Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2013-00054
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/24/2013
Parcel: 2S 104AB09600
Jurisdiction: Tigard
Site address: 12345 SW 131ST AVE
Project: Stoner Subdivision: MORNING HILL NO.6 Lot: 125
Project Description: Extend gas line, 10'to 15',and install gas insert.
Contractor: NW GAS LINES Owner: STONER,JONATHAN C&DEBRA S
16731 NE WASCO ST 12345 SW 131ST AVE
PORTLAND,OR 97230 TIGARD,OR 97223
PHONE: 503-256-2436 • PHONE: 503-590-0448
FAX: 503-256-2245
FEES
Specifics: Description Date Amount
Gas Fireplace 01/24/2013 $33.39
Type of Use: SF Fuel Piping 01/24/2013 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 01/24/2013 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 01/24/2013 $42.46
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Noti := . -• -r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direc .uestions to OU • b g 50 232.1987 or 1.800.332.2344.
Issue, By: , /`' Permittee S nature: p -L,� 7/�
Call 503.639.4175 by 7:00 a.m.for the next available i ction date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jan 2413 10:51a Tony Young 503-256-2245 p.2
Mechanical Permit Applica
OFFICE USE ONLY
City of Tigard ECEVED DDatemyy:' i �� }P Permit No.: r o —p5
13125 SW Hall Blvd.,Tigard.OR 9 Plan Review
1 - I: . Phone: 503.718.2439 Fax: 503.598.1960 JAN 2 4 2013 Date/By: Other Formic
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: turfs: ia See Page 2 for
Internet: www.tigardor.gov CITY OF TIGARD
Notified/Mettwd: Supplemental Information
i TYPE OF R=ING DIVISION IS(ION ! COMMERCIAL FEE* SCHEDULE- USECIIECKL(ST
Mechanical permit fees*are based on the value of the work
❑New construction Other: performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Other: mechanical materials.equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION '
RESIDENTIAL EQUIPMENT/SYSTEMS FEES'
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special Information use checklist.
Multi-family 0 Master builder ❑Other: Description 1 Qty. I Ea- I Total
• JOB SITE INFORMATION AND LO4ATION Heating'eoofing:
Air conditioning
Job site address: -3 VS" SW /3/0. 4 (requiressd m
cptanshowingplaceent) 46.75
/ �`!! Furnace 100,000 BTU(ducts vents) 46.75
City/Stntee'Z 1 P:. / gb/vl i 0 y 9--72,.P.-_J Furnace 100,000+BTU(duets/vents) 54.91
Suite/bldg./apt.no.: mot' Project name:` i.2 Heat pump
v`� (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: I 23.32 I
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 2332
l l rI.S7� f' �/S /hSL'i� Gas fentf r water 33.39
e-kf t6� 05/in.
/ /'k �/ �p Flue vent for water heater or gas
C1 J fireplace 23+2
Log lighter(gas)
23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
IA PROPERTY OWNER ❑ TENAN I Chimney/liner/flue/vent 23.32
S- Other: 23.32 ,
Name: �r,1✓ Environmental exhaust and ventilation:
Address: C�ldyl,e equipment kitcEtcn
9�' equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
�/ Single-duct exhaust(bathrooms,
Phone:( 217L1516-- !�0�7 O I Fax:( ) toilet compartments,utility rooms) ' 23.32
APPLICANT i ❑ CONTACT PERSON AUic/crawlspace fans 23.32 5 Other:
23.32
Business name: /40 fl/ PiiSC-5 D ILV 6( S /fle5 Fuel piping:
Contact name: i
/,J /, 7q /5 fj $14.15 for first four:$4.03 for each additional
Address: // 73j Y i Wd Sm Sr Furnace,et
Gas heat pump
Cite/State/ZIP: povia4/f GV 7?3 O. Wall/suspended/unit heater
Phone:(93) c„.? 7 3�,j Fax::93) ,2 sb�a?-ys Water heater
Fireplace
E-mail: //.ins 0 Clan CQcA lief J Range/2/.0,96/3 CONTRACTOR Barbecue •
Business name: r f o 4/, CI ' C Clothes d er as ��`
No J Other: i� r_�►�. I
Address: MECHANICAL PERMIT FEES'
City/State/Z I P: Subtotal
Phone:( ) Fax:( 3) C 56-023 Minimum permit fee($90.00)
, ( Plan review(25%of permit fee)
CCB lie.: CL� State surcharge(12;'0 of permit fee)
/' i "Q l TOTAL PERMIT FEE p0.go
Authorized si nature: This permit application capires ifa permit is riot obtaiithin ISO
g y9f days after it her been accepted as complete. ////'����
ft/ /3 • Fee methodology set by Tri.County Building Industry Service Board
I Print name: // �O2 i I date:�/ ''7 1
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