Permit CITY OF TIGARD MECHANICAL PERMIT
11
COMMUNITY DEVELOPMENT Permit #: MEC2012 00332
T [ G A D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
Parcel: 2S 111 CC21200
Jurisdiction: Tigard
Site address: 10240 SW GREENLEAF TER
Project: Wright Subdivision: SUMMERFIELD NO.5 Lot: 270
Project Description: (1) gas line for stove
Contractor: A & D PLUMBING Owner: WRIGHT
PO BOX 57 10240 SW GREENLEAF TERRACE
TROUTDALE, OR 97060 TIGARD, OR 97224
PHONE: 971 - 275 -2751 PHONE:
FAX: 503 - 674 -9625
FEES
Specifics: Description Date Amount
Range Hood /Other Kitchen 06/28/2012 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 06/28/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/28/2012 $56.61
Occupancy Grp:
Stories:
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 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. / �J /�► r
Issued By: ` �A e T Permittee Signature: O / � A - "PL /�� C 4 1 I DkL
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.
Jun 27 12 03:42p A &D Plumbing 5036749625 p.1
Mechanical Permit ApplicatioaCE '� FOR OFFICE USE ON Ll
City of T i g a r d t � n s e r e Permit N°: R e cola A. 0033
125 SW Hall Blvd., Tigard, OR 97223 J 1. N z 7 2012 Plan Review
' l 3
2 Phone: 503.718.2439 Fax: 503.598.1960
7F py�T oatarey. Other l'ettnil _ ,.‘ �• •
T I GA R D Inspection Line: 503.639.4175 CITY ( >* TIGARD Date Ready/By: ta' ' Q Su Bl ge 2 tar
Internet www.tigard or.gor BUILDING DIVISION Notified/Method:
hod: (pplemental lotormatiao
TYPE OF WORK I COMMERCIAL FEE• SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ddition/alteration/replacement I performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: 1 mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES"
and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use dtecUisL
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. I Total
' JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: (requires site plan showing placement) 46.75
CitylStatelZlP: J Furnace 100,000 BTU (ducts/vems) 46.75
�' (/ Furnace 100,000+ BTU (ducts/vmts) 54.91
Suite/bldg. /apt. no.: / Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic 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
Subdivision: Lot no.: Fluelvent for any of above 23.32
Other: 1 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
��jj � l/yL I� , ti Gas fireplace/insert ent for 33.39
' /'f' � � / 79-5 � Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/linedflue/vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Phone: ( ) Far ( ) tm
Single-duct exhaust (bathrooms, toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Other 23.32
Fuel piping:
Contact name: $14.15 for first roor, 54.03 for each additional_
Address: Furnace, etc.
Gas heat pump
Cityi 5tate'ZIP:
Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
1 Fireplace
E-mail: ail: Range I I'{1S )\3
CONTRACTOR Barbecue
Business name: ti 1 )K� Clothes dryer (gas)
� Other:
L.>
Address: Po n X .5 MECHANICAL PERMIT FEES"
City/State2IP: l c e , 9 706,0_ Subtotal i q _ S
-7
lu �r / Minimum permit fee ($90.00) C
Phone: ( 9 71 d 7 S - 2 Fax: �D ? ) f,74../ /6,25
b Plan review (25% of permit fee)
CCB lie.: / O of f ' 7 ,1 0 1 1 . State surcharge (12% of permit fee) • S (>
TOTAL PERMIT FEE t ()Da /
Authorized SlgnaLure This permit application expires if a permit is not obtained within IBIS
days after it has been accepted as complete.
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