Permit CITY OF TIGARD MECHANICAL PERMIT
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t3 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00657
Date Issued: 12/13/2012
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T f C,ARL? 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S110DD01600
Jurisdiction: Tigard
Site address: 10415 SW CENTURY OAK DR
Project: Imus Subdivision: SUMMERFIELD Lot: 23
Project Description: (1) gas insert, (1) vent and (1) piping
Contractor: ALL FUEL INSTALLATION & SERVICE LLC Owner: IMUS, CHARLES W & GLENDA J
PO BOX 69 10415 SW CENTURY OAK DR
TROUTDALE, OR 97060 TIGARD, OR 97224
PHONE: 503 - 674 -2350 PHONE: 503 - 747 -5569
FAX 503 - 674 -2693
FEES
Specifics: Description Date Amount
Gas Fireplace 12/13/2012 $33 39
Type of Use: SF Flue Vent for Water Heater or Gas 12/13/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp:
Fuel Piping 12/13/2012 $14 15
Stories: 12% State Surcharge - Mechanical 12/13/2012 $10 80
Minimum Fee Adjustment - Mechanical 12/13/2012 $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 503 232 1987 or 1.800 332 2344 //
Issued By: Liiq Permittee Signature: Oki �Q- P �
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. y / � L
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 lieu ' ` J 1012 01-r[cr_(SE ONi)
Ci ty of Tigard �/ � ��� Date/By: (a 3 I l a - Permit No : big - (vC 9 5 /
il
i "' 13125 S W lull Blvd., Tigard, OR 97223 Plan Review
Phone: 503.7182439 Pax: 503 598.19 C 2i 2012 e p y . other Permit:
r i G 4 r iy, Inspection Line: 503.639.4175 Date Ready/By: Iris: el See Page 2 for
Internet: www.tigard - or.gov env o TIGP V Notifed/Method: TT Su lafor•matioa
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❑ New construction Mechanical permit fees' are based on the value of the work
ddition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead and profit.
' v "I: [''' "• •^_ •:�� , ,� r t t•• l c: ter " ". " * . - still'- .nu_a'• r .'.c�l�: _ value: $
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.. �,tll� ^.E� 11�ti.u�[m. rt..t.J
- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building For special lrrforrnal:on use checklist
❑ Multi- family [] Master builder ❑ Other: Description I Qty. I Be, I Total
h•
io: lien 0 f , Ar p.,4,,:= w�e •'a 1 Wf.•''Tps� �u�, , r ��u " n . �. Heating/cooling:
4.111.1 , �.ix d t . ] d tl �. [ r' .' % , It 7 e
:ft!+:' e�,t -,ri' nail /is�r � • ;1u�:1::i5;u`t a�S tlu�l� ,��w,+ �: Air conditioning
Job site address: / Q S// S sC1J e_e / , Ca it Q D Ire , (requires site plan showing placement) 46.75
^� Furnace 100,000 BTU (ducis/vents) 46.75
City/State/ZIP: 7; -R I/t 97c7W Fumace 100.000+ ETU (ducts/vents) 54.91
Suite/bldg./apt no.: Project name: 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: .
?T♦t,11!, Je t; t'f 7rr t•` ?J; i j i u r u ; r m. J rte, Q fw1 u 3 : M
:�i�k�uu ,tr.` 4'�,���! i u a ^' sl' { o�`�' :• �,.�� r;i!,' '' � �'<•;' . ' J<., - � W ater heater 2332
„f d�Si' , ' "!',� *,x afcca �� ..i.,� al;�f mu,url f�4:f- h��ii.' ' •, y,
/ to /1 Gas fireplace/insert / 33.39 3339
A Skill On lie)" ail-6 ,,i,s(52.7-ifinct. Pluc vent for 'water heater or gas
fireplace 1 23.32 03. 3
69 I 3CIS//11 7 Log lighter (gas) 2332
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
� n . - r"-"' x , "-- ta7::tiu;•» ,r 1 sr',� "' • r ; rT ChirnneyAiner /fludvent 2332 •
pp((•, 'S!." ,:: !� . i 01 ;q �• c ii∎i ' i ?`i• ' kiji � , li i t •g ' 1 1 ka :T i c , t
,11 ,= °.InA:d "•-g5u,t �; ", ° M ` ;:Ia..u,6C3�L ,, c`. YG71(C �V7.t>ba:C�t' � �II ' l,!� v:1 -
: c- 1 .; �:�H'� +•.^�-'- , ��_+� Other. 23.32
/ -r ' • _� / j ,r i Environmental exhaust and ventilation:
Address: O ref$' (.310 at t i CAI( ve Range hood/other kitchen
equipment 33.39
City /State/ZIP: ^'-n9 / 04. a a•(/' Clothes dryer exhaust 13 39
Single -duct exhaust (bathrooms,
Phong: (cam 2& 7 4,'" Fax: ( ) toilet compartrnents, utility rooms) 23.32
y rs�ur' 1Jt�.l �r t o , i`� "r p r r �T
t ,, 1�i. ;S'1 F r. , lair• - ` p-t , f c•;
i if. 4ilu l kSEC, i` ?) .., t+� Lzy. '.� r t +#� d _. I'E t 1 :i 12 ,.. ; ;i i t Attic/crawlspace fans 2332 '
Business name: t ore e;fi9 Cfo ..f� P Other: 23.32
v�'•� Fuel pipink
Contact name: $14.15 for first four; $4.03 for each additional
Address: Fltmac e, etc. .
Gas heat pump
City /State /21p:
Wall /suspended/unit heater
Phone: ( ) l Fax: : ( ) Water heater
Fireplace / / f/C
E -mail: Allic 6 ...e. t • 111624 !i IIM In!F 2 A114 ii' "' ri yi7 i n j9r 1_, q _, •F •:, -{a ''v;,n:. r4 - :7 � � ,1 : Rage
��i t i 'fF' j in i 4 a [ ) d ti I C L IR )i' u. ., { Barbecue
`�litl� i�: l' ���t�rn 7 4)11. ',. 1 h .JF ' . . ��1� til.
Business name: m' 4 / skikdot and Sr-prep Clothes dryer (gas)
Other,
Address ' i 4• l F�',tq I tfltr � .�y ,"f1 �s at:l:ain� .'f!n�;r,i {i'tl4i ''`.�
9 1 I II ?+ o. t;;ss �r n r, ,;, r,'1 1'i 4
• V 1 iii � �PSi�+':P�`r��ci. %�,,,• - -'trat�cr_:1= +:i�i��3d,.' '� �i:rlaft *�;�`;�,
,' tin ua�� y.i
City/StatetZrP :-7 ij _J 16 DO 6 7' p Subtotal 74
Phone: (S03) 6 70. .a, s 4 , Fax ) d Minimum permit fee ($90.0 4 7 4 0.0 -p
��� °�� 7 Plan review (25% of permit feee )
CCB lie.; 7/d 51s-t.) 3 State surcharge (12% of permit e) a
_ TOTAL PERMIT FEE /02p,86 -
Authorized Signature: �' This permit application expires if a permit is not obtained within 1S0
Ge a days after it has been accepted as complete.
Print name: l 5ej c 7 0 ,o Date: ioyit),/ a. I • Pee methodology set by TYi- County Building industry Service Board
r:\ Sufl4ingTecmialsdPC- PermaApp.doe 03/07/22 r`' 440:4617T (1110Z/COM/W8B)