Permit y n CITY OF TIGARD MECHANICAL PERMIT
:f COMMU DEVELOPMENT Pe rmit #: MEC2013 00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/29/2013
Parcel: 1 S134ACO2646
Jurisdiction: Tigard
Site address: 11040 SW COTTONWOOD LN
Project: Swearingen Subdivision: ENGLEWOOD NO.3 Lot: 212
Project Description: Installation of gas insert and venting. Using existing gas line.
Contractor: EVERGREEN GAS INC. Owner: SWEARINGEN, LARRY
PO BOX 388 ROBERTA
WEST LINN, OR 97068 11040 SW COTTONWOOD LN
TIGARD, OR 97223
PHONE: 503 - 407 -9542 PHONE: 503 - 590 -3655
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 01/29/2013 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 01/29/2013 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12% State Surcharge - Mechanical 01/29/2013 $10.80
Stories: Minimum Fee Adjustment - Mechanical 01/29/2013 $33.29
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 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 t o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: I Permittee Signature:
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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