Permit ,
a CITY OF TIGARD MECHANICAL PERMIT
111 11 -_ COMMUNITY DEVELOPMENT Permit#: MEC2013-00458
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/07/2013
Parcel: 1 S125DB06100
Jurisdiction: Tigard
Site address: 7100 SW SHADY LN
Project: Reid Subdivision: SHADY DELL NO.2 Lot: 34
Project Description: Install gas insert,venting and gas line.
Contractor: EVERGREEN GAS INC. Owner: REID, RAYMOND J&CECELIA A
PO BOX 388 TRUSTEES
WEST LINN, OR 97068 7100 SW SHADY LN
PORTLAND, OR 97223
PHONE: 503-407-9542 PHONE: 503-244-4291
FAX: 503-344-6345
FEES
Specifics: Description Date Amount
Gas Fireplace 08/07/2013 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 08/07/2013 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 08/07/2013 $14.15
Stories: 12%State Surcharge-Mechanical 08/07/2013 $10.80
Minimum Fee Adjustment-Mechanical 08/07/2013 $19.14
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance ' work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification -• er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain copy of the rules
o direct questions to OU s b cal'ng 503.232.1987 or 1.800.332.2344.
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I ued By: / /, �l iI4 I>✓ % Permittee Signature: f --
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application - 1 olz OFFICE 1.ISE ONLY
Received ffire -.0 S
City of Tigard Dateiv g PermitNo.: ��
to 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C ' • Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A It D Inspection Line: 503.639.4175 Date Ready/By: Iaris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction dition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Adler: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
►;"'rand 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
11 Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
' 00 S 14',1f S Air conditioning 46.75
Job site address: e Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 6P Z Z) 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
`��yoil_
9` 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
Oth :Subdivision: Lot no.: � 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert I 33.39
Flue vent for water heater or gas
Tl/lis i—N l( A- Cos i k Sez Y V fireplace i 23.32
4- 6
Log lighter(gas) 23.32
�S lNe Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ROPERTY OWNER ❑ TENANT �� 23.32
r Environmental exhaust and ventilation:
Name: �e i i! Range hood/other kitchen
""ll 4-Y Address: ? equipment
33.39
o o v = Clothes dryer exhaust 33.39
City/State/ZIP: 6) 7 1 Z z Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:("'SS o)) 2 (/`/, (i z9/ 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
I
Phone:( ) Fax: :( ) Fireplace -
Range .
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)•Business name: Lj Lit,'C.I`ee 1/t l 5 i4(...‘ Other: MECHANICAL PERMIT FEES'
Address: ?to -3 0 X 3 O Subtotal
�s ( O e_It �17 8 Minimum permit fee($90.00) 90•
Go
City/State/ZIP: 4. /
(/ to _ Plan review(25%of permit fee)
Phone:(S6) U 07 55,1,_ Fax:(563) (�i!-6 3 Li S State surcharge(12%of permit fee) /Q•�D
CCB lit.: `U / 7 TOTAL PERMIT FEE (//y) C)
1 (�0 3 I — This permit application expires ifs permit is not obtained wi 180
days after it has been accepted as complete.
Authorized signature: ' / * Fee methodology set by Tri-County Building industry Service Board
Print name: V l J 11 1 l I (� wo b e/�[e.vi Date: �/ S i 3
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