Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 00633
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2012
Parcel: 2S 103DCO3000
Jurisdiction: Tigard
Site address: 11270 SW VIEWMOUNT CT
Project: Ziemer Subdivision: VIEWMOUNT Lot: 18
Project Description: (1) gas insert and (1) venting
Contractor: GO SALES INC Owner: ZIEMER, DENNIS V
14210 SE STARK ST BARTHOLOMEW, KAREN A
PORTLAND, OR 97233 11270 SW VIEWMOUNT CT
TIGARD, OR 97223
PHONE: 503 - 256 -3473 PHONE:
FAX: 503 - 254 -1011
FEES
Specifics: Description Date Amount
Gas Fireplace 12/05/2012 $33.39
Type of Use: SF Chimney /Liner /FlueNent 12/05/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/05/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/05/2012 $33.29
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 503.2232.1987 1.800.332.2344.
Issued By: /I I . I ,E C JIA ,_ �i'� Permittee Signature: 9A ,uC �Y
4 T i 6 t
�XXCJII���"'��Wtt//111 Call /// 5 CC O3 •t � Ft .6 333 39.4175 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.
Dec.04.2012 19:13 PAGE. 1/ 2
Mechanical Permit AnPliR E`
'4t VED Received
City of Tigard Date/By: 1 1 5 I2 i PunnitN ME C2012 00633
23125 SW Bell Blvd., Tigard, OR 97 • *3 C 0 5 2012 Nan Review •
Phone: 503.718.2439 Fax: 503.598. 1 DetaiOy. Other Permit;
i i t : ;-, it I ., Inspeelicm Line: 503.639.4175 CITY TIG Date R /J) ; bah:
CITY 61 `h' r � she Page 3 for
Interact: www.tigurd- or.gov Notificd/Mothud; Supplemental information
BUILDING DIVISION - __
TYPE OF WORK • COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
Mcchanica permit fees' are based on the value of thc work
❑ Ncw construction ® Addition /alteration/replacement performed, Indicate the value (rounded to thc nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, a ui mcnt, labor, overhead, and profit,
--- - Value: $
•
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES"
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For spedal lnfamarion use checklist
❑ Multi - family El Master builder 12 Other: Description r.___ FA. Total
HeatlnWeo Abut:
JOB SITE INFORMATION AND LOCATION . --- . -
' _ Air conditic sing
Job site address: 11270 SW Viewmount Ct. _(LeAuires site plan showing plaecman) 46.75
City/Stale/ZIP; Tigard, OR 97223 Furnace 100,000 NV./ (ducts/venta) 46.75
Furnace i(M,000+BTU (ductv/vents) 54.91 _
Suite/bldg. /apt. no.: Project name: Z 1 e $4.1 .e,r" Heat pump ,
(requires ecteplan showing placement) 61.on
Cross street/directions to job site: Duct work . 23.32
Hydronic Itwater ystemm 23.32
Kesidrmtiu oiler (radiator or
hydronic) 23.32
I1nit haate (fuel -type, not electric),
in -wall, in uct, suspended, etc. 46.75
- -- - Flue/vent ny of above 23.32
Subdivision: Lot no.: F
Other; I 23.32
Tax map /parcel no.: Other Net Ippllnnces:
DESCRIPTION OF WORK Water haste- 23.32
Install gas insert and venting �..-.. - -- pas fireplaceluiscrt 1 33,39
Flue vent fu • water heater or gas
fireplace 23.32
List lighter gas) 23.32 •
Wood/pellet stove 33.39
Wood fireplaoe/inscrt 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney/lin�r /tlucfvent I 23.32 23
• -- - Other: _ 2332
Name; Etwiron � cahoot and ventilation:
Range hood/ether kitchen
Address: equipment I 33.39
City /State/ZIP; Clothes dryer exhaust 33.39 ,
-- " -• —
City/State/ZIP: . xhausl (bathrooms,
Phone: ( ) Fax: ( ) toilet compu#tmcnts, utility rooms) - 23.32
0 APPLICANT ® CONTACT PERSON Attio /crawls co fans 23.32
Business name: CO Sales Inc
Other: _ 23.32 „ —
Fuel piping:
Contact name: Kristin Gentry $14.15 for first four; $4.03 for each additional _
Address: 14210 SE Stark St Furnace, etc.
-•— (ias at Let 1--- City/State/ZIP: Portland, OR 97233 Wall/suapei ad unit heater
Phone: (503) 256.3473 Fax: : (503) 254 - 1011 Water heater_
Fireplace
E - mail: kristingentry(3gosalesinc.com -. Range _
CONTRACTOR Barbecue
Business name: CO Saks Inc. Clothe dryer (gas) --
Other:
Address: 14210 SE Stark St MECHANICALPERMIT FEES"
City /State/ZIP: Portland, OR 97233 _ Subtotal 56.71
Minimum permit fee (590.00) 90.00
Phone: (503) Z56 -3473 Fax: (503) 254-1011 — ---
Plan review (25% of permit fee)
—
CCB lie.: 194285 - 1 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
' This permit pearled' expires it a permit Is not obtained within 150
Authorized signature: / 4 6- #4 2 .,- aye after It his been accepted tw complete.
Print name: t. Date: 12/04/12 - 1 • Fee mot set by TA- (runty Building Industry service Board
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