Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00148
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/07/2011
Parcel: 2S109AB08500
Jurisdiction: Tigard
Site address: 14255 SW 131ST PL
Project: BLOMMAERTS Subdivision: RAVEN RIDGE Lot: 14
Project Description: Gas line to range.
Contractor: ALL FUEL INSTALLATION & SERVICE LLC Owner: BLOMMAERTS, FRANK J
PO BOX 69 14255 SW 131ST PL
TROUTDALE, OR 97060 TIGARD, OR 97224
PHONE: 503 - 674 -2350 PHONE: 503 - 579 -3067
FAX: 503 - 674 -2693
FEES
Specifics: Description Date Amount
Fuel Piping 04/07/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 04/07/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/07/2011 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.
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: ....1111111111111111. Permittee Signature:
Ca 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 Application FOR OFFICE ESE ONLY
�� ltaciv ed permit No.: r per v
lig Cit of Tig d OR 97223 )lJ Date/BY: O 1. - ' •
13125 S50 Flail Blvd Fax: , � Plan Revitw Othemit:
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: e
T I G A R 1) inspection Liae: 503.639.4175 Date Ready/By: lurle: RI See Page 2 for
Internet www,tigard- or.gov 23ottfied/Iulethad: i Cs Supplemental Information
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giali :• i 1 t r cA`JA: 1 1 hii t ,/1 7 d i f il �E 14:x.1! . m ' u ..04,,„,.„..",i1„... i !f:r
w1 �8Y1f11l�1 : :- i . .;, �r6i f��IR'If. .• A� ° ur...ra + dEE , r.;issYO. �`` S ri,,. , -, rr: +. :� Mechanical permit fees* arc based on the value of the work
['New construction IN Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, e • ui • mcnt, labor overhead, and •rofit, .
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® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building . For special information use checkiiiX
❑ Multi - family ❑ Master builder ❑ Other; Description Qty, Ea. Total
a yeti ,>v . g Y 4 : sf _ i lF t, s° 'i 1t' Heatinp/eooling:
l l: , l i .N i , R i ° ,1! ii i r 3' °t n i lf. i ;.' t u t i ilti ,'6"' i " i�1t 'n l x,P roir : {,..i . 1 . , ' ; ; ! • :;° Air conditioning • Job site address: 14255 SW 131 Place (requires site plan showing placement 46.75
Furnace 169 BTU (ducts/vents) 1.1 46,75 Ell
City /State /ZIP: Tigard, OR 97281 : Furnace 100.000+ BTU (duots /veats
Suite/bldg. /apt. no.: Project name: Heat pump
quires site .tan shows: •lacemont 61.06
re
Cross streetldirectiOns to job site; Duct work 23
Residential boiler (radiator or .
, Unit heaters (fuel-type, not electric),
in-wall in-duct, sus ended, etc. 46.75
Flue/vent for an of above 23,32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel a '
:, r ; ;,• .,g r r;,; r :�,. 23.32
� y' �� }��l a t i7ef .. 1 3 : •,1 3 + { e ts'ii f , las'- Y INN
i,';IA4fE�"1iA3 y f +l? <rr tIHR;t'1,..rotea Y��. e ,•, i, ttalip PI�Yi�rl�lF ;`1io {rAi� 1)% 33.39
Gas firc.lace
Install gas line to range Flue vent for water heater or gas
fire •lace 23.32 IIII
Lo_ li:, ter L : 23.32
Wood/ •elleistove MIE 33.39
23.32
u I Wood fiire.lace /insert Chimne /liner/flue/vent 23.32
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'uM ! Ixrnf : � I r
,z ,.ss:."'111888'° ,.�.., �:Y�3° ,� -: °!' itOfl':�V�7o1�1•!
$! �r�, iMl • fl � �.I:�t;pF ��� r. zr {k tllS, lianr,� •' t other
Name: Frank 10iommaerts Environmental exhaust and ventilation:
Range hood/other ldtchen
Address: Same as Above enuiiment
City /State/ZIP: Clothes d er exhaust 33.39 MI
Single-duct tomp rt exhaust (uality rooms) s,
Phone. (503)579-3067 Fax ( ) toilet
g t compartments, utility ro
aY!��. , il . it fi a ({ii i!
i ° A! l iA E'ti47 d tl +ri J�s> Sli 0 ' f l , ' . , q4 t '"' ° 'x,1 Attic/crawls fans
i1,3krr � t t: ( u , .k :ifil.& 16. 4, :d t t xt. .. A ; ,. ,, 0 . J 23.32
Other
Business name; Sec Below Fuel thin.: •
Contact name; Eric Camp 514.15 for first four; $4.03 for each additional
Furnace, etc.
Address: Gas hcatpump
City/State/ZIP; ' Wall /sus. ended/unit heater
Water heater
Phone: ( ) Fait :: ( )
Fire .lace
E -mail: allfuel ()comcnSt.net R.an_a 14.15
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J,`. fR';t 1 4 � tJi tr l r t a AIM; 1�; E l ief r dd��A. ;, d ndt ' + { i �l� 't '^i� g(' l i! a $ il !l + ,7 , Barbecue
' �, ;ru 1, zY,YY... ll'iY ,l Y,.Aj,. ;�l; ;/ P., -,.1 � nr �.r.w ,rv�l•��.i., a�l ":,,ii��t j „L�. �+ „f`•r��R��N3 ..�tlt +l yrYlN rnY,`iYtF� +� li < ?,':r
Business name: All Fuel Installation and Service, LLC. Other:
Address: PO Box 69 uG :gg' ¢ + • y 7y + 19,' L r. ' ?2 51
r 15,, .1• !
. Subtotal 14.15
City/State/ZIP: Troutdale, OR 97060 ( $ 9 0 . 0 0 ) 90.00
Minimum permit fee Phone: (503) 674 -2350 Fax: (503) 674 -2693 Plan review (25% of permit fee)
CCB lit.: 169503 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT PEE _I 100.80
This permit application expires if a permit is not obtained witbln 180
Authorized signature: f ' days after it has been accepted as complete.
Print name: Eric Camp Date: 4/7/11 • Fee methodology set by Tri- County Building Industry Service Board
Ia9uildingiPermite c- PennItApp -doe 09/09/10 440 (t i102ICOM/WEa)