Permit - CITY OF TIGARD MECHANICAL PERMIT
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8 : COMMUNITY DEVELOPMENT Permit #: MEC2012 00616
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/29/2012
Parcel: 25111 CB04000
Jurisdiction: Tigard
Site address: 10415 SW LADY MARION DR
Project: Gustafson Subdivision: MARION ESTATES Lot: 13
Project Description: (1) gas insert, (1) gas piping, and (1) vent
Contractor: ALL FUEL INSTALLATION & SERVICE LLC Owner: GUSTAFSON, DEAN S & GLORIA J
PO BOX 69 10415 SW LADY MARION DR
TROUTDALE, OR 97060 TIGARD, OR 97224
• PHONE: 503 - 674 -2350 PHONE: 503 - 781 -7761
FAX: 503 - 674 -2693
FEES
Specifics: Description Date Amount
Gas Fireplace 11/29/2012 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 11/29/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 11/29/2012 $14.15
Stories: 12% State Surcharge - Mechanical 11/29/2012 $10.80
Minimum Fee Adjustment - Mechanical 11/29/2012 $19.14
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..22232..1//1
9�87�or 1.800.332.2344.
Issued By: i' �C-EL
O Permittee Signature: O/u, APPU 04110 Al
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 Applica pc , II FOR OFFICE USE ONLY
City of Tigard D Received
Date/By: i 1 .?.et b q - Permit No.:at. 40 . 2.- je 1
I 13125 SW Hall Blvd., Tigard, OR 2 VL I V E
• I - Fax Plan Review
. - • Ph°11e: 5"318.24" ; 50159819 . 2 9 2012 Date/By: Other Permit:
Inspection Line: 503. Date Ready/By: rude: El See Page 2 for
Internet www.tigard-or.gov CITY OF TIGARD Notified/Method: - Supplemental Information
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Mechanical permit fees* are based on the value of the work
0 New construction Ej Addition/alteration/replacement perfOrmed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other mechanical materials, equipment, labor, overhead androfit
Value: S $1,011.00
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El 1 and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
0 Multi-family 0 Master builder 0 Other: Description 1 Qty. Ea. 1 Total
Ot ; ' . ' , .1, , ;0414WitiNipqr640ijauggttimp_Impil:frIt Heating/cooling:
Job site address: 10415 SW Lady Marion Drive . (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97224
. Furnace 100 KU (ducts/vents) _ 54,91
Suite/bldg./apt. no.: I Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job Site: Duct work 2332
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
Flue/vent for any of above 23.32
Subdivision: I Lot no.:
• Other: 23.32
Tax map/parcel no.: Other fuel appliances:
, ijeginfigriallowilpowto4 logooptolAgrAvir
W ater ,,, .„, ,,, , , ..,.,,,•_n,piiE, .1,4144611, , ,,,.; , 4 1; 1 ,, ., . ii 1 mt,for.q,,,,-!,,-3,-,...1,41!,,:Sr.,,Witi,n,t,,! heater 23.32
Gas fireplace/insert ' 1 33.39 33.39
Install and vent new gas insert and install new gas piping
Flue vent for water heater or gas
fireplace 1 23.32 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
-
• Wood fireplace/insert 23.32
"4gli' ' lt5 ' .;:, '''',' ",..rtt gl } Isi.:! --4 . !,. .1. v I.,9 Chimney/liner/flue/vent 23.32
„;,,u hi ;;Iil!-- ital?Fj.•_ .'lco. .. • ' • , • '•• • • • - other: 23,32
Name: Dean & Gloria Gustaf Son Environmental exhaust and ventilation:
Range hoodlother kitchen
'Address: 10415 SW Lady Marion Drive
equipment 33.39
.
City/State/ZIP: Tigard, OR 97224 Clothes dryer exhaust 33.39
- Single-duct exhaust (bathrooms,
Phone:. (503)781-7761 Fax: ( ) . toilet compartments, utility rooms) 23.32
W 0 *A164011iiillgalikOi l, bb101040 ', Attic/crawls/we flins 23.32 ,
th 23.32
Business name: All Fuel Installation and Service O er;
. . Fuel piping:
Contact name: Eric Camp S14.15 for first four; 54.03 for each additional .
Address: P.O. Box 69 Furnace, etc.
.
Gas heat pump
City/StatetZT.P: Troutdale, OR 97060
Wall/suspended/uait healer _
Phone: (503) 674-2350 I Fax: : (503) 674-2693 Water heater
_Fireplace 1 14.15
E allfoel@conscast.net
Range
'2"111114114411MEIV,040 4 c 4040741171,r44"
Barbecue
Business name: All Fuel Installation and Service Clothes dryer (gas)
Other:
Address: P.O. Box 69
iii.Ellr !Nig ti
City/State/ZIP: Troutdale, OR 97060 Subtotal 70.86
Minimum permit fee ($90.00) 90.00
Phone: (503) 674-2350 Fax: (503) 674-2693
Plan review (25% of permit fee)
CCB lie.: 169503 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
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... This permit application expires if a permit is not obtained within 180
Authorized 5i
days after it has been accepted as complete.
Print name: Eric Camp Date: 11/29/12 * Fee methodology set by Tri-County Building Industry Service Board
1:1BuildinePeroi its \ MEC-FermitApp.doc 007/12 440-4617T (11/02/COM/WEB)