Permit CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: MEC2013 -00222
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2013
Parcel: 1 S135CD08600
Jurisdiction: Tigard
Site address: 9790 SW LONDON CT
Project: Wornath Subdivision: LONDON SQUARE NO.2 Lot: 38
Project Description: Install gas insert and gas piping.
Contractor: EVERGREEN GAS INC. Owner: WORNATH, BRIAN L & CINDY E REV L
PO BOX 388 7977 SW CHURCHILL WAY
WEST LINN, OR 97068 TIGARD, OR 97224
PHONE: 503 -407 -9542 PHONE: 503 - 620 -7785
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 04/24/2013 $33.39
Type of Use: SF Chimney /Liner /FlueNent 04/24/2013 $23.32
Class of Work: ALT Type of Const: Fuel Piping 04 /24/2013 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 04 /24/2013 $10.80
Stories: Minimum Fee Adjustment - Mechanical 04 /24/2013 $19.14
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 No' F •• enter. 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 • NC b . i 503.232.1987 or 1.800.332.2344.
Issu- • By: Permittee Signature:
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.
Mechanical Permit Appli , 4t 1 -1 fPr
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City of Tigar ■ Received tlirgigle Permit No.: Me e cy! 3 ..... 13125 SW Hall Blvd., Tigard, OR 9 v v
111
a Phone: 503.718.2439 Fax: 503.598. R 2 4 2 t) � 3 � a Review
Date/By: Other Permit:
I I i , \ I: I Inspection Line: 503.639.4175 Date Ready/By: kris: 0 See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified /Method: Sapplemntal Information
BUILDIN( DMSION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition /alteration/replacement 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*
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I >a_ I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 9790 SW London Ct Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: Tigard Oregon 97223 Furnace 100,000+ BTU (duets/vents) 54.91
Heat pump 61.06 •
Suite/bldgJapt. no.: Project name: pact work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Other
Subdivision: Lot no.: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
• fireplace 1 23.32
Log (gas
Install a Gas insert and the Gas line lighter) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner /flue/vent 23.32
® PROPERTY OWNER I ❑ TENANT Other: 23 32
Environmental exhaust and ventilation:
Name: Brian Wornath Range hood/other kitchen
equipment 33.39
Address: 9790 SW London Ct Clothes dryer exhaust 33.39
City/ State/ZIP: Tigard Oregon 97223 Single-duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: (503)6207785 Fax: ( ) Attic/crawlspace fans 23.32
❑ APPLICANT ® CONTACT PERSON Other - _ 23.32
Fuel piping:
Business name: Evergreen Gas Inc S14.15 for first four, $4.03 for each additional
Contact name: William Belden Furnace, etc.
Address: Po Box 388 Gas heat pump
WalUsuspended/unit heater
City/ State/ZIP: West Linn Oregon 97068 Water heater
Phone: (503 ) 4079542 Fax: : (503) 3446345 Fireplace 1
Range
E -mail: bill@evergreengas.net Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: Evergreen Gas Inc
MECHANICAL PERMIT FEES
Address: Po Box 388 Subtotal
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City/ State/ZIP: West Linn Oregon 97068
Minimum permit fee ($90.00) /0 •
Plan review (25% of permit fee) ____.—
Phone: (503) 4079542 Fax: (503) 3446345 State surcharge (12% of permit fee) f(r�
CCB lic.: 158031 TOTAL PERMIT FEE f QQ . FU
This permit application expires if a permit is not obtained within 1.0
� days after it has teen accepted as complete.
Authorized signatu e' • Fee methodology set by Tri -County Building Industry Service Board
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