Permit Y CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 00059
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/31/2012
Parcel: 2S111AD14900
Jurisdiction: Tigard
Site address: 14802 SW 91ST AVE
Project: WILKERSON Subdivision: MALLARD LAKES Lot: 17
Project Description: Installing gas stove and gas line to range.
Contractor: ALL FUEL INSTALLATION & SERVICE LLC Owner: WILKERSON, KERMIT
PO BOX 69 14802 SW 91ST AVE
TROUTDALE, OR 97060 TIGARD, OR 97224
PHONE: 503 - 674 -2350 PHONE: 503 - 539 -1670
FAX: 503 - 674 -2693
FEES
Specifics: Description Date Amount
Gas Fireplace 01/31/2012 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 01/31/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 01/31/2012 $14.15
Stories: 12% State Surcharge - Mechanical 01/31/2012 $10.80
Minimum Fee Adjustment - Mechanical 01/31/2012 $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: Permittee Signature:
_ i f
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.
Mechanica Per mit Applicatioia_ FOR OFF WE USE' ON IN
City of Tgrd R °Gen °ed ,�" '
u 13125 SW mall Blvd., Tigard, OR 97223 REE
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; ' II : ; Phone: 503,718.2439 Fax: 503 - 598.1960 , , Nte/By. Ocher Permit:
T I.C.1.A. R i n Inspection Lind: 503.639.4175 Dace Ready /By: El Sea Page 2 for
Internet: www,tigard- ot.gov JAN 3 1 201, Notified/Method: jp Suppiemental Information
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Mcchtutieal permit f ees" are based on flue value of the work
❑ New construction E3 Addition /alteratio e. r _ern• I �I I performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, e.ui.meat labor, overhead. and .refit.
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® I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special lnformalitn use checklist
❑ Multi-family t 3 0 Master builder ❑ Other �t Description Qty. Total
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Job site address: 14802 SW 91 Ave t' uirca site .fan shod _ •laoemenr 1111 46. Milli
Furnace 100,000 BTU ducts /vents) MI 46,75 MIN
City /State /ZIP: Tigard, OR 97224 Furnace 100 000+ BTU (ducts /vents) NM 54.91
Suite/bld /a t, no.: Project name: Heat pump
g p r'e uirca site •lan showin lacement MI 61.06
Cross street/directions to job site: Duet work13191MMI
H dronic hot water sem
. ,, Residential boiler r (radiator or
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- Unit heaters (fuel -type, not electric),
in -wall, in -duet eus.cnded, etc.
Flue/vent for any of above • MN 23.32
Subdivision: Lot nu,:
Other; 1= 23.32
Tax map /parcel no.: Other fuel a r , fiances;
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33.39 33.39 ' '
Install gas line to range, Install gas stove and venting, gas line is existing Flue vent for water heater or gas N
- fire .lace 23.32
Lo_ li_hter (.as) MI 23.32 EMI
Wood / • ellet stove 33,39 - .3r ��
Wood fire place /insert iaz7�
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��„„rh+r ?ca.• fay / r (f +�{ IU t1i 4 1g ° �, It L} �d t i - oft l Nt`�+j� Chi rnney /liner /fluevcnt 23,32
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Name: Kermit Wilkerson Environmental exhaust and ventilation:
Range hood/other kitchen �ME •
Address: See above e•ui
City/State /ZIP: taliMMEMIIIMMMI 33.39
- Single-duet exhaust (bathrooms.
Phone: (503)539 -1670 Fax: ( ) toilet corn artments utili rooms
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Business name: See Below •
Contact name: Erie Camp 514.15 for first four' $4.03 for cad' additional
Address: IEMEMIMI MEgIMIMIIIIM IIIMIMIIMIIIIIIM
City /State /ZIP: Wall /sue i ended/unit heater =I ME
Phone: ( ) Fax: : ( )
Water heater
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IIMMEMIIIIIMMIMIIIIIIIIINIIM
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Business name: MI Fuel Installation and Service, LLC. Clothes d 'Cr (as MINIM
Other; ,,. � c,u virtu t +.t' S i 1 } e+ +a�.�sa iMi } t. , t �t
Address; PO Box 69 1�i l a�tlElIlrl1Y�)tl�il i f 4,R4 ",r 3 'f w1N�l?l }cWf?
City /State/ZIP: Troutdale, OR 97060 Subtotal 70,86
Minimum permit fee (390.00) 90,00
Phone: (503) 674 -2350 Fax: (503) 674 -2693 Plan review (25% of permit fee)
•
CCI3 lit -: 169503 State surcharge (12 °/c of permit fee) 10,80
TOTAL PERMIT PEE 100.80
This permit application expkes iP a permit is not obtained within 130
Authorized signature; , "' d nys after it has been accepted as complete
Print name: Erie Camp Date; 1/30/12 _ ° Fee methodology set by Tri -County Building industry Service Board
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