Permit CITY OF TIGARD MECHANICAL PERMIT
• °F`g''" COMMUNITY DEVELOPMENT Permit #: MEC2012 -00631
T IG`ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/04/2012
Parcel: 25111 CB01000
Jurisdiction: Tigard
Site address: 14980 SW 103RD AVE
Project: Howe Subdivision: DEL MONTE SUBDIVISION Lot: 9
Project Description: Installation of radon mitigation system.
Contractor: ENVIRONMENTAL WORKS Owner: HOWE, GERALD E & JOAN M
2634 SE STEELE ST 14980 SW 103RD AVE
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 719 -6715 PHONE:
FAX: 503 - 482 -7440
FEES
Specifics: Description Date Amount
Other, Fuel Appliances 12/04/2012 $23.32
Type of Use: SF Other, ExhaustNentilation 12/04/2012 " $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/04/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/04/2012 $43.36
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 Notificatio ter. 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 qu ions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B : = � t Permittee Signature: e
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.
12/9/2012 09:53 p TO:+1 (503) 5981960 FR011:5039827990 Page: 2
Mechanical Permit Al 1 1,....,1 4 . EivED FOR OFFICE USE ONLY
: . City of Tigard Received ,
Date %By (.. 9 / 4 . Pennit No f A, hp ,_ 00 4,3 /
" 13125 SW Hall Blvd., Tigard, R ) 223 Plan Revie
1 1 ° Phone: 503.718.2439 Fax: 503.5913n 0 4 2012 Datet.Ry: Other Point
TIGARD
Inspection Line: 503.639.4175 Date Readray. See Page 2 for
lens El
Internet: WWW . t igard-or. gov
CITY of TIGARD N,fied„,nhe,d Supplemental Information
— ' ' 7 ' MilvilliP
ist N
• . , .(2,6,so.ii:Reiki. FEESCIIEDULE '- Ost 1
. . ... .
Mechanical permit fees* are based on the value of the work
D New construction 0 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
[2] Demolition 11aOther: mechanical materials, equipment, labor, overhead, andyrofit I
Value: $
CATEG9R:V, OF arigr RUCTION • '
' :RESIDENTIAL Et:jiitiMENTi SYSTEMS FEF.S.
... •
kI. and 2-family dwelling D Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family El Master builder D Other: Description Qty. La. . Total
•
JOB- INFORMATION AND LOCATION Heatin coolim i
Air conditioning
Job site address: 1 LA 9 80 ,_ )t.A
..3 i C5 rct AA „l e_ _ Inquires site plan showing placement) 46.75 ,
Furnace 100..000 13•1"U (ducisivents) 46.75 1
City/State/ZIP. - 1 - 1 °tax 0 p ...... CI ri D
Furnace 100,000+ BTU (luetsiventst 54.91 1
_ k
Suiteiblda_rapt. no.: L 1 Project name: Heat pump
) - (requires site pian showing placement) 61.06
Cross street/directions to job site: Duct work '1 17
- ..___
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 i 23.32
Subdivision:
I Lot no.: --,
Other: 23.32
fax map/parcel no.: Other fuel appliances:
. .. . .. . ... _
. . - ' • '-.• . •• .- • • ''' • - - ••• ' I :• •• - Vtrater heater 23.32
.... .,....,,,, .. - -- - • . ,••
Gas fireplace/insert 33.39
-- a.ii.on frAil cja.ii on S 9s Itryu Flue vent for water heater or gas ,
fireplace 23.32
------1
Log lighter (gas) . 23 32
, Wood/pellet stove 33.39
-1 1 Wood fireplace/insert 23.32
• - - • . • • - • . • • • A Chimiley,Ilinerlfluervent ;fp, Afft; it 23.32
D PROPERTY :OWNER: -•,';,,'.; .. . . ,: 0 TENANT ' ' . "
Other: r41.441brt,tyfe.,tht I
Name: Environmental exha 23,32
u. an ventila ion:
- Range hood/other kitchen
Address, equipment 33.39 1
___,
City/State/ZIP: Clothes dryer exhaust i 33.39
- ,
Single-duct exhaust (bathrooms,
Phone: ( ) 1 Fax: ( ) toilet compartments, utility rooms) 23.32 1
X. APPLICANT " • - • :j: - •••, - ' L::: I. . '0 !''CONTACT 11.,IiScib/ Attie/crawlspace fans dx I .1. J. --
j
Business name: E,r\v kV ONMUAkai klox Other: Fuel pMpinghf)art I i 2332
-
) , )
e..)Ch AAA Si-- I
i
I
Contact name: - 're,phOoty\cl, I1.111),:as At MI a 0 .
SI4.15 for first four; S4.03 for each additional
-,-- ---1
,
Address: 9 o (..k 3 ate-It Furnace, etc,
Gas heat pump
City/State/Z.1E . igt • -1-• a p._ g q1_2-. 1 D2_, Wallisuspended/unit heater 1-----)---1---1
1_____
Phone: ( n ) itg 6115 , Fax: : (6, La--11Aq6 Water heater
Fireplace
— 1
E-mail: • Q_ 1 I '' OC i • & Range 1 -, , • - 1
- •, ,....... „. . , Barbecue
,
Business name: e kyl)nr 1 tk)(0)014 S Clothes dryer (gas)
Other: •
,
,
Address: Z--000 • ..:• . MttliAly1.1cALPER3■ 117 Ogs.
city/State/ZIP: Subtotal I yg. 6y
Minimum permit fee (590.00)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: I es rl 8 I State surcharge (12% of permit fee)
_
TOTAL PERMIT FEE /OD. fov
This permit application expirft, if a permit is not obtained within 180
S''
Authorized signature: \c\C Th
\3j,,,,.\AJM days after it has been accepted as complete.
[ Trim
"m\f19\r\Ck,A1(1, C kr\ S Date:SVA\t) . Fee methodology set by Trt-County Building Industry Service Itwin)
I l.Buils-lingItlennits1MEC-PerrutApp doe 03107/12 840 ITT ii if02/C0MMEB1
12/4/2012 09:53 p TO: +1 (503) 5981960 FROM:5034827440 Page: 1
- Fax Transmission
To: 5035981960 From: Mathew Lowrance
Fax: +1 (503) 5981960 Date: 12/4/2012
RE: Pages: 3
Comments: