Permit CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00637
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2012
Parcel: 2S104CA03900
Jurisdiction: Tigard
Site address: 13645 SW MICHELLE CT
Project: Turpen • Subdivision: HILLSHIRE Lot: 39
Project Description: (1) gas fireplace insert, (1) gas line extension
Contractor: NW GAS LINES Owner: TURPEN, MITCH J & CARLENE M
16731 NE WASCO ST 13645 SW MICHELLE CT
PORTLAND, OR 97230 TIGARD, OR 97223
PHONE: 503 - 256 -2436 PHONE: 503 - 590 -2554
FAX: 503 - 256 -2245
FEES
Specifics: Description . Date Amount
Gas Fireplace 12/05/2012 $33.39
Type of Use: SF Fuel Piping 12/05/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/05/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/05/2012 $42.46
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: Stail Ol' K(f Permittee Signature: o A-PP C r70 �
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.
Dec 0512 10:17a Toriy Young . 503- 256 -2245 p.2
• Mechanical Permit Application FOR OFFICE USE ONLY
. . Received • 6" ( � adj�: ..e063
II - City of Tigard • Date/By: Permit No.: a R.
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.7182439 Fax: 503.598.1960 DatcIBy: Other Permit
TI G A R r�
Inspection Line: 503.639 Date Ready/By: Lau: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: i fp Supplementallnformation
TYPE OF WORK COMMERCIAL FEE" SCHEDULE — USE CHECKLIST
Mechanical permit fees" are based on the value of the work
❑ New construction ddition/alteration/replactment performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other mechanical materials, equipment, labor, overhead, and profit.
Value: S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
[ and 2- family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
[�{ Multi-family ❑ Master builder 0 Other: Description I Qty. I Ea. I Total
JOB SITE LNFORMATION AND LOCATION Hearing/cooling:
_ � / ' - Air conditioning
W
Job site address: /0 � ` S L�� / e ls e (requires site plan showing placement) 46.75
City /State/ZIP: -� J / / v 9 � / � ! ` . 3 4 3 I L lie `/ Furnace 100,000 B ( ( 54.91
- Furnace I00,000t BTU (ducts/vents) 51.9E
Suite/bldglapt. 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 Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32 •
.�, /, C Gas fireplace'insert / , 33.39
U
(.. �2 11 r Gt 5 ch J /0c5 (1,//5 5 // f, Se Hue 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 . ❑ TENANT Chimney /liner /Rue/vent 23.32
• Other: 23.32
Name: 7 i I �( , Environmental exhaust and ventilation:
Address: / Range,hood/other kitchen
S 11,#/4-• equipment 33.39
City /State/ZIP: Clothes dryer exhaust 1 33.39
Phone: ( ) 5 7 — Z 5 S / Fax: ( ) toiler
Singe-duct exhaust t s (bathrooms, o I
toilet compartments, utility rooms) 23.32
' JAPPLICANT CONTACT PERSON Attic/crawlspace fans 23.32
Business name: , j/ . / 1 p ' / ,, r l (/1/ � e S
Other: 23.32
!''✓ d7'Iy �! ►�r,j'�1V1 � (/,r� /vi" Fuel piping:
' 7 y
Contact name: y La xm 4 $14.15 for first four: 50.03 for each additional
Address: / , 73 /, " J/ . !/, & o ✓ ` �� 1% - Furnace etc.
` �Y N Gas heat pump
City / State/ZIP: W all/suspended/unit heater
Q ✓� /ate l ✓ .
, Phone: 673) o & ,_,,,,A L I Fax: : () 5/ 1,5...... Water heater
E -mail: f ^ ��1,, t�1 Fireplace /
�t`� ( 1JI�el � S 6 Ga� . //c� Range
CONTRACTOR Barbecue
Business name: /( y 6 &3 / �.e ..S Clothes dryer (gas)
/ 6! [ �7 Other
• Address: /,73/ /V /ir/QtSL�:v \S"—T-., / 23 MECHANICAL PERMIT FEES'
•
City / State/ZIP: Subtotal
Phone: (67, a 5Z, -- /3 fax: (j / — p /� ' i Minimum permit fee (590.00) `�0, t
V(.� -� ��lD L Plan review (25% of permit fee)
•
CCB lie.: /5Z/ )L/ 8- [ State surcharge (12% of permit fee) l O • 1
/� /�� I � n1 U
TOTALPERMsT ��
Authorized signat `' r' 6 't� r.�Z fj J Thus permit application permit if a pmit is not obtained xilbiu 180
days after it has been accepted as complete.
Print name: ,` ptty Date /� / G ., — • Fee methodology set by Tri- County Building Industry Service Board
l :\BuadiagtPvmiulMaC- PemiAp ?doe 03/07/1Z 44D-461 ( I I.NZJCOIWWEo) '