Permit CITY OF TIGARD MECHANICAL PERMIT
>• COMMUNITY DEVELOPMENT Permit # MEC2009 -00542
Date Issued 10/15/2009
3�I Gi'IRD 13125 SW Hall Blvd Tigard OR 97223 503 639 4171
Parcel 2S104CA05300
Jurisdiction Tigard
Site address 13188 SW ESSEX DR
Subdivision Lot 0
Project Shingledecker
Project Description Install gas line
Owner FEES
SHINGLEDECKER, PETER J & Description Date Amount
DIANE G, 13188 SW ESSEX DR
TIGARD, OR 97223 Fuel Piping 10/15/2009 $1415
12% Slate Surcharge - Mechanical 10/15/2009 $10 80
PHONE Minimum Fee Adjustment - Mechanical 10/15/2009 $75 85
Contractor
A -1 INSTALLATIONS NW LLC
8116 SW DURHAM RD
TIGARD, OR 97224
PHONE 503 - 620 -5657
FAX 503- 620 -1696
Type of Use SF
Class of Work ALT Type of Const
Occupancy Grp
Stories
Fuel
Fuel Types
Gas Pressue
Total $100 80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code State of OR Specialty Codes and all other
applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, • - suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utiht - , otification Cent- Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100 You m fain a copy of the rules
or • rect questions to GU •y a g 503 246 6699 or 1 800 332 2344
Is-. ed By I / POw ( Permittee Signature I-. -
Call 503 639 4175 by 7 00 a m for an inspection that business day
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection
I 1___I I
Mechanical Permit Applic c E % \ J t p „ FOR OF 1 u 1 ti sr (IN Li
r cccw,.a
Li of Tigard P enu lt No
I w 131 Hall Blvd , Tigard, OR 97223 4 2009 Plan Review
�Q H p E GG j% CO 5V
P tIKV
': b Phone 503 6394171 Fax 503.59819j0 1 1 . Date/By I Oilier Perron.
TIGAR inspection Line 5U3.b39.4 i75 T1GA Date Ready/By I mrlyi &l See P age7ur
.. Internet. www,Ggard -or gov CNN Or V1S1O Nonfied/Metad
/ Su pplemental .nformutimt
S1NG i 1I��YY �,,$ I.
5 9'1 ! ItrA A. c3 'li d 711 It ■ xo J'j5'i' ,4 d) Ig r , }:.c OVA,* n. p Y ,., c. I i�a, t : hi�"elide �it
�)I�Btt t i r 7k ■r��V'4re' a�t!� ,�fji�a t n � , if7�if� � " I >m ,�it(y)f 1t),t'a , � �s t
M ti aluca permit arc based on the va • hl t fees" bd thlue 4 f rk
❑ New construction El Addition/alteration/replacement
Dc ' ounce. Indicate the value (rounded lo the rte est dollar) of all
❑ Demolition iA Other: mechanical materials, equipment, labor, overhea . and_protit.
`i`l ;a , + nt,4, ,. .� , .n , .;Ie" w & y fr;. `d,'r +"t Value
like y, ,at
❑ 1- and 2 -family dwelling El Commercial industrial ❑ Accessory buildin ' ('tt ' p. 3 "'" � Jt Jl
For special ti(forrauon use check] st
❑ y ❑ builder 0 Other. Dori tion Qty Total
Multi -family Master b
� yry _ p t Ea
- (tti,11N7i • d , d � i' )rli, ,,..m",n�., P 1 t 't -
cit 4' `/ / 14� � w,lt w ,
' s J1 A •in III 4dl o J
Clr^ ° '
u ��. ��, � G• t�dAl�li;r,17 vLt HeannPJaoplm� I
Ant ondrtioning II
Job site address: � (mores site plat) skew.? placement) 75
y !jai e90 q?--- huiGeo° M,000 Id RI (ducts/vents) 50.75
Fur 100,000+• BTU (dacis/vcnts) 34 91
I Sutte/bldg./apt. no : r Project name. yea[ pump E) 06
Croce strecUdirecGOns to job site. Dui work 213 32
Hydramc hot water system 33 32
ReJdential boiler (radiator or 1'
hydronic) 23.32
Unit heaters (fuel -type, not electric), I'
in -wall, in-duct, suspended, etc 46 75
Subdivision Lot no : FIu&vent for any of above _ 13 32
Oar
33 32
Tax map /parcel no,. Other fuel appliances _
;8 y "7:c; iefr+1vg l "ipso G2- ° ") g c114 'Ink #' °Il(f Wap heater 3
'.Claw' rill) dtriStS. tint fires his L,W _ '.3 9 taisin.uncS ai lslitigus
Gasifireplace
i WI a - fr Q', / Flu vent for water heater or gas
fire 32
Lo lighter (gas) 23 32
W stove 33 39
Wood fireplace/lnsert .t 32
7 e. -,rA i -t„ ,co•� t, , . , - -- .•a ,ya. to Chgwey /liner /flue /vent 32 -
y l- �t6rBRItlbb1"9�fd�r m v" ", -ti, u'iu�1)1j1N 21G -
C 1 O hir- 32 1
t ine' n•'oy4 IQ t Pck W �? ki / i - e tL ec —R1 Enalroumeutal exhaust and ventilation
Address, C., _ J Rarj�e hood/other kitchen
51 w� .l.P.( ) 5 - ,e x JD r equ men) 3339
city /atCity/State/ZIP 2 ✓ d ( o p q 7 a 1 � Clothes t es d er exhaust — 33 39
Simile exexhaust t (bathrooms,
Phone L5Oj) ,_ Fax: t 1 toilet compartments, utility rooms) 23.32
1 4' '�aa,,u�,[[ tali q' I 11;rr,if� '✓r / Imam x qq�pp p
� i ' ';v p;.•:„„W • , :47 .i „.,: a 'Id g f li : i .:)i' � ;q9i " s Ante/3.45p= funs 2
Business name: Other 2 32
Fuel piplag
Contact name. , (.!✓ Y Svyt'ili ! /t i t • Pas - I 514.15 for first four, S4 93 for each additional
Address '
I L F u�ace, etc I t
Gaslicat pump '
City /State/ZIP: _ Wad/suspended/unit heater
Phone, ( ) I Fax• • ( ) Water neater 1;
Fireplace
E -mail: D -
Rat / �- '�
, ;l , y • c, t . hy q it 4$ � I o 11 }",dI � p
IkntftiliNMO.+ a, � I '..rl ' , .w�ev�a�Z�S� s Yf1++ ' ''
J`F'ox ' j . .�,'�'�41�RN': °Id��S°. J. Bar4c'000
Business name: _ / t 4,t j c tit o A J ) / 0 Other
;
Clotnes dryer (gas)
Address. e/ / ( ks )c-, ' if "J ' ' 'i.- ° S " + r wro';
l a
City/State/ZIP: ) )/l / Subtota 'I
Phone: ) toaO _ &51 1 Fax ( w •— Mb Plan renew permit tee rmit fee' ef'D
P lan review(25% ofpermd feel
CCB ire -: /&7 S 1 U aC( /�/ 1 State surrharpe (12 %of pemtu fee;i //) MD
/ I I TOTAL PERMIT PEE agi
Author' Thi4 permit application expires du permit as not obit fined within ISO
d ays after it has been accented as comp /tic �y
Print name: t (+,/ I in (pp J Dale / (} // (// , 9 • P ✓ , IC methodology t el b y To-CCounty Building Industry Senn1 Rid 1„
( I L(/� t
I NaddtngWcrmttt)MLOPcrmn App4oe l OMAN 450- 46i7r(11I01CON/WEB)