Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Permit #: MEC2013 -00026
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/15/2013
Parcel: 2S 110AD02100
Jurisdiction: Tigard
Site address: 14678 SW 106TH AVE
Project: Crombie Subdivision: LANG HILL Lot: 18
Project Description: (1) gas fireplace zero clearance and (1) flue vent
Contractor: EVERGREEN GAS INC. Owner: CROMBIE, RICHARD D JR
PO BOX 388 14678 SW 106TH AVE
WEST LINN, OR 97068 TIGARD, OR 97224
PHONE: 503 -407 -9542 PHONE: 503 - 841 -8355
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 01/15/2013 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 01/15/2013 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12% State Surcharge - Mechanical 01/15/2013 $10.80
Stories: Minimum Fee Adjustment - Mechanical 01/15/2013 $33.29
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: I t i / Permittee Signature: ili-PPO --w j
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.
JAN-13-2013 06:49 FROM: TO: 5035981960 P . 2
Mechanical Permit Application IOU (H I I( I I 'l ()\I 1
City of Tigard Received i j , Penult Nott ce_jo 1 3 -
' I II • 13125 SW Hall Blvd., Tigard, OR 972EECEIVED Z
. Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Pennit
,_. Inspection Line: 503.639.4175 Dote Ready/By: , i11 .7 5- ,.. El See Page 2 for
Internet www.tigard-orgov JAN 1 4 201 oti
Nfied/Method: ‘ca supptementsi Information
' .:.1 TypE OF v giWYOFTIGARD ..:::,...
:COMMERCIAL FEE* SCHEDULE - USECHECKLIST
-
0 New construction ig .., ,ditionhutc_BLILOPrellip G Mechanical permit fees* are based on tho value of the work
performed Indicate the value (rounded to the nearest dollar) of all
0 Demolition • Other: mechanical materials, equipment, labor, overhead, and profit
..
' • , ' . CATEGORY ' OF CONSTRUCTION • Value $
. RESIDENTIAL, EQUIPMENT / SYSTEME FEES*
and 2-family dwelling 0 Commercial/industrial 0 Accessory building .
For special information use checklist.
( TMulti-family 0 Master builder 0 Other 'Description I Qty. I Ea. 1 Total
'' Ar 'LOCATION -• - ,,.., • ::.-: Heating/cooling
Air conditioning or heat pump
Job site address: 1410 7g; 5 ‘,..) /196 .a (requires site plan showing placement) 14.00
City/State/ZIP: l
-77:71- a / /9 i< 4 2 ( Furnace 100,000 BTU (duos/vents) 14.00
Furnace 100,000+ BTU ((bets/yaps) 17.90
Suite/bldg./apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
bee. 6.4y Ze / 0 de 4.1-Arpr c-e_ Residential boiler (radiator or
hydron ic) 14.00
A e . e.- toi e eee . Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: I Lot no.:
Other: 10.00
Tax map/parcel no.: ..:,..;:, .. Other er filrlapplianees
;-...',':',. : ,- , - ; :;1;:` , :i ,•:: ::-:. J. ;0 •i ' , . , •.:',.DESCRIPTION OF 'WORK , " .."....‘, wter heater 10.00
Gas fireplace 1 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
- Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
•: --, , . , 0:.-TENANT
Name: " - - , :., . •-::.
Other: 10.00
,, .....44,, Environmental exhaust and ventilation
Range hood/other kitchen
Address: / 72, St..,) /es 6 t equipment 10.00
City/State/ZIP: i'.4...„/ a .,g_ 9 7 Z z ,1 Clothes dryer exhaust
- 10.00
Single-duct exhaust (bathrooms,
Phone: ( 3 ) e /.. 935 Fax: ( ) toilet compartments, utility rooms) 6.80 ,
0:r4 . :. ' : -,; : : : .'_ : 0: CONTACT , P Eitso k .1 - , Attic/crawlspace fans 1000
Other 10.00
Business name: Fuel piping
Contact name: $5.40 for first four: $1.00 for each additional .
Furnace, etc. ,
Address:
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
-
Phone: ( ) Fax: : ( ) Wata heater
Fireplace
E-mail: .
,
., ;• - :: - ,;: r. :; - ,.': ,. ''.:, :,,'; '1';':':' :";'. I COTRACTOR • . , , Barbecue
Business name: 0
fo:',Ve. 6 45 121- c.- Clothes dryer (gas)
Other
Address: 31 x
4- .3 6 6 2 . mEttiANtehitpordozo....!
City/State/ZIP: (A r t Ai„,, ft 97D 4, 8 Subtotal
Phone: 3 ) yi 7 - I ry 2_ Fax: ( ) 3W .. to, 3 1/;- Minimum permit fee ($72.50)
Plan review (25% of penult fee)
CCB lic.: ir 2 A3 /
I .7 V State surcharge (8% of permit fee)
0
TOTAL PERMIT FEE lab .go
This permit application aspires Ifs permit is not obtained within 180
ignature: Th d
Authorized s 0. ay' after it has been accepted as complete.
name: I
Print L 6 II i 0 F e4 „..„ I D / i r 3 /....5 • Fee methodology set by Tri-County Building Industry Service Board
1(BuildingWominVvtEC-Permitapp.doe 04/06/06 44 61 (11/02/COMAVEB)