Permit CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00225
Ti G A 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2012
Parcel: 2S112CB06100
Jurisdiction: Tigard
Site address: 15412 SW 82ND PL
Project: Stutevoss Subdivision: ASHFORD OAKS NO.2 Lot: 75
Project Description: New 2# gas line to patio area for fireplace, barbecue & high output burner
Contractor: AMERICAN CONTRACTING Owner: STUTEVOSS, DALE •
7855 SW OLESON RD 15412 SW 82ND PL
PORTLAND, OR 97223 TIGARD, OR 97224
PHONE: 503 - 407 -8538 PHONE:
FAX: 503 - 244 -9556
FEES
Specifics: Description Date Amount
Mechanical Permit - RES 05/08/2012 $90.00
Type of Use: SF 12% State Surcharge - Mechanical 05/08/2012 $10.80
Class of Work: ALT Type of Const:
Occupancy Grp:
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 1.800.332.2344. A
Issued By: Permittee Signature: Of ( q PPu /� `l'n0�
__)ALk/_6jz2t_ Call 503.639.4175 by 7:00 a.m. for the next available inspection date. (�► I r
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.
2012 -05-04 09:48 AMERICAN CONTRACTING 5032449556» 5035981960 P 2/3 51'
Mechanical Permit A licati ECEIVE I i• ite (u l l( 1.1 ,,l.(1.11
R eceived
City of Tigard Permit No.:
Ili 2 5 SW Hall l Tigard, OR 97223 Date�y: , H � C �� =
a 131
P hone: 503.718.2439 Fax: 50 3.598.1960 MAY — 4 2� �2 Platt Review
Date/fly; aver Permit:
VI( ; A lit) Inspection line: 503,639.4175 ® See Page 2 for
Internet: www.tigard,u.gov CITY OF TIGARD Supplemental Information
BUILDING DIVISION
TYPE. QF WORK :. COWIERCIAL FEE' SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based an the value of the work
❑ New construction , Additiun/ultcration/rcplacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
- • -- Value: I
. . CATEGORY. OF CONSTRU • : RESIDENTIAL EQUIPMENT / SYSTEMS FEES* •
I - and 2- family dwelling ❑ Commercial/industrial 0 Accessory building
For special Infnrntpffon use checklist Multi family ❑Master builder 0 Other: Description I Qty. I Fa. I Total
JOBS E INFORMATION AND LOCATION Heatitgl/cool
R Air conditioning
Job site address: `5i_u � c R Al PI (requires site plan sbowinp placement) 46.75
City /5taleJllF: Furnace 100,0011 H'fU (ducts/vems) 46.75
L l s 1v- . i p l� f 7 2 - a Li _ Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
�I {,�� (21--e- J 1_ D
Residential hot watt r system
iator 23.32
r'� lr! C_Y Residential boiler (radiator or
A fa h drunic 23,32
C' � Unit hcmcrs (fuel -type, not electric),
in -wall, in -duct, suspended, etc. • , 46
� _ •
Flue/vent for any of above _ _ _� 23.32
Subdivision: I Lot
- Other: 23.32
Tax map /parcel no.: Other fuel appliances:
•
. DESC;1UPTION OF • WORK.. Water heater 23.32 —
•
.1 f t.' • . . f Gas fireplace 33.39
• 0.. j _ Flue vent for water heater or gas
fireplace 23.32
-� --. Log lighter (gas) 23.32
Woad/pellet stove 33.39
Wood fi eplace/insen 23.32
g •PROPEI2'fl OWNER • • • _1 q . , Chimney/liner/flue/vent 23.32
r� . Other: 23.32
Name: '�,�. VDSS Environmental exhaust and ventllatlon:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: _ Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility_rcxrms) 23,32 • Q.'APPI +11 . • . Q' CONTACT PERSON • , Attie/crawl5page fans 23,32
Business name: Other: 23.32
- — / Fuel piping ' ?�
Contact name: . for first four, S4.03 for each additional
—
Address: Furnace, etc.
• . Gas heal pump
Ci ty/Statc2IP: Walt /suspended/unit heater _ .
Phone: ( ) Fax:: ( ) Water heater ✓
E-mail:
Fireplace
Rangc ✓
Barbecue
Business name: 4ryl f>�y'(,.Cet A �1 fhY' - , k Clothes dryer (eas) �7 t' Other: fR clef g3 ivr- / .� y
Address: ` j Q f , t C. 1 '.S��r t r, MECHANICAL PERMIT FEES'
City /State/ZIP: la.. y -t - 1 , i t L7'& c)-1 3 Subtotal li ,is.
(/_ r Minimum permit fee($90,00) Gi
01'llone: (6 t.� 07'" v S ig ei � t � Fax: ( 5 1 1 , 1 3 ) d' yGt 7 e � 5
'"1 Plan review (25% of permit fee)
'B lie.: , l3a -iCt ---/, ) State surcharge (12 %of permit fee) j�
/ - - I'f1TAt_PF.RMIT FFF t (�p -" tt j
111 Permit applkadoa expires if a permit b not obtaire8 within 180
Authorized signature: g L • N�- ��
days after it has been accepted a complete.
F I;; : int name: 41, C, I' ', ', f •[': P ,„• Date: r,/ 7..? (� • Iree mnhodoto to by Tri -Cowry Building Industry Service hard
I Avil Gnevan 4∎,MFC•P itApp.doc tl4me/10 410.461 rr (i I/ovt:OM,wF.9) /OD