Permit CITY OF TIGARD MECHANICAL PERMIT
¢`' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00143
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 1 S135DCO2401
Jurisdiction: Tigard
Site address: 11795 SW 91ST AVE
Project: Dieker Subdivision: Lot: 0
Project Description: Install gas insert & gas line.
Contractor: T & K MECHANICAL Owner: DIEKER, ELIZABETH
PO BOX 116 11795 SW 91ST AVE
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503 - 844 -9173 PHONE: 503 - 407 -0312
FAX: 503 - 846 -0195
FEES
Specifics: Description Date Amount
Gas Fireplace 04/06/2011 $33.39
Type of Use: SF Chimney /Liner /FlueNent 04/06/2011 $33.39
Class of Work: ALT Type of Const: Fuel Piping 04/06/2011 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 04/06/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 04/06/2011 $9.07
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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. • - . _ -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir- t questions to O C : • a 'ng 503.232.1987 or 1.800.332.2344. \\
Iss d By: I / / Permittee S i g ' ' ar/ /
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.
04/05/2011 12:09 5036269138 HOT SPOT FIREPLACE PAGE 01/02
Mechanical Felrmi Ap t i c _ an on • 1 01: O I 1 t ( I t. ,I.. (t.1,
City of Tigard n it. y 've° 411MINVON tit I o.: f-/ ,j/ G10/ 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Other Permit!
Phone: 501630171 Fax: 503.598.1960 DetelBy:
I 1 t , }, t Inspection Line: 503.639.4175 rate Ready/By. Ai
Internet: www.tigard-or,gov Notige4QMtctbod:
/ATE OF WORK • - COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fuses' are based on the value of the work
New construction XAddition/alterationhoplacement performed. Indicate the value (rounded to the nearest dollar) doll
❑ Other: mechanical materials, oquupmen labor overhead and . rofit.
❑ Demolition value: S
- { CATEGORY OF C01V6TRUl I xuN RESIDENTIAL EQUIPMENT / SYSTEMS FEES`
r 1- and 2- family dwellii g ❑ Commercial/industrial 0 Accessory building For special information use checklist.
O Multi- family 0 Master builder ❑ Other: Description Qty. Elm Total
-
JOB SITE INFORMATION AND LOCATION 1leati t : coati ..
I q s 5 c.� 1 Autdip
Job site address: , (requires site plan shooting placement 46.75 MI
Ci /State2IP; 3 Furnace 100 000 B11) duce/vents 46 NM
tY l l 4 r[.� ✓ Furnace 100,000 BTU " daela veuts 54.91 NM
Suite/bldg./apt. no.: V I Project naroe: Hcatonp 61.06
-
Cross streetldlrecdons to job site: Duct work III 23.32
- H drone hot water 23 -
Residential boiler (radiator or MIM
. Unit eaters (8tel- -type, not eieouic), PS
in- - i . . s .... ,, e tc.
Floe/vent for , of above
Subdivision; hat no.. Other. MI 2332
- Tax map/parcel no.: Other fuel a 1 . "lancers
DESC3 IFTIO OF - WORK Water heater � �
Gos , , - eras fi - ' 0 .0 u1..
IZGiS 11 Vl(p vas i y1se7! Flue vent watutleater gas �
"ace
Lo: li:. to y: .
Wood/ • het stove --
- wood has •lace/insert IMM
C ' , - /liner/tlue/ lent OrMigningM
NE
0 PROPERTY OWNER - d TENANT Other. _ 2332
Name: j 7_+t) & . f J eD ;,,e k_, Environmental exhaust and ventilation
I 7 9S � 4' ` '1 1J '7 4 f- U� e hood/other kitchen Address: Jr_CJ ��
City /State -LIP: 1 - 614 6 9 �_ Clothes , . exhaust 3339 Mil
! single-duct exhaust (bathroom, WM=
Phone: (53) Q - el, 0___ toilet compartments, utility rooms)
APPLICANT 0 CONTACT PERSON Amefcrawl ., its MIMI.
• Other 23.32
Business name: - f/ r p /mo• -e— _ Fuel ..1
Contact name' ' ■ e/ 4, $14.15 for first fora $1.03 for each ad i
Address: // < �C� u, . Gas beat , , — -
City /State/ZIP: e le i _ _AT d r I, 7des wants • -, unit heater 1111111.111.111111
IIMMIIIIMEMIHIMMIIIIMIM
E -mail: k t 0 .k ply(,c i vep O e c � .I 414 '/. tic) IMINIMINIMIMMEI EMI
CONTRACTOR Clothes dryer (gas) _ � IIIII
- Business ""stun: 774- ,� Other: - -
Address: Q ♦ . X / MECHANICAL PERMIT FEES*
CttylStateflIP : .cby , 6' .pt,�° el— 7 7416, Subtotal Minimlm" permit fee (590.00) or "
Ph one: ( ) Fax: ( ) Plan review (25% of permit fee)
CcB Sc.: /a // 6 5 State surcharge 12% of permit fee) 40 ,
- TOTAL PERMIT FEE a D..' •
+ This >�t application expires if a permit a net obtained within 130
Authorized ail : ,, ,,, / days att er trims been accepted as complete.
� ���� w 1 " - • Foe methodology set by 111 County Building Ludwgy Service Board
print name:
-. wJWinay..,ved..P..PPemitAoo.doc 10101/09 4404617r(11/02/0014/WEB)