Permit CITY OF TIGARD MECHANICAL PERMIT
I ' • COMMUNITY DEVELOPMENT Permit #: MEC2013 -00332
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/17/2013
Parcel: 2S110BA02800
Jurisdiction: Tigard
Site address: 11650 SW CLOUD CT
Project: Keller Subdivision: SHADOW HILLS Lot: 36
Project Description: Install gas line for kitchen and fireplace.
Contractor: EVERGREEN GAS INC. Owner: KELLER, BOB M & SUSAN D
PO BOX 388 11650 SW CLOUT CT
WEST LINN, OR 97068 TIGARD, OR 97223
PHONE: 503 - 407 -9542 PHONE: 503 - 624 -1125
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Fuel Piping 06/17/2013 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 06/17/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/17/2013 $75.85
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 opy of the rules
or direct questions to OUNC b 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 Applicatio Oi OFFIC E 1_ isi: (l,�`1. \'. -
City of Tigard I J D3trJB R y /7 /3 rj� /1c 0/3 0033.
14
Permit No.
13125 SW Hall Blvd., Tigard OR 97223 Plan Review
C - Phone: 503.718.2439 Fax: 503.598.1960 JUN 17 Z013 Other Permit:
Inspection Line: 503.639.4175 Date Re
l' I G A K 0 Insptx: Date Ready/By: �: F21 See Page 2 for
Internet: www.tigard -or.gov CITY OF TIGARD Nobfied/Method: 7//,— Supplemental Information
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TYPE OF WORK
WILDING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition/ 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*
® 1 - 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
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 11650 SW Cloud Ct Furnace 100,000 BTU ( ducts/vents) 46.75
City/ State/ZIP: Tigard Oregon 97225 Furnace 100,000+ BTU (ducts/vents) 54.91
Heat pump 61.06
Suite/bldg. /apt. no.: 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, induct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Oth
Subdivision: Lot no.: 23.32
Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Install a Gas line to the kitchen and fireplace fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner /flue/vent 23.32
® PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Susan and Bob Keller Range hood/other kitchen
equipment 33.39
Address: 11650 SW Cloud Ct Clothes dryer exhaust 33.39
City/State/ZIP: Tigard Oregon 97225 Single exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: (503)624 Fax: ( ) • Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel pipes
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 2
Range 1
E - mail: Barbecue
CONTRACTOR Clothes dryer (gas)
Oth
Business name: Evergreen Gas Inc `'
MECHANICAL PERMIT FEES*
Address: Po Box 388 Subtotal q' , 00
City/ State/ZIP: West Linn Oregon 97068 Minimum permit fee ($90.00)
Phone: (503) 407 -9542 Fax: (503) 3446345
Plan surcharge (25% of permit fee)
State surcharge (12 /% o of permit fee) /Q . cf
CCB lic.: 158031 TOTAL PERMIT FEE /oil , gel
This permit 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
Print name: Date: 06 /17/2013
I:\ Building\ PenniteVslEC _PermitApp_040113.doc 440-4617T (11 /02/COM/WEB)