Permit ,, CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2012
Parcel: 2S112CD10600
Jurisdiction: Tigard
Site address: 7817 SW ALDER ST
Project: CHAPMAN Subdivision: HAMBACH GROVE Lot: 4
Project Description: Gas piping for barbecue.
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Contractor: TRI COUNTY TEMP CONTROL INC Owner: CHAPMAN, JIM L & JANICE
13150 S CLACKAMAS RIVER DR 7817 SW ALDER ST
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: 503 - 557 -2220 PHONE:
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Gas Fireplace 02/03/2012 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 02/03/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/03/2012 $56.61
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 50'•75 by_7:00 a.m. for the_next available_inspectiondate. ._ /
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.
FEB -2 -2012 07:38A FROM: TO : 5035981960 P.1
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Mechanical Permit Application ¢y - I Ol (11 I' 111.O,NIIA
• City of Tigard ^ l. Date/By: Received
� : � PertnitNo
13125 SW Hell Blvd., Tigard, OR tih , 9 4 l%\r ;3 _-_01); _ I
- ti Phone: 503.639.41.71. Fax: 503.5' 1.' .0 " Plan Review
■ l t f t t Inspection Line: 501639.4175 0 r R' D " y: wit'
Internet: Line: Bard 639.41 ` '� �Vr ` 1 P., \. Date Ready/By: NM S See Page 2 for
M. O ff ( k .\j Noutied/Metbod: Supplemental Information
1 ,. _ 'EVP P O..WOR " �yl. - -
j, . i., .:, .'� :, -- - '
E " F �!' �' I � - , CO1Hl14ER1"rAL F -. US ,
❑ New construction ® Addition /alterationtreplacement 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
-. ° . CATEGORY O1 ±.: CONSTRTJCTION- '' :. - ' '. - .. Value: $
® I• and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIA :EQU.iPMENT'/ SYSTEMS SE
. For special u,#ormalion use checklist.
❑ Y ❑Master builder ❑Other: Description I Qty. I Ea i Total
- . FOR ` NF'ORMA p T y W ' h C T y : { .AND .LOCATION . _ HeatInp,/coeling
Job site address: 1g f 7 6' J r Alder V `- . Air conditioning
City / State/ZIP: yr,Y� (1 r 1(► F ur n a ce site plan showing placement) 46.75
l v 1 `'n v Pom 100,000 BTU (duets/vents) 46.75
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 54.91
Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydmnic) 23.32
Unit heaters (fuel -type, not electric),
in-wall; in -duct, suspended, etc. 46.75
Subdivision: Lot no.: , Flue/vent for any of above 23.32 ,
Other: 21.32.
Tax map/parcel no.: Other fuel appliances
DESCRIPTION:- ,OF-WORK, • -. Water heater - 3.32
Gas fireplace 33.39
(�/� Flue vent for water heater or gas
Elas ,f4 t0 13661 fireplace 23.32
Log lighter (gash 23.32
Wood/pellet stove 33.39
Wood fireplace/insert - 23.32
PROPERTY OWNER . `, Chimney /liner /flue/vent 23.32
• p + v� yy� p ❑ L'rrN. ., , . . Other: 23.32 '
Name: " , , J t I 1 Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City / State/ZIP: - Clothes.dryer exhaust . 33,39
1 � ( �-y Single -duct exhaust (bathrooms,
Phone: () Q Fax: ( ) toilet compartments, utility rooms) 23.32
.. - tk AP ?l4CAN I' .. • ' • ': , 0 • CONTACT -PERSON . -, ' . ' ' Attic/crawlspace fans _ 23.32
Business name: Same as contractors _ 23.32 . Oth
' Fuel piping
Contact name: Diane Mason $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) •Fax:: ( ) Waterheater ..
E -mail: Fireplace -
Range
- i - CONTRACTOR ' .. Barbecue /-1/--15-'
Business name: Tri County Temp Control Clothes dryer (gas)
- Other:
Address: 13150 S Clackamas River Drive - MECIIANICArL- PRRMITEEES+' - .
City /State/ZIP: Oregon City, OR 97045 Subtotal /CI , 1r
Phone: (503) 557,2220 Fax: (503) 557.0919 Minimum permit fee ($90.00) 90,00
Plan review (25% of permit fee) V
CCB lie.: 72623 �/ �p „ State surcharge (12 %ofpermitfee) 1/�n t elf)
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Authorized signature: °�,
I, Zt / 1 / n[/��/ > TOTAL PERMIT FEE �"-- -aJ
This permit a pplication expires if a permit li not obtained within n 180
�y� moon 42112 days after it has been accepted as complete.
T tL
Print name: L 1 M► moon Date: - • Fee methodology set by Tri- County Building Industry Service Board
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I:uadnecr utskINEC•Pa mitApp,doc 10/01/09 440 -4917T(I lro2/COM/WFB)