Permit 74 . `� : :. CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC201300121
Date Issued: 03/05/2013 .
13125 SW H all Blvd., Tigard OR 97223 503.718.2439
T1G1fiRD g Parcel: 2S 111 C600500
. . Jurisdiction: Tigard
• Site address: 14805 SW 103RD AVE
Project: Munhall Subdivision: DEL MONTE SUBDIVISION Lot: 4
Project Description: Install gas insert, venting and gas piping.
Contractor: EVERGREEN GAS INC. Owner: MUNHALL, JEAN
PO BOX 388 14805 SW 103RD AVE
WEST LINN, OR 97068 TIGARD, OR 97224
PHONE: 503 - 407 -9542 PHONE: 503 - 620 -6330
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Flue Vent for Water Heater or Gas 03/05/2013 $23.32
Type of Use: SF Fireplace
Class of Work: ALT Type of Const: Wood Fireplace /Insert 03/05/2013 $23.32
Occupancy Grp: Fuel Piping 03/05/2013 $14.15 .
Stories: 12% State Surcharge - Mechanical 03/05/2013 $10.80
Minimum Fee Adjustment - Mechanical 03/05/2013 $29.21
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 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: Permittee Signature:
,/‘/ /f'J " ^
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.
MAR-3-2013 10:53 FROM:
1 TO: 5035981960 P.1
CE i.01(01.1.1( I. I 'I ONI.
Mechanical Per A lication .7e cei ved 3® -� PermitNoHgr� /3 ii 2
DatelBy:
City of Tigard OR 97223 ` A , Plan Review Other Permit:
Illi 13125 503.718.243 Hall Blvd., Tigard, Ptl 4 L U 1 Dat Re en BI See Page 2 for
■ Phone: 503.718.2439 Fax: 503.598.1960 Date ReadyBy: Supplemental Infotm
In tern e t n Line: 503.639.4175 C ITY F TiG , s '! ottfed&Method:
I I • n 1c i� atton
Internet www.tigard-or.gov ! ` COMMERCIAL FEE* SCHEDULE - USE CHE CICIAST
TYPE OF WORK Mechanical permit fees' are based on the value of the work
rformed. Indicate the value (rounded to the nearest dollar) of all
CI New New constructionddition /alteration/replacement mechanical materials a i.men labor overhead, and .rofit
❑ ❑ Other: Demolition RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
CATEGORY OF CONSTRUCTION For special Information us kl Total
Accessory building •
:�-' and 2- family dwelling ❑Commercial /industrial ❑
■Multi - family Description
❑ Master builder ❑ Other: H A conditioning
g, eoolln:: 1111,111111111111 JOB SITE INFORMATION AND LOCATION f ir irn site ten ehovrin± •Iacement _� �
• —� Furnace 100 000 BTU ducts/vents _ 54.91
Job site address / + Furnace 100 000+ BTU cruets/vents 11111 la Heat pump 61.06
Project name: wires site fan showin: lacemen _�
Cross _ _no.: s to job site: Ductwork us 23am
Cr street/directions
Residential boiler (radiator or IIIMINI
h dronic
Unit heaters (fuel-type, ended etc III 46.75 um
in -wall s _ ®�
Flue/vent for an ofVe 23.32
Lot no.: Other:
Other fu a lia nees: _��
Tax map /parcel no.: �■ 33.39
DESCRIPTION OF WOE ®�
Floc vcnt for water heater or ga
fire lace 23.32
' $ Lot li: ter :as
NM 33.39
�� _, r • 1 " Woodl�elletstove 23.32
Wood tire .lace/insert
Chimne /liner/flue/vent ��
rri OPERTY OWNER ❑ T ENANT Other:
Name: ^ 4 J . 4 .. E ust and ventilation: ventilation: Address: r flan hoo �U�1Ci ki
City /State/ZIp: A in 33.39
Phone:' f �/�'` Cloth g esd e
� 0 Single d u et exhaust (bathrooms, • 33 .39
❑ A PPLICANT toilet m e n u u tili rooms
❑ CONTACT PERSON Atticicrawls.ace fans • 23.32
l Business name: _ 23.32
Other:
ddres name: Fuel 1 In_: 23.32
Address: 514.151br drat fou 54 f or each a dditional
Oas heat um _ _
�I Phone: ( ) __
CONTRACTOR al _=
• �� Cloth Cr :as �
Address: G • Other: �_
sO _
, _1( , i®6, ,
Phone: (� a Subtotal
t Minimum •ermit f ee ($90.00) rillIPM9
Plen rev i ew( 2 5 %ofpe
State surcharg (1 of perm fee) ;thin ;:o .-274j-
Authorized • s `� T OTAL PERM FEE /
r - , I � � `� This permit application et plrrs 1 pe h not obhined
�// � d after It has been accepted as complete.
/ Date: • Fee melh odolo
r:1BuildinalPaaucal C- P.rm,Npp,d of /o7 /I] 8y set by Tri•County Building Industry Service Bo
. ' _ .- ___._. --- -- 44' 617T Uovcom wag)