Permit • CITY OF TIGARD MECHANICAL PERMIT
a ' COMMUNITY DEVELOPMENT Permit #: MEC2013 -00125
T [C 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/06/2013
Parcel: 1 S135DB05600
Jurisdiction: Tigard
Site address: 11400 SW 95TH AVE
Project: Virtue Subdivision: MILLER Lot: 9
Project Description: (1) gas fuel piping to range
Contractor: THE HEATING SPECIALIST INC Owner: VIRTUE, LISA R
9300 NE HALSEY ST GALINAT, RAYMOND A
PORTLAND, OR 97220 11400 SW 95TH AVE
TIGARD, OR 97223
PHONE: 503 - 257 -7000 PHONE:
FAX: 503 - 257 -7702
FEES
Specifics: Description Date Amount
Fuel Piping 03/06/2013 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 03/06/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/06/2013 $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: k LJ`ic-f- Permittee Signature: 00 V`f I e✓T1
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. 5. 2013 11:33AM The Heating Special ists No. 3150 P. 2
Mechanical Permit Application Hilt OFFICE usr ONLY
III City of Tigard RECEIVE � ) /4 (13 s' Permit No. :M6c / 3— DO/ )
n 13125 SW Hall Blvd., Tigard, OR 97223 Sj Plan Re
g Phone: 503.7182439 Fax: 503.598.1960 Date/By: Other Permit : 5 j dot X3 .)—
Ti G n r . n Inspection Line: 503.639.4175 MAR 5 Date Ready/By; hew El See Page x for
Internet; www.ligncd or.gov 2013 13 Notified/Method: 6 Supplemental Information
— CITY (W TIGARJ) coMMEnciAL 1•rEit SCHEDULE deli: cllsc�ia� fsr
TYPE OF w iMI DING DIVISION Mechanical permit feat are based on the value of the work
❑ New construction 115 Addition/alteration/replacement performed, Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
. Value: $
CATSGORY CONSTRiiCfT014 • R EhrfiAL EQUIPMENT/ SYsrEths F e '
• F- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For apeciallnformarlon use Medals.
CI Multi - family ❑ Master builder ❑ Other. Description I Qty. , Ea. Total
JOB SITE 1NFORMA'CYOI4 ' AN'f) LOCATION ..
Heating/cooling:
Air conditioning
Job site address: I i M f70 S l cis 4- k - A p ,.,,E (requires site Om placemen0 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
Ciry /State/2�: l VV
1 I `7 A /4) � o ( D Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldgiapt. no.: Pro 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 no.: Flue/vent for any of above 23.32
Other. 23.32
Tax map /parcel no.: Other fuel appilances:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace/insert 33.39
I . &Z, S 4-!a 11 l:7 �+ A'5 Li OP., 4 �+ : —arm Flue vent for water heater or gas
fin-place 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fueplace/iuser 23.32
n' .ROPERT'Y OWNER , . ❑ T73N'Allff Chimney/linedfiue/vent 23.32
n Other. 23.32
Name: j A .c g (-) g - („i ,J 14-f Environmental exhaust and ventilation;
Address: ) j li O D Gl�•/ f1- f Range hood /other kitchen
,t r ` equipment 3139
City /State/ZIP: , o 0 R ie7 / D A Clothes dryer exhaust 33.39
r , f t F Single-duct exhaust (bathrooms.
Phone: (03) -3 ac, ` rI 2_, Fax: ( ) toilet compartments, utility moms)
i!:: • PLICANT ❑ c01!CI'ACr Attic /crawlspace fans
Business name: (- FfrJr I V y `SO t� 6
L.t6 }` Fuel
/ . `-
Contact name: , 1 " I r 514.15 for first four; $4.03 for each additional
Furnace, etc.
Address: « 1\)?,, '� N a Y Gos heat pump
City/State/ZIP: 1 a G ., i 1, 0 • . . 0 Wall/suspended/unit heater
Phone: 257 _7 00 ' Pax: : Sr5 -- 2.5 7702 Water healer
Fireplace
E- mail: . ' I\c 1 r io4m c...i s1 a ,s - CD t"'"-- Range I 1 4 r1
CONTRACTOR . . Barbecue
Business name: . 1--1( (‘- -p ec,i A u+
Other dyer (gas
Address: 131 J) � r C J4 II3ECHAMCAL .'
City /State/ZIP: d le. - Li l N() p re 9 7 2-2.-C) Subtotal 114 , i,(
Minimum permit fee (S90.00) q Co . OD
Phone: (c -5) - "7DC. C? 1 Fax: (CO 2,512 - 7 7 0 Plan review (25% of permit fee)
CCB lic.: ' + • State surcharge (12% of permit fee) al;
- TOTAL PERMIT FEE • • • it
This p ermit application expires ifs permit Is not obtained nitrite Be
Authorized el:, : ere'
days after it tins been accepted as complete.
Print name: .( • i L . e . Date: 3 NMI 9 Fee methodology act by Tri- County Building Industry Service Board
1 :113mIdioecrmArV C-Pc dGAppdoc 03107/12 440- 1617T(11IOLCOM,W6B)