Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2012 -00472
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/13/2012
T[ G A. Et. D 9 Parcel: 1 S 134DB01400
Jurisdiction: Tigard
Site address: 11060 SW 115TH AVE
Project: Martinsen Subdivision: WINTERS ADDITION Lot: 6
Project Description: (1) fuel piping for clothes dryer
Contractor: TRI COUNTY TEMP CONTROL INC Owner: MARTINSEN, CHRIS
13150 S CLACKAMAS RIVER DR 11060 SW 115TH AVE
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE: 971- 570 -1188
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Fuel Piping 09/13/2012 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 09/13/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/13/2012 $75.85
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.
Issued By: 4)j Permittee Signature: PPU -noki
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.
Mechanical Permit Analicati ` l Ftlll tltrl( 1_ t 51: ILI,1
City Tigard Dat of Ti and r ? ILA ° 1
-• ' Dot ve e/By. Q t I II2„.., Permit No.:u i 12• Day 1 L
13125 SW Hall Blvd., Tigard, OR 97223 S E P 1 3 2 012 Plan Review Other Pencil:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: -
I t c: ,nun tnspection Line: 503.639.4175 Date Ready /By: Ms, RI See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: r f ip Supplemental Information
13L411 nI IG ! /'uf-O
TYPE OF WOR COMMERCIAL FEE* SCHEDULE — USE - CHECKLIST
CI New construction ® Addition/alteration/replttcement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar). of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. _
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
IS I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building . For special tajnnnartoa use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description _ I Qty- � Ea. I Total
JOB SITE 6‘11 IIN FORMA
�� LOCATION Heating/cooling
Job site address: 11060 115t -ti �pV'III V , (req conditioning
site plan showing placement) 46.75
City / State/ZIP: 7Qr't''l�d Olt C y T l 3 Furnace 100,000 BTU (duets/vents) 46.75
Furnace 100,000+ BTU (duels/vents) 54.91
Suite/bldgJapt. no.: I Project name: Hent pump 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: ' l Lot no.: Flue/vent for any of above 23.32
Other: 23.32 _
Tax map /parcel no.: • Other fuel appliances
DESCRIPTION OF WORK Water heater 2332
�. , ) O 6 n Gas fireplace 33.39
gab Flue fireplace
for writer heater or gas
• fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/inscrt 23.32
�p OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
J°1 A,. Other: 23,32
Name: C.11115 Ma h Environmental exhaust and ventilation
Address:
Range equipment kitchen
equpment 33.39
City/Slate/ZIP: Clothes dryer exhaust 33.39 , —
(411 ) F'1Z0 I It� Single-duct rt exhaust (ua s.
Phone: Fax: ( ) toilet t compartments, artrnents , utility rooms) oms ) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: Same as contractor Fuel piping
Contact name: 'Diane Mason $14.15 for first four; $4.03 for each additional
Furnace, etc. •
Address:
Gas heat pump ,
City/State/ZIP: Wall/suspended/unit heater •
Phone: ( ) I Fax: : ( ) Water heater Fireplace ,
E -mail: Range
CONTRACTOR Barbecue
Business name: Tri County Temp Control Clothes dryer (gas) l
Other.
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES*
•
City /State/ZIP: Oregon City, OR 97045 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 557 2220 I Fax: (503) 557.0919 Plan review (25% of permit fee)
CCB lie.: 72623 State surcharge (12% of permit fee) Ian a 0
TOTAL PERMIT FEE ` �
T his permit application es titres if a permit Is not obtained within 180
Authorized signature: d ays after It bas been accepted as complete.
Print name: ict 1V ma on I Date: R 11 Ill.., I ' Fee methodology set by Tri- County Building industry Service Board
I. Vauildina \Patmit.\MBC- PermuApp.doe 10/01/09 440.46177 (I I/OLCOM/Waa)
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