Permit y ,, CITY OF TIGARD MECHANICAL PERMIT
` ' . I ; COMMUNITY DEVELOPMENT Permit #: MEC2011 -00591
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2011
Parcel: 2S103ACO3900
Jurisdiction: Tigard
Site address: 12578 SW 114TH TER
Project: Stephens Subdivision: WALNUT GROVE Lot: 8
Project Description: Install gas stove to existing gas line.
Contractor: TOM BISHOP CONSTRUCTION Owner: STEPHENS, GAIL 0 & JAMES F
4578 SE 103RD AVE 12578 SW 114TH TERR
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 644 -7868 PHONE:
FAX: 503 - 626 -9138
FEES
Specifics: Description Date Amount
Gas Fireplace 12/21/2011 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 12/21/2011 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12% State Surcharge - Mechanical 12/21/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 12/21/2011 $33.29
Fuel
Fuel Types: Natural Gas .
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct s - io o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued %y: / / Permittee Signat re: , 0;1,, �J/ / _____,
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
12/20/2011 17:41 50362691338 HOT SPOT FIREPLACE PAGE 02/02
Mechanical Perm A,npIlc CEIVED 1:r)1, 0 . 1 . R. i. '41: ( ) \ 1 . 1
City o f Tigard I';. 1:; +) 0 2011 / pf ,e0 M lrernitNo.: /Vie ,/ 57
y am' 13125 Sw Ball Blvd., Tigard, OR 97273 Plan Review
- _1c� Phone: 503.639.4J7i Fax; 503.598.1g�p� ma y _ Other Permit
1, ; A �; � 1
� Inspection Line: 503.639.4175 ,' l l'Y OF TIGARD
Intoned www.tigerd or.gov ; t f) I N r � Ready /Br la See rage 3 ror
O D, V ISIO N Noti$raUMelhad! snpplerneatal Information
TYPE OF WORK COMMERCIAL IEEE* sCI RULE -- USE CHECKLIST
❑ New construction. , Addition/alteration/replacement Mechanical permit fees arc based on the value of the work
performed. lodicate the value (rounded to the nearest dollar) of all
O Demolition Cl Other: mechanical materials, equipment, labor overhead, and profit.
_
CATEGORY OF CONSTRUCTION Value: $
Pki 1 - and 2 - farpul dwelling RESIDENTIAL L EQUIPMENT / SYSTEMS FEES*
$*
Y g 0 Commercial/industrial [] Accessory building --- --
❑ Multi - family ID Master builder El Other:
For special information use checklist.
Description Qt E a. Total
JOB SUE INFORMATION AND LOCATION Heatingfcooliog
-
lob site address: ' J Air conditioning
S 7 8 �� 1 N �l t QTY, &e �- (remdres site plan showing placenaept) 46.75
City /State/ZIP: • Cl 0 ✓ fl as 3 Furnace 100 000 BTU ducts/vents 46.75
Suite/bldg./apt
- a Furnace 100,000+ uctsNcnts BTU (d 54.91
8 ap
no.: Project name: - Z -
"' - - 1.0
Ite �t PAP 6
Cross street/directions to job site: Duct work _ _ 23.32
Hydronic hot water system 23.32
- - Residential boiler (radiator or
hydranic) 23.32
- Unit heaters (fuel-type, not electric),
in -wall in-d sus od etc 46.75
Subdivision; --- I Lot Flue/vent for any of above 23.32
. - Other: 23 32
Tax map/parcel no.; _ Other fue appliances
DESCRIPTION OF WORK Watencnater 23.32
I VI, . ♦ $�i'� eI 33.39
rr� -. t to 4.. . Fl vent for water heater or gas
/ 1!ilwftiaau- ) 0-9— I 23 -32
Log lighter (gas) 23.32
•
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
PROPERTY OWNER El TENANT
Chimney/liner/Due/vent 73 -32
f Other. 23.32
Name:
. I i 1M Si-e eilev1„3 Environmental exhaust and ventilation
� r Range hood/otherkitchen
Address:
I Gt 5 54-0 � ,
I / t, 1 e y- Ir a c -Qti , c ui ment _ _ 33.39
City/State/ZIP: -T i Cl Q , + 0 v qi i. 3 Clothes dryer exhaust 3139
Single -duct exhaust (bathrooms,
Phone: ( ' ) Fax: ( ) toilet comparunents, utility rooms) - 23.32
►i APPLICANT El CONTACT PERSON Attic/crawlspaccfans _ 23.32
Business name: / Other: 23.32
• J� op„ +P I /Q( __ — Fuel piping
Contact name; to /, , 11 $14.15 for first four; $4.03 for each additional
Address: "� l Furnace etc.
Address: �, S+ i tJ �( Vl c� 0 L
�� Gas cheat pump
Cit /State/ZIp:.- pa 0 e a 1 �7
J' Y"� f l p ! Walllsuspendedh,nit beater
Phone: 60 , . -46 Fax:: ) T/ 38 Water heater
jj 11 r Fireplace
E -mail: 1 QT ,5 pal C i , ( . p p la c d ) FAO f W V ? i 1- cO Y Range
CONTRACTOR Barbecue
Business name: - i t , - I- 5 No t C-1 e1 r /.(t.. , I I 14 Clothes dryer (gas)
Other: •
Address: 3
_ i r % / 0 k i _ MECHANICAL PE
ff City /State/ZIP: , ea ,.).6 i . v „. i D I„ D OS . . Subtotal 5/,7J
Phone: (9)3)/ ti ii, 7 y6, S.- I Fax: ( ) Minimum permit ($90 - qQ F
_ Plan review (25% ofpennit fee)
ecB rte.; i' 5 7 7 / J �- State su (12% of Permit fee) /D W
TOTAL PERMIT FEE O O
Authorized sign / This permit application expires if a permit is not ebeZied within 180
• F.0_, �� t.•rI dons after It has been accepted as templet&
Print name: �� t? ��.1 re ate; p // • Fos methodology set by r�i County Building Industry Service Board
1 :1BuiWingTermitt 11 ; ac 10i01/Qy 440-4617T(I1/07FCOMIWEB)