Permit q CITY OF TIGARD MECHANICAL PERMIT
;' . 11 COMMUNITY DEVELOPMENT Permit #: MEC2012 00580
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/07/2012
Parcel: 2S 104AB07300
Jurisdiction: Tigard
Site address: 13187 SW KATHERINE ST
Project: Brunkart Subdivision: MORNING HILL NO.4 Lot: 102
Project Description: (1) gas insert installation and (1) gas line
Contractor: NW GAS LINES Owner: BRUNKHART, JULIE E
16731 NE WASCO ST 13187 SW KATHERINE
PORTLAND, OR 97230 TIGARD, OR 97223
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PHONE: 503 - 256 -2436 PHONE:
FAX: 503 - 256 -2245
, FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 11/07/2012 $23.32
Type of Use: SF Fuel Piping 11/07/2012 $14.15
' Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/07/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/07/2012 $52.53
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 O / NC by calling 503.232.1987 or 1.800.332.2344. .
Issued By: //(/ I[ t/� ,, �{� ' cC/1 Permittee Signature: Q� 4 PP(� t ` A ri0 M
�i /� y ll.
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.
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Nov 0712 08:26a Tony Young 503 - 256 -2245 p.2
Mechanical Permit Appli' `3 E FOR OFFICE USE ONLY
City Of Tigard i Received l i I ' Permit No. Mae, 1Z
0,.oam,
.
• 13125 SW Hall Blvd., Tigard, OR y3 �
13 2012 P1ae'ByReview
Phone: 503.7182439 Fax 503.598.1 � 0 L Daterey: Other Permit:
T I G A R D Inspection Line: 503.639A175 Date Ready/13y: !tar. 0 See Page 2 for
Internet: waw.tigardor.gov CITY 1 TI nA Notified/Method: Tiro. S pplemental Information i
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I TYPE C I R,�IG D+ v isION COMMERCIAL FEE' SCHEDULE — USE CHECKLIST
/ Mechanical permit fees* are based on the value of the work
❑ New construction \ fig Addition/al teration/rep lac ment performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other. mechanical materials, equipment, labor, overhead, and profit.
Value: S
CATEGORY OF CONSTRUCTIt N RESIDENTIAL EQUIPMENT /SYSTEMS FEES"
1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building For special information rise checklist
❑ Multi - family ❑ Master builder ❑ Other. Description I Qty. i EL Total '
JOB SITE INFORMATION AND LOCATION Heattog/coolii:
`,, Air oonditionine
Job site address: // 7 J`fN d e ,S/ 6 (requires site plan showing placement) 46.75
� � Furnace 100,000 BTU (duets/vents) 46.75
City/State/ZIP:
T/ 9 Gf '9y 91 -�3 Furnace 100,000+ BTU (duets/vents) 54.91
Suiterbldgiapt. no.: ✓ Project name: Heat pump
(requires site plan showing placetncat) 61.06 ,
Cross street/directions to job site: Ductwork 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: l Lot no.: Flue/vent for any of above . 23.32
Other: I 23.32
Tax map/parceI no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32 3
f ,f Gas fireplace/insert / 3339
3 1.
r .x f (1 � 4S hhe. ) ,/z ci' // fa S / �• Flue vent for water heater or gas
/ ✓ fireplace 2332
Log lighter (eas) 23.32
Wood/pellet stove . 3339
Wood fireplace/insert 23.32
bd PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 2332
Other 2332
Name: �/ l 1 6 7p jJ G /' Environmental exhaust and ventilation:
Address: /3l 87 .___C Sf : equipment hood/other kitchen 33.39
Ci /Stale/Z[P: / :faf Lf 0Y '97;;-..--75 Clothes dryer exhaust 33.39
I
Phone: Single exhaust (bathrooms,
) Fax: ( ) toilet compartments, utility moms) 23.32
APPLICANT ❑ C )NTACTPERSON Attic/crawlspace fans 23.32
Business name: / / �r 4 ' f S Uv b 7 fvs � J /DV
&S / I Other: 23.32
tiara. F ue l p i p ing:
/
Contact name: i Yf) t/ 6 q 514.15 for first four; 64.03 for each additional
Address: /4,7 �l ! y C/ hilS'o _sr-: Furnace, etc.
Gas heat pump
City /State/ZIP: d Qr 7 ?3 Wall/suspended/unit 9 � Wall /sus ded/unit heater
Phone: ( s,) 5-6_,,. , :_�. r.., Fax:: (93) � L-/S Water heater _
1 Fireplace / /4//
E -mail: 4� / /��/ ./),,,..,..,)0 �' /�YYI�� S7 �� Range
•J� CONTRACTOR Barbecue
Business name: Al
(5 s-/ ,yc Clothes dryer (gas)
! �/ 6 Other:
Address: 1( 7 3 /( jgi J,IJ (? `7' MECHANICAL PERMIT FEES"
City /State/ZIP: ' y vT Subtotal , 6
Phone: ( 3) <� — v 7 ) 4 Fax: i3 a,5 Mi gO�n {�
•� Plan review (25% of permit fee)
CCB lie.: /j Leg, g State surcharge (12% of permit fee) /(.,g0
TOTAL PERMIT FEE J g 0
Authorized signature: / / �/�� 07/01 'This perm application espires if a permit E not obtai " within 180
/V � r e / . days after it has been accepted as complete.
Print name: LaLi Y. i Y'UM / . //7// 2
l , • Fee methodology set by Tri Building industry Service Board
J Date: �� ,
!: 1BuildiagiPermits \MEC- PermiiAppduo 07107/12 �� JJ 440-46 77(1troVCOru�I