Permit CITY OF TIGARD MECHANICAL PERMIT
I N s COMMUNITY DEVELOPMENT Permit #: MEC2012 -00460
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/10/2012
Parcel: 2S109DA04200
Jurisdiction: Tigard
Site address: 12798 SW WILLOW POINT LN
Project: Nasser Subdivision: SUMMIT RIDGE Lot: 19
Project Description: Installation of gas line for outdoor fireplace.
Contractor: CORNERSTONE HARDSCAPE INC Owner: NASSER, MICHAEL S & KIMARIE I C
8700 SW YAKIMA CT 12798 SW WILLOW POINT LN
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -6542 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 09/10/2012 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 09/10/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/10/2012 $75.85
Occupancy Grp:
Stories:
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 • if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otificatio enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or --erect questions to . NC • • • .fling 503.232.1987 or 1.800.332.2344. ,
I sued By: � • /,/,, 4 Permittee Sign= � /
Call 503.639.4175 by 7:00 a.m. for the next available inspe '•n 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.
Sep 06 12 09:30a Cornerstone Hardscapes • 5036128612 p.2 -
• ;III
Mechanical Permit Applicatio ECV FOR OFFICE (.SL ONLY
City of Tigard. ' Eteccirai e Q G t A , % Permit No.: kit e o /? ve9 60
" 13125 SW Half Blvd., Tigard, OR 97223 SEP 0 2012
• 111111 Plan Review Other Permit: Phone: 503:718.2439 Fax: 503.598.1960 . D
T I G AR D .Irispettion Line: 503.639.41 75 C • r- T 1 D Date Ready/13y: Iris: B Sec Page 2 for
Internet www.tigard- or.gov BUILDING DtVJS No Notified/Method: Sepplermhal Information
TYPE OF WORK COMMERCIAL FEE' SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
[] New construction XAddition /alteratiofl/replaceme nt performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: Mechanical materials, equipment, labolor, ) overhead, and profit
CATEGORY OF CONSTRUCTION Value: $1�l � 7r+� L'i
RESIDENTIAL EQUIPMENT /SYSTEMS FEES'
E gli- 4 and 2- family dwelling ❑ Commercialtindustrial ❑ Accessory building Fee special Informofton use checklist
❑ Multi- family El Master builder ❑ Other: Description Qty Ea Total
JOB SITE INFORMATION AND LOCAL • N Heating/cooling:
•
An conditioning
Job site address: � . ` ' ' (requires site plan s1wieg,pfacemcntl 46.75
Furnace 100,000 BTU (ductshente) 46.75
■i ljf [y t� �j Furnace 100,000+ BTU (duaswents) 54.91
- Suitc/bldgJapt. no.: Project name: as>r Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 2.3.32
Hydronie 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: I Lot no.: Flue /vent for any of above 23.32
Other: _ 23.32
, 0 Tax map /parcel no.: Other fud appliances:
• DESCRIPTION OF WORK Water heater 23.32 -
• -r^ Cif '. &v^d )(1 _ ,� t • , ,,\ r 11/ ^. Gas f ximset 33.39 gas }� ` i l 7 V f f r , Flue vent ent for water heater or
ek l _4 t _ . it 1 /A •
L, A liri..i1 1 I • ib a fireplac 2332
Log lighter (gas) 23.32
t I / i I,ift Wood/pellet stove 3339
4 . Wood fireplace/insert 2332
d - . )6 PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32 •
• r� IJG� 1 other 23.32
. .
are: �.1 1 Vi ' / Environmental exhaust and ventilation: •
Address: ' � ` f ]� � s 1 /� Range hood/hood/other kitchen
�� j t r• _ 1C ` 1 � {��` (� 11 '�C I / t� f L.U►.u�� equipment 3339
O City /State/LIP: e j `• l q 4 Clothes dryer exhaust 3339 .
J A w' Single -duct exhaust (bathrooms,
li fl Phone: ( ) Fax: ( ) toik:t compartments, utility rooms) 23.32
?if APPLICANT
+� /� , �❑ y CONTACT PERSON Attic/craw'Ispace fans 2332
Business Herne l rUi nP l fJ Q,�('l L{ C C t I I lt_ F 2332
1 Fuel el piping
Contact name: �' 1 �� ,�(� ����/" 514.15 for first four; 54.03 for each additional
Furnace, etc.
- i Address: ii; �i �� Gas heat pump �' .
City /StatelZIP: (�{ /J J 41 n ( � Q � Wall/suspe�rtded/ttnit heater
Phone: ( _ .' t ' Z . + Fax:: ( ) Water heater I ,
71 l � Y t � l "" ram' el� /► t/,/ L � ' � . 1 j1 q.ic 1 •IC
- ail: 1 v 5 f vwdsa� • t`em Range
i Etr
i l CONTRACTOR -Barbcctte -
Q • Business name: Clothes dryer (gas) -
• J Other: '
O( Address: MECHANICAL PERMIT FEES"
Gy ' City /State/ZIP: • . Subtotal Lg. Is--- d Minimum permit fee (590.00) 1 J
2 . Phone:'( ) 1 Fax: ( ) Plan review (25%of permit fee) ....--•
• CCB lie.: l' / ' 4, y p-- State surcharge (12% of permit fee) M. 8O
41 TOTAL PERMIT FEE /00, W
Authorized si attme: ~ This permit application spires if a permit is not obtained within ISO
• -� 4 , 'days atter it has been accepted as complete.
c Print name: ,ems _ (A/ I Date: ClJtol1 Z I - Fee methodology set by Tri- Cooney Building Industry Service Board .
p .........._,
I IBwldinyTermiistMGC- PenmtApp. • . 03101/12 4413-3617T (I IN2MOM WEa)