Permit n CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00519
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/10/2012
Parcel: 1 S 134CA00110
Jurisdiction: Tigard
Site address: 11555 SW TIMOTHY PL
Project: Fromme Subdivision: WOODBURY LANE Lot: 7
Project Description: Installation of gas line and gas insert
Contractor: T & K MECHANICAL Owner: FROMME, SEAN
PO BOX 116 11555 SW TIMOTHY LN
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503 - 844 -9173 PHONE' 503 - 807 -9099
FAX: 503 - 846 -0195
FEES
Specifics: Description Date Amount
Gas Fireplace 10/10/2012 $33.39
Type of Use: SF Fuel Piping 10/10/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/10/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 10/10/2012 $42.46
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, or • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N ''cation Cente Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or dire questions to OUNC Ilin 503 232 1987 or 1.800.332 2344.
•
Issue By: Permittee Sig ature: i? f' Jc -
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.
10/09/2012 11:31 5036269138 HOT SPOT FIREPLACE PAGE 02/02
Mechanical ermit APPlicaho ► E: >, , ,,: ► . ► , ► ► 1
City of Tigard , Permit No.:
13125 SW Bali Blv, Tigard, OR 97223 0 C T 0 9 2012 P t o '! J,
Phone: 503. 2439 Fax 503598.1960 O Other Permrt
on Linc: 503.639.4175 A fl W
1 ! , , r 1'. I :: t i CITY VT T I f�1 Due Read//By: • S1 pt P 2 for
Intern Internet www.tigard - Notified/Method: &ma meacat t tstf oformsbaa
BUILDING DIVISION
-
TYPE OF WORK COMMERCIAL ME" SCOEDULE - 118E CHECKLIST
0 New constriction Addition/alteration/replacement laexmlent Mechanical permit foes' are based on the value a the work
feP performed- Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other mechanical materials, equipment, tabor, overhead, and profit
Value: $
CATEGORY OF CONSTRUCTION Rai ,SIDIRMA)LEQUIplllFRr / swims rm.
I and 2 fanaiily dwelling [] Cottstnerciallindustrial ❑ Accessory building F or special i at,«mrmt use dual&
El Multifamily ❑ Master builder 0 Other Description _ L Qty- I Ea. I Total _
JOB SITE INFORMATION AM) LOCATION flea , moll „ _:
— , Air conditioning
Job site adders: / / 5's S�'l e� ' / I ifyjorkei ral &glum site plan showing elsormcnt) 46.75
City/State/ZIP: ��� _ Furnace t I 1 000 BTU 46.75
• ,.e Furnace 100,000+ BTU (Aass/vet* 54.91
Suite/bldg./apt no.: Project name: Bean pump
(requires site plan showoag placement) 61.06
Cross street/directions to job site: Duct work 23.32
dmnic hot water system 2332
Residential boiler (radiator or
hydronic) 2332
Unit heaters (fite4type, not electric),
in-wail, hi ,,, . • , : etc. 46.75
Subdivision: I It no.: _ Flue/vent for any of above 23.32
Other 2332
Tax map/parcel no.: Other furl appliances:
DESCRIPTION OF WORK Water heater 23.32
L ( . t ._ a ]� , 1 V 2 Gas v - , 3339
l2LJ Flue vein for water heater or gas aim
/ ...lace
1', ter _ 2332 MN
Wood/pellet stove E nil INTIM=
Wood fireplaorlmsett Mil 2332 Mil
C,f1 . /liner/flue/vent 1P> »4 `T'3
. PROPER'T'Y OWNER ❑ TENANT Otlxx 23.32
Name: • ■ L/ a Environmental exhaust and ventilation:
Address: j i I A r • A - / Range hood/other kitchen
equipment 3339
City /State/ZIP: [ I 1 t D. cr1) -� Clothes dryer exhaust _ 33.39
Single -duct exhaust (bathroom,
Pima: j)3) )t7 /; rq y Fax ( ) toilet compartment utility moms) 2332
XAPPLIMNI t 0 CONTACT PERSON Attic/crawlspag tans 2332
Business name: SS� f(1/t P od 23.32
Contact name: � ' ti J2 514.15 for fast fber; $4.03 (breach addlttomt
Address: // 5.25' s►,_ „9.4 1 Furoace, etc.
Gas heat pomp
City/State/ZIP: a , • _ ' 11 . Oe q 7aD5 WadUsuspmded/unitheater ,
Phon
e :. 3 ) (pa t i.. (d Fa ( ) l - '7138 Writer heater
rmail: ►� $ Q�i o # vu pla t P ® h - w 1 . f0
Fireplace � . 1111111
_ CONTRACTOR Barbecue NM
Business name: - 1:4-K t-le ,"v t e.•0 - Clothes ,, et _ �
Other
Address: lb $O.6 1 l SO MECHANICAL PERMIT FEE$
Ciy /State ZIP: F , -G,, p a- 4 1 - 11 _ sebeotal l
Phone: ( ) l Fax: ( ) Minimum permit fee ($ -- •
Plan review (25%ofpermit f
CCB lie.: i a u b6 Stale surcharge (12% of pariah fee) to
TOTAL PERMIT FEE I /Oa . :vat
A u t h o r i z e d si . u. , , , ` , A - . 4 T i s t e r M i k a d o d a permit a u I
not obtained wet SO
days after ft his bees ereeptai es complete.
Print name: , , ,n e : , Date$ /e 7 AMI • Fee methodology set by MU-County Building lodusty Strike Board vt ......f.c...ao_......mege •s....,an !,. n alrl2 940-4617T (r r/OM:OM/WM