Permit CITY OF TIGARD MECHANICAL PERMIT
11 a COMMUNITY DEVELOPMENT Permit #: MEC2013 -00292
T 1GARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 06/03/2013
Parcel: 1 S135CA09500
Jurisdiction: TIGARD
Site address: 11452 SW 96TH AVE
Project: W1SNIEWSKI Subdivision: SOLERA Lot: 4
Project Description: Install gas line for new fire pit.
Contractor: RELIABLE GAS SYSTEMS LLC Owner: WISNIEWSKI, ASHLEY KRYSTYNA
810 COLUMBIA DR 11452 SW 96TH AVE
MOLALLA, OR 97038 TIGARD, OR 97223
PHONE: 503 - 679 -4529 PHONE.
FAX.
FEES
Specifics: Description Date Amount
Fuel Piping 06/03/2013 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 06/03/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/03/2013 $75.85
Occupancy Grp:
Stories:
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
issuan - , or if work • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili Notification Center. Those ules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or • irect questions to OUNC b • ing .03.232.1987 or 1.800 332 2344. y
Iss ed By: ,, / Permittee Signature: /�
Call 503.639.4175 by 7:00 a.m. for the next available insp: ion 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.
Reliable Gas Systems 503 -829 -5953 p.1
Mechanical Permit Applicatio FOR OFFICE 15E ONLY
City of Tigard ' �ECEI�E D Dat e/ B [� r 3 ZIP) Permit \a.: M avl3 — e t' t
III
131225 5 Date1 SW Hall Blvd., Tigard, OR 97223 Plan Review 503 718.2439 Fax. 503 59R_ 1 960 MAY 3 0 2013 Date/By: Other Permit: -
I' I G A t D Inspection Line: 503.639
te
Date Ready/By r - ra See Page 2 fur
Internet: www.tigard CITY OFTIGARD Notified/Method: Supplemental Information
BUILDING DIVISION COMMERCIAL FEE' SCHEDULE — LSE CHECKLIST
TYPE OF WORK
❑ New construction la cemen[ Mechanical permit fees" are based on the value of the work
P performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
❑ Demolition ❑ Other:
Value. S
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
,0 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special lnfomsarion Eire checklist.
❑ Multi family ❑ Master builder ❑ Other: Description I Qty. l Ea I Total
JOB SITE INFORMATION AND LOCATION HeatirrpJeuofirrg:
Job site address: 1 /b ,/ S' L/ 1 C � 1., Air conditioning 46.75
1 Furnace 100.000 13TU (ducts/vems) 46.75
City/State/ZIP: j -iGw'd Q2 c aC,3 Furnace 100.000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: I Project name: Heat pump
Duct work t 61.06 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler (radiator or
bydronic) 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: 2332
Subdivision: Lot no.: -
Other fuel appliances:
Tax map/parcel no.: Water heater 2332
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Pi 6-n5 n Flue vent for water heater or gas
6 TO 4..-e.. A' 1 fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23 32
Chimney/liner /flue/vent 23.32
Other: 23.32
❑ PROPERTY OWNER ❑ 'TENANT Environmental exhaust and ventilation:
Name: Range hood/other kitchen I
C equipment i 33.39
Address: // v5-2_ / Qy 6, r� Clothes dryer exhaust 33.39
r
City/State/ZIP: .. c) v' P 3 Single -duct exhaust (bathrooms,
!! toilet compartments. utility moms) 23.32
Phone: ( ) Fax: ( ) Attickrawispace fans 23.32
ja APPLICANT ❑ CONTACT PERSON Other. 23.32
I Fuel piping:
Business name: R r b c- 1 i 071 S
514,15 for first fm - $4,03 for each additional
j Contact name: 3 Furnace, etc. _
Address: '/a Co je A .A,'r, Dim Gas heal pump
A � WalUsuspended/unit heater
1 CityiState/ZIP: C10/41/4-- dfi /703(5' Water heater
Phone: 5 ) C7/ / 1f 5'2, y , Fax:: (i. s.,24. 5953 Fireplace
E -mail: I Range
Barbecue
CONTRACTOR Clothes dryer (gas)
ne / / � 6 / C t :W Other
Business name: MECHANICAL PERMIT FEES*
Address: f /C) Cal',' , ice. Subtotal
City /StaterZIP: filo I/- f (g- Og q7035 Minimum permit fee ($90.00) c ii- 0
`J t55 J p. t G , Plan review (25% of permit fee)
Phone: (, 5 V 3 ) 679 % d 2. ' Fax: (5 ) o/ - I � .S
State surcharge (12% of permit fee) /p,g)
CCB lie.: ` 79 3 7 / / /, / r TOTAL PERMI F FEE lq/). 810
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: ■ • Fee methodology set by Tn- County Budding Industry Service Board
I Print name: ,,Q 6ai. t.t- I Date-s'f // 7
IaBuitdng'Permit MEC_PemitAMr_040113 doe 440-4617T (I 1 /02,COMAVBB)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11452 SW 96TH AVE, TIGARD, OR, 97223
Residential - Mechanical
610 Gas Line
06/06/2013 00:00
MEC2013-00292
PASS
Standard pressure verified 10 lbs 15 min
Violation Summary:
Inspector Contractor