Permit CITY OF TIGARD MECHANICAL PERMIT
II 2 COMMUNITY DEVELOPMENT Permit #: MEC2013 00246
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/13/2013
Parcel: 2S 111 C D03300
Jurisdiction: Tigard
Site address: 9625 SW BRENTWOOD PL
Project: Roth Subdivision: SUMMERFIELD NO.9 Lot: 522
Project Description: Installation of gas insert and venting
Contractor: EVERGREEN GAS INC. Owner: ROTH, BARBARA A REVOCABLE LIVING
PO BOX 388 ZIOLKOWSKI, ADRIAN
WEST LINN, OR 97068 9625 SW BRENTWOOD PL
TIGARD, OR 97224
PHONE: 503 - 407 -9542 PHONE: 503 - 477 -2481
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 05/13/2013 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 05/13/2013 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 05/13/2013 $14.15
Stories: 12% State Surcharge - Mechanical 05/13/2013 $10.80
Minimum Fee Adjustment - Mechanical 05/13/2013 $19.14
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 quest . •UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /, / • 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.
Mechanical Permit Applic FOR OFFICE L U;S1 ONLY !�
Ci of Tigard Rived / Permit No.:
UP h' Datemy: 5 H � ��
a 1 3125 SW Hall Blvd., Tigard, OR 97223 A��
2 Phone: 503.718.2439 Fax: 503.598.19 Plan Review
-: 9�4 1 3 2013 Date/By: Over Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Ituis: ® See Page 2 for
Internet: www.tigard -or.gov
CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New constructionddition /alteration/replacement 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*
- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist
/❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
OB SITE INFORMATION AND LOCATION Heating/cooling:
r (3-(e_ LO PL Air conditioning 46.75
t /
Job site address: �g e( �j� Furnace ace 1000,, 0000 BTU ( ducts/vents) 46.75
City/ State/ZIP: 1 f� Q 7 2 Z� Furnace 100,000+ BTU (ducts/vents) 54.91
Heat pump 61.06
Suite/bldgiapt. no.: I Project name: Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
4 4 0 4 6 4-S' f L 411560--fes fireplace V 23.32
V r Log lighter (gas) 23.32
L Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner /flue/vent 23.32
OWNER ❑ TENANT
23.32
>loPROPERTY Environmental exhaust and ventilation:
Name: 6,�.�-,� seld''k• Range hood/other kitchen
Address: equipment 33.39
�S �G'f a f/✓ `J 0 3 /� ! L` Clothes dryer exhaust 33.39
City/State/ZIP`'� 4-- 6. j 9 7 f Z Single -duct exhaust (bathrooms,
{{ f� c !!! toilet compartments, utility rooms) 23.32
Phone: J3 ) 7 _ 29// Fax: ( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: _ 23.32
Fuel piping:
Business name: $14.15 for first four, $4.03 for each additional
Contact name: Furnace, etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone: ( ) Fax: : ( ) Fireplace
Range
E -mail:
Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: E1-rierVeedt 4.4-__5 Other:
� MECHANICAL PERMIT FEES*
Address: ? Q J c\ V �^` )G 3 -8 9 g / Subtotal
•
City/ State/ZIP: `� J Minimum permit fee ($90.00)
, c Plan review (25 %of permit fee)
Phone: (5 )) 3 7_ �3iy F ax: ,(5 ) ✓ �/ v4 `.Trs State surcharge(12 %of permit fee)
CCB lic.: / 3 f ✓V/ TOTAL PERMIT FEE f� .S 6
` .3g° r This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri- County Building Industry Service Board
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9625 SW BRENTWOOD PL, TIGARD, OR, 97224
Residential - Mechanical
699 Mechanical final
05/14/2013 00:00
MEC2013-00246
PASS - No C of O
Standard pressure verified 10 lbs 15 min
Violation Summary:
Inspector Contractor