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Permit . '!'1 CITY O MECHANICAL OF TIGAR® I a.: COMMUNITY DEVELOPMENT Permit #: MEC2009-00559 1 7� , ' i 13125 S H all Blvd. Tigard OR 97223 503639.4171 Date Issued: 10/21/2009 TIGARL Parcel: 1 S136CB05400 Jurisdiction: Tigard Site address: 11020 SW 83RD AVE Subdivision: STEVE + HUGHIE'S PLACE Lot: 26 Project: Lafferiere Project Description: Install gas fireplace insert and gas piping. Owner: FEES LAFFERRIERE, GERARDO Description Date Amount 11020 SW 83RD AVE TIGARD, OR 97223 Gas Fireplace 10/21/2009 $33.39 Fuel Piping 10/21/2009 $14.15 PHONE: 503 - 670 -1190 12% State Surcharge - Mechanical 10/21/2009 $10.80 • Minimum Fee Adjustment - Mechanical 10/21/2009 $42.46 Contractor: RICK'S HEATING &COOLING 686 S. 25TH CT., 686 SOUTH 25TH CT CORNELIUS, OR 97113 PHONE: 503 - 680 -1046 FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue: 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 -0100. You may obtain a copy of the rules or direct questions to OUNC calling 503.246.6699 or 1.800.332.2344. 7 . # _ Issued By: ®, , ► r / Permittee Signature: "lib.. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. 9 �dl � t . 1 A ; '� :) 4111 b 11 Yi';!�I0 ),1 dryu ^�"',nl:4.1 ` r y H,r, tb { i �b v ,4, xdYi nl ,A fip • j � , �4 u,a,c� "i��'� ' "' tr; FOR OFFICE USE ONLY I, 1, r t i ; 1 ' k r y a''i �p hr „? x Recei ed ,,,',ri it nv a. Pen nitN o t,,,e ;' .,;, � t, , + II 1 ' J ds � ';� t • Mechanical Permit A ilea , , b 1 ,,, � ,�, cit of Tigard Date /B ,.« /' 'l,E,�o2a0 9 Q9 5 5 r 13 12 5 S W • Hall. Blvd., T OR 97223 ((�� 1 Plan Review t Phone: 503.639.4171 Fax: 503.598.l96 ' 1 1 ���� Other Permit:, Date /By: 4TIIGAvRD� Inspection Line: 503.639 -�/ y / �ry Date'Ready /By; Juris: ® See:Page 2 for Ott tt�t w,Cm'tua1 Internet: www.tigard or.gov .CITY OF 1 I.(ARD Notified /Method: 7 Supplemental Information` B UILDING DIVISION :;,, 4 +a..� p ", j '.. - y,, n ..r . arty >: w- §.�., s:�gtF' eai" �.s'C* �C' = ., a k .„,. - a ,, z� -: ys' w ...? ... ..a a .... r ,.... �c*am .n r .. a ,„..:. s z;,..rwa ar�-na.,„„. .„„..., ' 1 74—WK ` <s... t i f i ... W.OV > s: r# _ : 1 COMMRCIAL EE SHEDULE S`"'�IJSE CHECKLIST y�'.4 i:a",ae. n>� - ''' 'i' '''a' ''''' - '''icT I'i. . a w . .'*c „vLs ?v -'j . 3” ")`..`J._.. ,7 ' -' m E '', �w ..:m C aa�. C - ..z he 'f.,::. .sow work' n..:. u(vfi New construction Addition /alterat ve Mechanical "permit fees* are'based on the value of the work' ❑ ion /replacement performed. Indicate the 4alue to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment,,labor, overhead, and profit. '.M °!', �'2 "4 SY bY"t� w+ +z, - ewFm . .x, �" r^'�.. ='ua.':� Value x ..} , t _ f tg r CATEGORY OIE CONSTRUCTIO N, ; X 4� ' : « .tki.....� M � RESIDEN g ' " U x : % S T EM F1E ' t} t .% - �r;:t: ATWAQ xx �t.:x '^ mx :+zr� a i .r.. A' k1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information, checklist. '❑ Multi- family ❑ Master builder . ❑ Other: .Description 1 Qty. Ea: Total u R �4 4JOB SITESSIF ' ' T4A1 A,Eti ATIOPI ` `Sy r Heating /cooling Air conditioning Job site address: I iOde9 4 .). 8 3 (requires site plan showing placement) 46.75 w / G f�h.3 � t Furnace 100,000 BTU (ducts /vents) 46::75 City /State /ZIP: l Furnace 100,000+ BTU (ducts /vents) 54.91. Suite/bldg. /apt. no.: Project name: Heat pump 61.06 Cross street/directions to job site: Duct work 23:32 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 Tax map /parcel -no.: Other fuel appliances , H A t.. > DES Rt ION O WO{ RIr' 7.1C aif*-I � Water heater 23.32 Gas ;fireplace 1 33.39 ,33 r 39 6 4 � < e � f +� I. ( / 4 i 6 -e-- pi ✓T? . P . 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 ro mot n � , Chimney /liner /flue /vent 23.32 k ) , PROPERTr OWNER � 4 s x I TENANT � r It 1 4 a Othr: 23:32 Name: 0 .e rQr•Q d L-a-� e- 1`i -e :r� Env.ironmental exhaust and ventilation //adz, ' l.� q 3 Range hood /other kitchen Address: 'v equipment 33.39 City/State/ZIP: -71-6' Clothes dryer exhaust • 33.39 �� Single- duct.exhaust (bathrooms, Phone: (5703) 6 5,0 ! ! gGe7 Fax:,(: ) toilet compartments, utility rooms) 23.32 A ISIS APPL CANT * y t; n? -1' N,,- 'ACT PERSON - Attic/erawlspace fans 23.32 r _ Other: 23.32 Business name: / / � S I�i�r. t 64..,,c), / Fuel piping Contact name: r� +— - _ $14.15 for first four; $4.03 for each,additional . , 11` `�t� S r I f lea . Furnace, etc. Address: 6 k6 .; ' . j - Gas heat pump City /State /ZIP: e_ZY � �\ / � / Wall/suspended/unit heater Phone: ( 93> f 3 © ,r zi Fax: : ( ) Water heater /� Fireplace 1/46 /5 E-mail: �-1�1�- /t�� - Z � l r , �. Range *' Ar,A,7,110,1%; t ° ra, 'CTO21 x �,r�r t 7 / 3 a Barbe c Clothes dryer (gas) Business name: '� s , {�—F �� Lt f� (j Other: Address: r f . 6. , $ t r. a o' nw'ME PERMIT EESt i P,, - .. City /State /ZIP: corM e_e s (5/' —1 i C3 Subtotal Minimum permit fee ($90.00) r J e1 , Phone: ( / 6 �/ �y � Fax: ( ) Plan review (25 %:of permit fee) CCB tic.: / 1 � ` / j 6.8 l G/ / J f State surcharge (12% of permit fee) 7 ,F.6 ,F.6 , `' / t j TOTAL PERMIT FEE /OD , ,f '/) • .This permit application expires - if a permit is not obtained within 180 Authorized signature: days:after it has, been accepted as complete. Print name: Pi /<-- S % Date: I d — i',_0 ` Fee methodology set by Tri- County Building Industry Service Board 1_t Building 'Perm its \MEC- Permit App. doc 10/01/09 440 -46I7T (11 /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi - Family Fee Schedule: $0.00 to $500.00. Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the "first $500.00 and $3.07 for each additional $100..00 or fraction thereof, to and including $5,000.00. $5,000.01 t'o $10,000.00 •$207.21 for the first $5,000.00 and $2.81 for each additional $100:00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363'.71: for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608:71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new, commercial buildings require 2 s ets of plans. I:\Building \Permits \MEC -PermitApp;doc 10/01/09 2