENS" , and 2.1'amily dwelling ❑ Commercial /industrial 0 Accessory building For special information use cbeeklls/ ^ � MuUi- litmily [] Master builder ❑ Other: -- - Description Qty, La. Petal JOB SITE INFORMATION AND LOCATION Heating/cooling _Job site address: lip li Ck1 LJ C' ti ' Air conditioning ►Y V \ :� . , ___ (requires site plan showing placement) 46.75 ___ ` City/State/41F: '"j10. ( 7 L. I Furnace 100,000 BTU (ducts /vent9) 16.75 _ J Furnace 100,000+ RTU (ducts /vents) 54.91 Suite /bldg. /apt. no.: Project name: Heat pump 61.06 Crass strcet/dircetions to job silo; • , Duct work 7.1 .12. " -_ .. I Iydronic hot water system 23.32 Residential boiler (radiator or .... • hydrunic) Unit healers (fuel -type, not electric), U L____ 0-7- ct in -wall, in -duct, suspended, etc. 46 75 Flue /vent for any of above 23 32 Subdivision; Lot no — .,...- ,_..._�� Other: 23.32 Tax map /parcel no.: Other fuel appliances ..... -.. -- DESCRIPTION OF WORK Water heater _ 23.32 -' r — " Gas fireplace 33 39 6 l ,_ i . 4 t. t oi.±_ .. +. Flue vent for water heater or gas itrep ace 23 32 Log lighter (gas) 23.32 • r Wood/pellet stove 33.19 Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23 .t2 PROPERTY OWNER ❑ TENANT Other; -- - -� �1 1� - ,. .... ,...."_. Name: . GV1 e cic1Y`re- Environmental exhaust and ventilation Address: 11..41 lC C). ��_ � 1 Range hoodlothcr kitchen C -,„„ C?IIti C o e equipment _ 33.39 Cit /tiutte /7IP: ; k r ; t 1 - 7 hausl Clothes drycr 31.39 x Single -duct exhaust (bathrooms, nom:: ( ) Fax: ( ) toilet compartments, utility rooms)_ 23.32 _ APPLICANT ❑ CONTACT PERSON Attic /crawlspacc fans _ T 23.32 Other: 23.32 Itusiness name: - -- ,....._...._�_ L. - — .._..._ ^.......- _,,,m,,.. i Fuel piping; C ontact name: it ticr C) SI4.! 5 _ for first four; 34.03 for each additional Address: a roma etc. — - ................... - - as heat pump - ...i Cil) /Stale /7.11>: Wall /suspended/unit heater - — Phone: ( CI g Fax: ( ) Water heate -- Fireplace i — h- email: Range - CONTRACTOR Barbecue ^ ...- - -• --- _ W ( Business nu me: �0� /� l � Clothes dryer (gas) - en F I� u 1,. ,,. r— Othe - Address + (3 a0) 0 g r MECHANICAL PERMI FEES* - City/Stow/41P; 2 i'• _... _ C - C T _.,..,, p subtotal I. 7 1 ` si 3 3 `5 Minimum permit fee ($90 DO) 5 2‘1 - f Ian I'evlgw (25% uCpenmt fee) .'It tic.: - Stale surehur a 12/a o ermit fe e) j - i y TOTAL PERMIT FEE ► c.) -)� 'thi p e rmit application expires if a permit is not obtained within 18a f luthetriiCCf iignntur days after It has been accepted as complete, 1 e C � ' rani name: I)atC `a '( • Fee methodology set by Tri•Cnuniy Building tnduxlry Service !Ward 1 linddwc4'ci nnlh\1l(1mrmil Ain Cur Ie /SItt9 44U. I o'r I/U2/COM/WE/3)