Permit CITY OF TIGARD MECHANICAL PERMIT
;'�1 I COMMUNITY DEVELOPMENT Permit#: MEC2014-00146
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2014
Parcel: 2S110DD06200
Jurisdiction: Tigard
Site address: 10615 SW HIGHLAND DR
Project: Freeman Subdivision: SUMMERFIELD NO.4 Lot: 162
Project Description: Install gas line and gas insert.
Contractor: T& K MECHANICAL Owner: FREEMAN
PO BOX 116 10615 SW HIGHLAND DR
FOREST GROVE, OR 97116 TIGARD,OR 97224
PHONE: 503-844-9173 PHONE: 503-922-3324
FAX: 503-846-0195
FEES
Specifics: Description Date Amount
Gas Fireplace 03/31/2014 $33.39
Type of Use: SF Chimney/Liner/FlueNent 03/31/2014 $23.32
Class of Work: ALT Type of Const: Fuel Piping 03/31/2014 $14.15
Occupancy Grp: 12%State Surcharge-Mechanical 03/31/2014 $10.80
Stories: Minimum Fee Adjustment-Mechanical 03/31/2014 $19.14
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.-- ions . 'UNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: Ks. I /h �,y�/ /� y Permittee Signat �. `i✓ ma".r_
�Y�/""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 31 14 10:22a T&K Mechanical 503-846-0195 p.2
Mechanical Permit Application lEIVED FOR 0 FF1C:E(SE ON1.1
City of Tigard I ilia.tli DatRacci*tdI VC ) = lagfiMil PelmitN° life. ./ -oo/z/
1114_.i- ph13 125.70311:31197411;li,TiFgard.,5003R.599723
n 3 1 2014 Plan Review
DatelBr Other Permit
.i.i C.... }„, inspection Line: 503.639A175 Date Ready/Hy: lune Ea See Page 2 for
'. Internet WWWtigard-Or-gOV aryoF nelAfiD Notified/Methoth Soppleomeobd laonnation
. .
: ' 'DIVISOI ' -'
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Mechanical permit fees*are based on the virtue of the work
ID New construction ( :1 Addition/ahead:ion/replacement
- performed.Indicate the value(rounded to the nearest dollar)ad! ,
0 Demolition 0 Other. mechanical materials,equipment,labor,overhead,and profn.
'CtlitG. a R Y- ' :. Value:S i
' ::.RESIDENTIAL EQvrpMEItrJSYsrEMS FEES*
. ?..3 l-and 2-family dwelling 0 CommeniaIfindustrial 0 Accessory building
For spacial information use checklist
i Muhi-family 0 Master builder 0 Other: Description 1 Qty. Ea_ I Total
40**-Siti*INFOIthiATIOri;500.1047.**':-.::: ...-S-.-- '- •=i: fleafinRiatoling
Air conditioning
Job site address: 1 0 lc t..5 5(,) 1....L., 0.4-,le,y,,,,3 D Y (requires okapi=shawinApheersocen) 46.75
City/SWOZIP: —T:, c),-,1 6 C ,,_c.. TA-7 a at--j France 100,000 BTU Cducts/vcath) 46.75
Furnace 100.000+B7U(ducts/veids) 54.91
Suite/bldg./apt.no.: Project OM= 7:.r e kl ,1 CL V\ Heal Pun 61.06
-Ctoss street/dir'ections-tojob site: . -- - - •- - - - __ — — _ ...Duct.worL____ . _ _ ._
Hydmnic hot water-system 23_32
Residential boiler(radiator or
hydronic) 2332
Unit heaters(fuel-type,not electric),
in-wall,in-duct.saspended,etc. 46.75
Fine/vent fur any of above 2332
Subdivision: Lot no.:
Other: 2132
Tax runpfpamel no:. Other fad appliances
rokielittiiiii.444*.'::-:-.:7-::2:-----:-::.,:-..:-.-:- :._,7::. _, Water heater 2332
Gas fireplace 1 3339 3 3 c't
,
e--, \; ir■,P C.v—..ck cs.sc.., S .., r■,--,_■<.' ,..,- --- Flue vent for water lamer or gas
fireplace 2332
'Log lighter(gas) 2332
Wood/pellet stove 33.39
. ,Wood fireplace/insert 2332
chmcvlhncdfluelvent 2332 ..?,3 3-k
- Other 23 17
'r- Environmental exhaust and VCIladiDll
Range hood/other kitchen
Addmss: I( I 1 6 S o.) H-;chit,..kck+nC- Ni-- equipment 3339
civistaterziP: -T -. 0_ a.-.A C.. vd: (NI—) ; --A -( Clothes dryer exhaust 3339
Single-duct exhaust(bathrooms,
Phan=(irDC))) C1 3A.- -34-J);1.),.1.t. Fax( ) toilet compartments,utility roams) 23.32
CI-A*4"NT - '-,: :-`::,7:-;',Ki ..--;- 1 :A:CCoff:*** EAtSOPir":::,5-.,::: Attichaawlmace fans 2332
Other: 2332
Business name: —74 y..„. ‘r-r) c•-,...k -,-, ,• (-•c., — Fuel lilting
Contact name: Y.,.., ,,...-,. $14.15 for first four;$4.03 for each additional
Address:
Furnace,ete
0 C)) 0 )( t 1 L 0 Gas heat pump
City/State/ZIP: cCri('C--k C::-1.-CV C-- C3A,_e_ ci-1 11 1-P .Walt/suspeadedAmit heater
Phone: 4....i - CI I 1 5 -I Fa2c:(;IS) 5.5-11 Lo _ etc( 5-- Water heater
Fireplace : 4`i,‘C.1 14,i ic•
E-mail: —1-1,.3 1_C) C,,5 u...";0 vr-N C.. Y.N 4-1 CC g) LAC-4/100 % C11-\-- p
01"01400e;' ;4: ,' - Barbecue
Clothes dryer(gas)
Business name: --14 K. me c lAc, ,1 1 cc._ ( Other.
Address: F r) R DX ( 1( 0 ::•.:::;::, .mgc*Ailitir-TirEiSer,:7-;•!.7...; - :1::
City/StateiZIP: Cnr e si c-j-r cv- _ O% (AltliP .. Subtotal
hfinimum permit fee(S90.00) CO.'i)
Mime:( 5°) SLI 4 -CI 1 7.- , I va • ( Cji) cr-S-Ll t fi •-(..) 1 ci 5 • Plan review(25%of permit fee)
CCB fic-: lalicc. 3/n )1. ,_ State surcharge(12%of permit fee) ;03-o
_ TOTAL PERMIT FEE ;00
Authorized signature c\34\--..„.1,----- This permit appiiranim espirrs if a pennit is aid admitted with:iv ISA
days after it has been accepted.as catapteir-
IPrint name: 1LAi; k_ L,3 4 r ‘,.., I DiliC 3. 31- 11 i • Fce methodology set by Tn-Coarly Building flutasty Semi=15--e.“1
tz,B.ILAier..Pearirs,MM-Tioottfint.dte 10401/09 eiN4e7T(1 hs12/COhnfilM)