Permit n CITY OF TIGARD MECHANICAL PERMIT
H COMMUNITY DEVELOPMENT Permit #: MEC2013 -00036
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/22/2013
Parcel: 2S114BD00700
Jurisdiction: Tigard
Site address: 9995 SW RIVERWOOD LN •
Project: Miller Subdivision: PICK'S LANDING NO.2 Lot: 81
Project Description: (1) gas fireplace installation and (1) fuel piping for fireplace
Contractor: EVERGREEN GAS INC. Owner: MILLER, JULIA G
PO BOX 388 9995 SW RIVERWOOD LANE
WEST LINN, OR 97068 TIGARD, OR 97224
PHONE: 503 -407 -9542 PHONE: 503 - 684 -4463
FAX: 503 - 344 -6345
FEES
Specifics: • Description Date Amount
Gas Fireplace 01/22/2013 $33.39
Type of Use: SF Fuel Piping 01/22/2013 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 01/22/2013 $10.80
•
Occupancy Grp: Minimum Fee Adjustment - Mechanical 01/22/2013 $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.
A
Issued By: f J A di/ Q Permittee Signature: 0113 J-PPL ��� � v' Call 5 03.6 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.
JAN -18 -2013 05:13 FROM: TO: 5035981960 P.2
Mechanical Permit Applicatio 11e 11 t 11 I I , I
.. city of Tigard - , Pest. tto.., ( 1. A i 3 -Jq'1 o •
l • 13135 SW Hall Blvd, Tigard, OR 97223 E C E IV EIL p . pew
Phone: 503.639.4171 Fu: 303.598.1960 Dtlday Other Pcmat.
I I ; , , ,, i , Inspection Line: 503.639.4175 JAN 2 2 2013 orc Ra.d er• , (O BStipp See Pale
aat t �raraatlar
Internet: www.tlgard-or.gov Notified/Method:
CITY of TI(ACD, •
T YPE OP WO 0111 DING DIVISION- L1 plMMp3tt~Il1L' � • t3CNED1fLfi = U a il rc itl '
❑ N ew construction I Go.Jaltelad � t i I L pleoanrnt Mechanical permit tees• are based on the value of the wick
peribrined Indicate the value (rounded to the nearest dollar) of a0
❑ Demolition 'L.I Other: mechanical mattaials, equipment, tabor, overhead. and profit
CATE(.ORY OF CONS IUJC1YON Value: S
• RESIDENTIAL EQUIPMENT / $YSI0MS PEES' .
and 2-family dwelling ❑ Commercial/industrial CI buildln Accessory building For special bp'meratbbn tine cherA
Multi - family ❑ Master builder ❑ Other: ' Description 1 QIR I Es. I Total
VititsillTIONkIRMATION 'AND LOCATION ' } Natiyreoofoe
j A ir conditioning or hat pump Job site address: L 4-) _ i�t(V Gr �( I Oemdr site plan shouts dampen) 14.00 , _
City/Smte2iP: /w �. / f' � 7Z Z
Ftlmaeo 100.000 BTU (duds/mats) s) 14.00
• f Pumaee (00.(to06TU edowA 17,90
Suite/bldg /apt no.: Project name: Gas hat pump 14.00
Crass street/directions to job site: Duct work 14.00
r Hydronie hot water sntem 14.00 ,
._ Reaidandal boiler (mdietorerr
- I Wrestle) 14.00
Unit haters (Otebtypo, not dextrin).
/ in -wall. in-drct, suspended. etc. 10.00
-
• Flue/vent for any of above 10.00
Subdivision: Other, 10.00
w
Lot no.:
Tax map/pnrccl no.: Other fled eppllaneea _
• .. ., •.ir ' ?:;.DLLSCRIPTLOM OF WORK . "'' ' .r -i W a t er heater l . 10:00
:. .: •' .i� b r 10.00
1 i5i 4 . 6 7 s Li 14C.. IA .4 Loy Flueventforr water hotter orgas t I. 10.00
rr ,,,J fireplace
S 8.1 Lan tighter (tern) , ' 10,00
Woodlpdkt stove 10.00
W ood fireplace inset 10.00
Chimnev/liner /Onelvan I0.00 _
` �ry; ai QT�t1: UWNER "'r" "Y'• .,i . . 0"'TENANT Other: IQ.QO
Nam,, 1 :) , rnA / U _
es E vtroemee1al cabalist and ventilation
Addra : v � // 5 5 r ' ( Y �. L �/�(f � �d
W
pm ent hood/ether kitchen
10.00
City/State/ZIP: T Cf 7 Z r Clotho deter exhaust 10.00
_ Sieale4uci exhaust (bedrooms
Piton ip vy.. L �( Fax:( ) toilet comNe eats utility rte) 6.80
" " Altivaewls0ae 8ma 1000
I:a •t1 Aite(QAK1+. •r 0 CONTACT Papaw •• • •
Other: _ 10.00
Business name: .
Feel IPID[atl
Contact name: 53.401ljr BM /bar•. $1.00 for each pddltioaai
Furnace. etc. ,
Address: oas heal numa
City/State/ZIP: , Wall/suspended/unit hater
Phone: ( ) I Fax:: ( water hater
Fireplace I
E-mail: e _
f 1..,, 1 : .l. X400 croR .. ashcan
6.4r T pothn drys (t�s
BWirte s name: �f/ fC`h c yy L Other
a j) {..
Address: (0 3 6 6 elgf�C ;1lb11e,►1:PER1Nt�°iNEESR r ��" _
City/StaterzzP: mit S r� s- D t 7D G 0 Subtotal
3 y� - �s �Z 1 3 3 1- aumbm permit �)
Phone Fax: ( ) t na a nimu (1591 of [t fee)
CCB lie.: Stain surcharge (844 of permit fa)
It TOTAL PERMIT REE /JO -
711, p..•U.ppUeaal.s *pare -if a permit h ad obtained within 110
Authorized signature: heat hte.
, days after It has he tempted ea cemp
CM=W R / i Dt figs Dale: Lv . Fee meltmdclo6y act by Te - Cmeay Balding Industry Seruloe Bond
I. suitdepp .7oimtMac.hmltApp4oa 44 61 (II •• , ..