Permit 114CIi
TY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00942
TI GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/29/2017
Parcel: 2S111AD16100
Jurisdiction: Tigard
Site address: 15034 SW 91ST AVE
Project: Caminschi Subdivision: MALLARD LAKES Lot: 27
Project Description: Adding(1)fireplace insert to living room and(1)gas stove to kitchen both to existing gas lines.
Contractor: OWNER Owner: CAMINSCHI,ANDREI &KIMBERLY S
KIMBERLY CAMINSCHI 15034 SW 91ST AVE
15034 SW 91ST AVENUE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 425-753-6669 PHONE: 425-753-6669
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 11/29/2017 $33.39
Type of Use: SF Range Hood/Other Kitchen 11/29/2017 $33.39
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 11/29/2017 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 11/29/2017 $23.22
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: / /dr
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit ApplicatiREC- •VEP FOR OFFICE t SE ON L\
Cityof Tigard Received
g I Permit No•
111
13125 SW Hall Blvd.,Tigard,OR 97223 '!I 017Date/By: / A �� — '!�
Phone: 503.718.2439 Fax: 503.598.1960 Dam Review Other Permit: L. . O
�r s
T I C ARD Inspection Line: 503.639.4175 H �� i' ' Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: SupplementalInformation
BUILDING DIVISIO
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:15034 Sw 91a Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard OR 97224 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,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 x 33.39
Flue vent for water heater or gas
Existing Gas line. Fireplace insert in Living Room fireplace 23.32
Gastove in Kitchen Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
CI PROPERTY OWNER Other: 23.32
TENANT Environmental exhaust and ventilation:
Name:Kimberly Caminschi Range hood/other kitchen
Address:15034 SW 91st Ave equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Tigard OR 97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(425)753-6669 Fax:( ) Attic/crawispace fans 23.32
0 APPLICANT 0 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 x
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Cl it ./A77-72-- Other:
vv MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/Z1P: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized Sign * Fee methodology set by Tri-County Building Industry Service Board
Print name: W(—E'lleD e:11/29/17
I:\B \uilding\PermitsMEC_PermitApp_040113.doc �/( (!!!I I/02/COM/WEB)