Permit p CITY OF TIGARD MECHANICAL PERMIT
I '1 s ' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00534
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/17/2012
Parcel: 2S114BD01100
Jurisdiction: Tigard
Site address: 9890 SW RIVERWOOD LN
Project: Ballas Subdivision: PICK'S LANDING NO.2 Lot: 72
Project Description: (1) wood stove installation
Contractor: HAVEN SPAS AND POOLS Owner: BALLAS, ERIC A
10560 SE HWY 212 LIN, JENNIFER E
CLACKAMAS, OR 97015 9890 SW RIVERWOOD LN
TIGARD, OR 97224
PHONE: 503 - 655 -9440 PHONE: 503 - 686 -1105
FAX: 503 - 655 -9514
FEES
Specifics: Description Date Amount
Wood /Pellet Stove 10/17/2012 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 10/17/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/17/2012 $56.61
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. /� Tio
) 14) ./ 4 1/
Issued By: \ l A ���/� - tT Permittee Signature: Dl A "PLIe4 l
�
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.
Mechanical Permit A lica FOR OFFICE tISE ONE)
City of Tigard �l r L � Dates yy: / D 1 / / a - Sr Permit No.: la 6-e...-ApicaL. GAS
13125 SW Hall Blvd., Tigard, OR 97223
V 'i Phone: 503.718.2439 Fax: 503.598.1' ' n Plan REST' Other Permit:
�--� - = � C T 16 2012 may:
L�spection Line: 503.639.4175
- 1' I �� ,�l: L) Date Ready/By: rurir Bl See Page 2 for
Internet www.tigard or.gov CITY ADI)
s 1. • t. l • tl . Jtll Notified/Method: -r Supplemental Information
• A
Mechanical permit fees* are based on the value of the work
a. ew construction ❑ Add ition /a teration/r+eplacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
a.
Value: $
ble 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea 1 Total
IEIMIIIIIIIIIIEIIEIIIIIIIIIIIMIIIIMIM 13eatInJcooling:
Air conditioning
Job site address: C'() SW 1 Vtr N eio d F• I '^ (requires site plan showing placement) 46.75
City/State/ZIP: d , /1,n 017 2 2. Ir ` Furnace 100,000 BTU (dams) 46.75
OR l� ! Furnace 100,000+BTU (ducts/vents) 54.91
Suite/bldgJapt. no.: Project name: FY I L .TJ Ql t I cur- 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.: Flue/vent for any of above 23.32
Other: _ 23.32
Tax map /parcel no.: Other fuel appliances:
1 ' Water heater 23.32 I, •
Gas fireplace/insert 33.39
- el ± It._!4 .1) _' Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 1 33.39 33.
Wood fireplace/insert 23.32
:,r Chimney/liner /flue/vent 23.32
. Other. _ 23.32
Name: Er I C. 13 a auy Environmental exhaust and ventilation:
Address: 95310 61),) P LT Lori d LA . Range hood/other kitchen
equipment 33.39
City/State/ZIP jr 0 -7a 2.) . Clothes dryer exhaust 33.39
FA Single-duct exhaust (bathrooms,
Y
Phone: (50 ) l. • , , I I() .5 Fax: ( ) toilet compartments, utility rooms) 23.32
;Ss: Attic/crawlspace fans 23.32
. i
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four, 54.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP:
Wall/suspended/unit heater
Phone: ( ) I Fax:: ( ) . . Water heater
E -mail: Fireplace
Range
Business name: Clothes dryer (gas)
N .., l 1 _m i J, a!F>
Address: 16 5 ton Ar `1- Other.
City /State/ZIP: (+ '/) n A m n 4 701 J Loral .3 , 9
Phone: (503) to 66 .6/q40 F ax: ( ) 066 • q ( Minimum permit fee ($90.00 qo°°
66 C� Plan review 25% of fee
1 ( - rmit Pe )
CCB lic.: 175* _ F i . State surcharge (12% of permit fee) lQ, 8'
�/ TOTAL PERMIT FEE MO, 6
Authorized signature• d 4111WIE I �. � / I' rs permit days has been accepted is not obtained within 180
J ys as complete
Print name k ai Date: Q • ( - _Mill . • Fee methodology set by Tri- County Building Industry Service Board
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create a haven in your home
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Clackamas 503-655-2900 Aloha 503-649-2201 ' Vancouver 360-5740135
10560 SE Hwy 212 20945 T.V. Hwy 2009 NE 117 St
Clackamas, OR 97015 • Aloha, OR 97006 Vancouver, WA 98624
FAX 6034554614 • FAX 50344941242 FAX 366.113-1266
£00/T0012 Did 6T:ZT ZTOZ/9T/OT