Permit n CITY OF TIGARD MECHANICAL PERMIT
1 g COMMUNITY DEVELOPMENT Permit#: MEC2013-00704
Date Issued: 11/21/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111 CA11600
Jurisdiction: Tigard
Site address: 9773 SW OAKS LN
Project: Nealon Subdivision: SATTLER PARK Lot: 1
Project Description: Installation of gas fireplace/insert.
Contractor: CASCADE CHIMNEY CARE Owner: NEALON, FOREST
P.O. BOX 775 34680 NE KRAMEN RD
ESTACADA, OR 97023 NEWBERG,OR 97132
PHONE: 503-314-1274 PHONE: 503-887-3134
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 11/21/2013 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 11/21/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/21/2013 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct ons to NC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: Permittee Si ature:
•
Call 503.639.4175 by 7:00 a.m.for the next available inspec•= date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application f OR OFI ICE.LIS C)NL\'
Received
Cl of Tigard / Patna No.. X70
City g 'r Dare/By: // ilte&Y3"
° 13125 SW Hall Blvd..Tigard.OR 97223 Plon Rcvicw
Phone: 503.718.2439 fax: 503.598.1?=:r "`. patey. OthcrPermit:
Inspection Line: 503.639.4175 ' Date Ready/By; • orris: Et See Page 2 for
T1G.9 . Internet: www.ti ard=or. ov Supplemental Information
g g ` '. �,`w 1� '1013 NorifitxUMethod:
TYPE OF WORK ,v NI* COMMERCIAL.FEE* SCHEDULE - USE CHECKLIST
1 Vi ` Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration'•_- T rl,a v v- performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Other: TOO _mechanical materials.equipment,labor,overhead.undproftt.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For speciality ormallon use checklist.
❑Multi-family ❑Master builder 'Other: Description Qty. Ea. I Total
• JOB SITE INFORMATION AND LOCATION' ' ' Heating/cooling: .
Job site address: ` J /
Air conditioning 46,75,7 sW I i 4vFurnace 100,400 BTU(duets/vents.) 46.75
City/State/ZIP: �a , OR I iz2.4. Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.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
Other: 23.32 -
Subdivision: I Lot no.:
Other fuel appliances:
Tax map/parcel no,: Water heater 23.32 _
DESCRIPTION OF \VORK Gas fireplace/insert l 33.39 31 3°f
Flue vent for water heater or gas
fireplace 23.32
— Log lighter(gas) 23.32
Wood/pellet stove 33.39 •
Wood fireplace/insert 23.32
—Chimney/liner/flue/vent 23.32
Other: 23.32
[,"PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name: F eS+A/e4/O 4 Range hood/other kitchen
equipment 33.39
Address: 3 463 t- ICi^aw7jeo RI Clothes dryer exhaust 33.39
City/State/ZIP: /t 4,the OR 974 Single-duct exhaust(bathrooms,
/v �1'�J 1 toilet compartments,utility rooms) 23.32
Phone:(28)$8 7- 3i3.- Fax:( ) _ Attic/crawlspace fans 23.32
leAPPLICANT . 0 CONTACT..PERSON Other - I 1 23.32 I _
Fuel piping:
Business name: CIc4, Oa a� Spy $14.15 for first four.$4.03 for each additional
Contact name: -e ire j� Furnace,etc.
Address: )7 7S Sb sz^d fiP. Gas heat pump ,
Wall/suspended/unit heater
City/State/ZIP: GLd 0,,,, / OR 97&7 Water heater
Phone:(5o3) 6s--6-00Z( Fax::(9n 4117 `tv -00,2,o Fireplace
Range
E-mail; Barbecue
CONTRACTOR . Clothes dryer(gas)
/'I� Other,
Business name:tra SL �r f/!+"I C� MECHANICAL PERMIT FEES`Address: reOr "77 s r Subtotal 13.31
City/State/ZIP: �S cad OI OR q7 D� � Minimum permit fee($90.00) `IO•Qp
/ Plan review(25%of permit fee) ,
Phone:(S3) 3/4.- /Z74. Fax:( ) State surcharge(12%ofpermit fee) 1os'O
CCB lie.: 115110 . TOTAL PERMIT FEE 100.20
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 tndusiry Service Board
Print name: . ■i7 LGItL Date: i//i/M3i
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