Permit n CITY OF TIGARD MECHANICAL PERMIT
1 1 11 1- C COMMUNITY DEVELOPMENT Permit A: MEC2013 -00411
13125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/18/2013
TIGARD 13125 2S109DB03400
Jurisdiction: Tigard
Site address: 13086 SW HAZELCREST WAY
Project: White Subdivision: SUMMIT RIDGE Lot: 72
Project Description: (2) gas piping for outdoor fire pit and barbecue.
Contractor: MINYARD PLUMBING LLC Owner: WHITE, JONATHAN J & NICOLE L
8316 N LOMBARD, PMB #361 13086 SW HAZELCREST WAY
PORTLAND, OR 97203 TIGARD, OR 97224
PHONE: 503 - 962 -9797 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 07/18/2013 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 07/18/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/18/2013 $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
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: 0/� 4 C9�0,
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.
07/18/2013 12:31 4100 PAGE 02/03
Mechanical Permit A licati . El E p� l t ` , i ; , c , l t t t 1:1 :-.11:. e,. .,
City of Tigard
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13125 SW Hall Blvd.. Tigard. OR 97223
Dc/B �� /3 Permit NoC fEC�j /3 _d
Phonc; 503.718.2439 Fax; 501598.1960 JUL 1 8 2 013 flan Review other Permit;
1 ' 1 i ; r 1 . 1 Tnspcction Line: 503.639,4175 bct9 Rc
Internet; www.tigard- or.gov Detc Ready/By: fine Page 2 fir
CITY OFTIGARD Netiticd/Method:
Fiffl Supplemental Information
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El New COttStritction ddition/alretation /replacement c Mechanical permit fees' arc based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Q Other mechanical materials equipment, labor. overhead, and profit
r . .,/. ;.'. y 4 ,,. ;il ,v,,i r' 'a. F " ",: , `,, s �i •�s , - Value; $
yr •, ±;.^,. r � ',� � o �` Y �,.• ��i Y �m'�F. +4 1, i.t�'�j ��'�+�. �� t '•' n ' S ' .. ,- ,. :} ,,,,r. !, �' 'j , ''.0` , .i:
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.36- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Information use checklist
❑ Multi- family ❑ Master builder ❑ Other; Description
Q. I Fa. Total
• ;•2 ;tti4r t:1 ri. ∎' ;•' li y - - :1 {r,,,,, ,y,,,,, . , . :,, C Heating/cooling:
tic conditioning 46•75
,lob site addr
ess: 1 d e «L - C1J Furnace 100,000 BTU (ducta/vcros) 46.75
City /State/Z1P: 'T'4 f ( �'1 tn c . J i4 Furnace 100.0001• BTU (ductsivents) ! 54 -91 -
Heat p Suite/bldg./apt. no.: Projectname; work 61.
Duct work 23,32
Cross street/directions to job site: HYdrnnic hot water system - 23.32
Residential boiler (radiator or
hydronic) 2132
Unit heaters (fttci•dype. not electric),
in -wall, in -duct, suspended, etc. 46.75
- Flue/vent for any of above 23.32
Subdivision: I Lot no.: Other: 2332 -
Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
."" Ni.. 'b(tl.v ,�lf,�, :1 5 '.. c `ds :n .4 A -P, +.w, ` ..: w sv,l G Cs fiteP12'fmscrt 33.3
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.. .�!n1:, ...•+�' +1.'J..; , :N���t!1��: ) '�:� p: �. i � . �1� 1 � • , y '�v .( A.�
] F lue vent for water heater or gas
`) A'S 1. T-44-e. Te, 3 R Q fireplace • 23.32
6 & clt. .. Lou lighter (ans) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
I Chimney/liner /fluc/vent 23.32
a.,•. :..'; Other,
M'Y.: 1 ;t,? r :; ': �;':,;::y. ,',,,`r,Ll. � y> ;;: il wr:..r:t 1 44944'01M , 23.32
cn)'.s i. .. 1...•. ;r ,. - •• .i -� n - Ahv:;'rt n.:f•r :4- • "- ., ..,.,. 'i l'r 4'''1..v ".
- ^'' `° � ' � "�' • � Environmental exhaust and ventilation:
Name: Range hood /other kitchen
Address: equipment 3339
Clothes drier exhaust 33.39
City /Statc2fP; Single -duct exhaust (bathrooms,
toilet com�artmcnts, utility rooms) 23.32
Phone: ( ) Fax: ( ) Anicfcrawlspaa fans 23.32
I .r ° �: ;f � i �' ti � 4: : ti: �,. { ,i ._. ..�.^r., x1�.�..y '. i17�i Pa y 1�1'�t':�.• {� ;• other: .23.32 _
Business name: ' ^ V pi if.,,i) - Fuel piping:
i * : - all. $14.15 for first four: 54.03 for each additional
Contact name: 5 ( ( A-% lit „ '7 ■ c p f ,� Furnace. etc.
Address ;. 0 ` 3 (4 Al ( r)» 64 P B .4 f Gaa h p
l c � Wall/suspendcd/unit heater
City/State/ZIP: : 1Y. 0 7 O Water heater
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Phone: ( �Q� G Fax: : ( ) Fireplace 6 (r4 R,
E -mail: ,Y� ) pi, 1 Y D Ke �Gi'l ,,2 (r ,,, Range '
, .c.,,1,, �., �. j, �. �^ :c:F;,j'�: l. i.1 ' i �fif r � w;�sf�,r.n,1.. . � :J �, ' ;r .. ;., Barbecue I I 1
1 • �� ,� ?, p W F r � ;:"2 ¢; ri .hcs (IT
. t�.�A�4 r „ y• o � � ,_,✓.t".��a�x�1 �'�1'•S��Y;b'�1'iu6: A�i � r.�r nb%y���l1 a.��k Cln{�I cr (gas)
Business name: MI ,ca V1 Other:
Address: n �' ;; < I,�pf „�r�s:�I
3 ! c h. t.6 3 n at 36 ( Subtotal
City /State/VP: 9 �. G`I'„.�) r cm_ e)7.1-0 Minimum permit fee ($90.00)
Plan review (25 %ofpermit fee)
Phonc: &03) 7(p ° l 7 3) F O X ; ( ) State surcharge (12%ofpermit fee)
CCB lie.: TOTA PERMIT FEE G
S� �� 09 r o 9i / �y TOTAL
permit application mires ifs petrol is not obtained thin 180
days after it hart been accepted ea complete_
Aut oriltcd si? •••• . • Foe methodology act by Tn- County Building Industry Serviec Board
07/18/2013 12:31 4100 PAGE 01/03
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