Permit q CITY OF TIGARD MECHANICAL PERMIT
= COMMUNITY DEVELOPMENT Permit #: MEC2012 -00646
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2012
Parcel: 2S103DA01901
Jurisdiction: Tigard
Site address: 10825 SW DERRY DELL CT
Project: Szklarz Subdivision: DERRY -DELL NO.2 Lot: 19
Project Description: (1) radon mitigation
Contractor: CASCADE RADON INC Owner: SZKLARZ, THOMAS E & CINDY R
2761 NE HALSEY SUITE B 10825 SW DERRY DELL CT
PORTLAND, OR 97232 TIGARD, OR 97223
PHONE: 503 - 421 -4813 PHONE:
FAX: 503 - 281 -6170
FEES
Specifics: Description Date Amount
Attic/Crawlspace Fans 12/10/2012 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 12/10/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/10/2012 $66.68
Occupancy Grp:
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 503.232.1987 or 1.800.332.2344.
Issued By: A fif Permittee Signature: «L( A PPL /C,4 To/Li
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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2012-12-10 1834:50 (GMT) 18 882800214 Frorn: LIP Bullock
12/10/2012 13:17 5035981960 - CITY OF TIGARD PAGE @1/01
To; Page 1 ar2 2012- (OlaF) 14802500214 FrOM: Undo Bullock
)Vecharsical Perroit ApplicaMC EivED ,„.„•,..,,..:
City of Tigard Ruched
lig ..- 13125 SW Hall Blvd., Tigard, OR 17223 DEC 10-2012 7)..: , i /4110 11. ',-- P-0
Poe nor.
• Phone! 503.71112436 Far, 303.5981960 lIssiedlyt 011iss Perath
Linc: 503.149.41 75 CITY OF TIGARD Dge It .
Suri , El See Page 2 rqr
lmerner www.tigard-or.gol
B UILDNG DIVISION N1 4e. --ri .0. dapple:meow Intbrasetlaa
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tweehaniad pcmik fees* arc based cm Ilia of the Work -`----
0 New coos/ruction lirAdditinniaireration/mplacement performed. Indicate the valise (rounded to the-nearestdollar) eat)
0 Demolition C3 Other mechanical underlain, equipment, tabor, overhead, and profit.
Valmr S
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13.6-and2-fanniy-dwemag 0 Cornmercial/industhat 0 Accessory building ; I Apr merle/ Asfinennient we okreldise
0 M ul ti-farn i 1Y 0 Master builder CI Other; ' Description J Qty. 1 13a, I Tout
• 4 - H fin II
Job site address: siblit :kill . - AM lill ' (mem sit; Wen showilm plaanneal) 46.75
Parana 100 000 BTU datetiv__,Ma________.
City/Stara/ZIP: 'r-4 cx iio .
Forerun 100,0130+ STU owennangl _ $4.91
Suitt/P.1144d. na,". [Project name: 5 z... Ki e z... . lient Map
f itprITS aiarytan a6o•liaskamarn6 _ 61.06
Cross =act/direct:tans le job site i pun ‘..___.: ft VII_____
Hydro:etc last ft/el stem 2332 ;
Residential boiler (radiator Or
hydroeieL 27.32
' Unit beaters (firet•typc, not electric).
• in-urall In-dect, enmerlded, els 4635
. - Flue/vent for raiv QL1.13oaa 2332
Svhdiltiai011: 1.471 no.:
' Other, —I 23.32
I Tex map/parcel no.; I Other be arthfieneft
L . :-::.-: •:;,....... .- :._. . .,-. ;....:::...:':::.5418CH011ttilltr_r.t•WORI( 1.• • , :-..:. -:. • . .::-..- ...:.:. ---; :::..' f w heater 23it2
; Cs s firoptatethisen
33.39
s ....
el.....11.s. ' ia III 41 Flue vete ex water hat= �r gas
rimmlace . 2112 •
1 Lax infhtsf (IMO 23.32
- 1 _Wood/pellet sane 3339
Wood firanhate/insat 23.32
—... . . „.. • • . . .- -
'7. :,• : - ii .; , , . ....1 .. .... ......0: ,..7. :::. • I , • clopmsynintlyourivent 1 2.1,32 •
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Other: 23.32 .
Name: E Res4rotheratat cabana and ventilation:
Fudge Med/other kitchen
• Address- - . equipment 3339
Ci1y/State/7.1F: I Clothes dryer exhaust 3339
, SilticilmillettIllattSTOSIIM,OMS.
Phone: ( ) Fax:( ) , tact compartments, tglilY mann) 21.32
. • '' ' ' ; .."' ' 1.7APTC1.60.7 -- v --. . • - ". , . - - -.:' •• 13 ::: .".: AttiO3'"16meo:Azg 23,32 I.
,---- , Other -
EnotheSS =De ,-- s. =44.7 .._... _ , alika
Fuel 40101V
Contact name: r ... • - . - "
....... ..e ..a.-..441.11. S14.IS ref Rau lam: $4.03 email addlifaaai
I .
Farman. ara.
Address: ' • Ilk ow • % _AZ Aileos : .a tilb
CV braver=
City/Sudo/ZIP: t ?,„1-A : yp,rrk ..._
metaQ4111c,.. IS M . WanOwniendedlualt hamar
Water heater
Pirepineo ,
F.-mail: ea VIII r_.....A.1,4, act 46. !lb ... FlOnfte
- PONT.4 - ACTOR: :: -: • .:.%,-- .. ."...'.: '''.. .r. ., - . -. .._•-• : ..•-. turbo:us
BasaterS 08111C7CCO•Leak...2262D C101iteg dryer ttes)
Other . I
Address: 1, . . .ge. 1.,4k7,-", • - lali._ 1 : :'.,' ..... • :- -.: 1 '.... • •• -
Subtotal
Crty/StateiZIP. ;. Igs,..,au.... • .?
Minimum pun* he ($9
%oar: . / , :i . . ,•... Fax:
'•■. .Ai. ' fb -
Plan revival (23% otpennk fee)
=111r Ilk .I6 St= sorcliarge (12% of perrnit fee)
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• ,
Authorized signateirr,,,14_, J-,.--Q.Qct.-( Thu Para41.apnedisa men. seernat bam obeiburt watts* 160
days aftsip Iv bas bees gawped as tectplate
Print.divne: b ,A el e.. - 1?) (A I 9 „I.( ' Date: LA - (0 - t I I • Fee inathorlatatky sa ay Tn•Ccsody raaldina 624=61 Ravine Board
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Iffki4ctlaOsmeiwitIEC.PrymMAgrp.iko OlVfM2 14114617T 11.1112M61/611)
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