Permit CITY OF ®® MECHANICAL PERMIT
= COMMUNITY DEVELOPMENT Permit #: MEC201000230
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/19/2010
Parcel: 1S133CD13900
Jurisdiction: Tigard
Site address: 13984 SW BLUESTEM LN
Subdivision: PEBBLECREEK NO. 2 Lot: 30
Project: Spillman
Project Description: Replace gas furnace.
Owner: FEES
SPILLMAN, ART Description Date Amount
13984 SW BLUESTEM Gas Fireplace 05/19/2010 $33.39
TIGARD, OR 97223 12% State Surcharge - Mechanical 05/19/2010 $10.80
PHONE: 503 - 626 -0336 Minimum Fee Adjustment - Mechanical 05/19/2010 $56.61
Contractor:
EVERGREEN GAS INC.
PO BOX 388
WEST LINN, OR 97068
PHONE: 503 - 407 -9542
FAX: 503 - 344 -6345
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 Notifi . • ' e - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dire •uestions to OUNs:• lino $3.246.6699 or 1.800.332.2344.
Issu d By: Permittee Sign re: ` " :' "?
— / Call 503.639.4175 by 7:00 a.m. for an inspection that busin • ss 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.
.. = ?1AY = -2010 05:40 FROM: TO: 5035981960 P. 1
Mechanical Permit A 1 `� , _ n, r � :'1'( im i( l � ° I sa + . FNED
,' t4 C of Tigard Received
IPermitNo.: K , , i ®-•( � 1
. Ili n 13125 Hall Blvd., Tigard, OR 972,���/ 1 8 20 0
® �. , 'rte Plan Plan ffRc Review
4, :, , Phone: 503.639A171 Fax: 503.598. Day Other ~ it:
ifj " ?t . 1 ., Inspection Line: 503.639.4175 BUI I 1 r -(-�/ OF "�tGARD Date Ready/By: r EA, ® See Paget for
isi4auili Internet: www.tigard- or.gov V' DI \IIS ON Notified/Method: ,Al (� Supplemental Information
LDING V
TYPE OF WORK COMMERCIAL FEE' SCHEDULE — USE CHECKLIST
❑ New construction ® Addition/alteration/replaccmcnt Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $ 1400.00
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. Ea. I Total
JOH SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address: 13984 SW Bluestein Ln
(requires site plan showing placement) 46.75
City/ State/ZIP: Tigard Oregon 97223 Furnace 100,000 BTU(ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pwnp 61 -06
Cross street/directions to job site: Duct work 23.32
Hydronio 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 Ito.: Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 1 33.39
Flue vent for water heater or gas
Replace the Zero Clearance Gas Fireplace fireplace 23.32
Log lighter (gas) 23.32
dGG (J , fi: 8 Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner /flue/vent 23.32
® PROPERTY OWNER ❑ TENANT Other: 23.32
Name: Art Spillman Environmental exhaust and vendlatlon
Rangehood /other kitchen
Address: 13984 Sw Bluestem Ln
equipment 33.39
City/ State/ZIP: Tigard Oregon 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503 )626 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping
Contact name: $14.15 for first four, $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall /suspended /unit heater
Phone: ( ) Fax:: ( ) Water heater r-t
Fireplace t
E -mail: Range
CONTRACTOR Barbecue ,, i A/ rl'°
Business name: Evergreen Gas Inc Clothes dryer (gas
Other:
, ) Address: Po Box 388 MECHANICAL PERMIT FEES*
$/ City/ State/ZIP: West Linn Oregon 97068 tal Phone: (503) 407 -9542 Fax: (503 -) 344 -6345 n r ew 25 %it fee mit Subtof e ) �
Plan review (25% of permit fee)
CCB lie.: 158031 l 7, (slit State surcharge (12% of permit fee) f • , 40
1 TOTAL PERMIT FEE )� 2 .
Authorized signature: This permit applicadon ys Rer It has been accepted as co plete. w thin 180
I Print name: William Belden I Date: 5 - - I • Fee methodology set by Tri -County Building Industry Service Board
l:/BuitdingWennia\M C- PeimitApp.doc 10/0109 44046177 (t 1/02/COM/WEB)