Permit 1111 CITY OF TIGARD MECHANICAL PERMIT
11 COMMUNITY DEVELOPMENT Pe COMMUNITY
MEC2021-00522
Date Issued: 7/14/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112CB10200
Jurisdiction: Tigard
Site address: 15378 SW KENTON DR
Project: Cichy Subdivision: ASHFORD OAKS NO.2 Lot: 116
Project Description: Install Gas fireplace. 10/19/21: REPRINT to add(1)fuel pipe for fireplace.
Contractor: HAVEN SPA POOL&HEARTH Owner: CICHY, CATHARINE
10560 SE HWY 212 15378 SW KENTON DR
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503-655-9440 PHONE:
FAX: 503-655-9514
FEES
Specifics: Description Date Amount
Gas Fireplace 07/14/2021 $33.39
Type of Use: SF Fuel Piping 07/14/2021 $14.15
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 07/14/2021 $42.46
Occupancy Grp: 12%State Surcharge-Mechanical 07/14/2021 $10.80
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
Issued By: i , Permittee Signature: Sr-e-
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 Application RECEIV FOR OFFICE (SF ONl i"
City of Tigard `�' ��y�
( Date%By: �� av�.�� ,� t 2 J �&
13125 SW Hall Blvd.,Tigard,OR 97223 OCT .� �1 7021 Plan kevien- /
Phone: 503 718.2439 Fax: 503.598.1960 Datc'By: tither Permit.
re Read B}: '"
l I C:;1 K()
Inspection Line: 503.639.4175 CITY OF TIGAR)� y' '" Fa See Page 2 for
Internet: wHH.tigard-or.gos Notified/Met!od&-- f Supplementallnformarion
c3LJILDING DIVISION ,-, _l
I]'PE 01- >KJ12K COMvf:kK(1AL bls "S� _ to
-a tit chin it rerun let:: are based on the value of the work
Lj Ncsv construction . -Acldthuu alto t tcpl.n,in:itt i perhnmcd.indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials.equipment,labor.overhead,and profit.
\ehic
C r)F .{31Ot" OF (O ss Hai t ION RESIDLNT1Ai,EQUIPMENT r t SYSTEMS FEES*
❑ i-and 2-fiunik:,its t rim)! [i( +unlu:I CaiNtidu;,u ial ❑ Acccs<nn building_ For.peciwl injormariun use eher/di.m.
0 Multi-family L] !Slasier builder ❑Other: Description 1 Qty. Ea. Total
_ ._ : JOB SITE PeFORMATION ND:LOCATION — I Heating/cooling:
Air conditioning 46.75
i Job site address: 15 3 ._45 5 V O' Furnace 100,000 BTU L (hick vents) 46.75
City Brae/Z1P: Furnace 100.000+on:td.xr.vonta
Heat tum 61.0x6
�Swie b!dg.'apt,no.: Project name:
t C k� Duct work 23.32
iJ Cross street/directions to job site: flydronie hot water system 23.32
— Residential boiler(radiator or
hvdronic) _ 23.32
Unit heaters(fuel-type,not electric),
!�' _ in-wall,in duct,suspended,etc. 46.75
Flue vent fix any of above 23.32
-- Other. 23.32
Subdivision: Lot no.:
-- --- Other fuel appliances: _ _____
Tax reap/parcel no.: Water heater 23.32
•q `r� 'r ;4 f xz , r o x` vx Gas fireplace/insert 33.39
:g a ..v,'''',r.,✓r,k ''ut..�trr!`t t;'/''v'7'""''t'a«r.s.. .'' . d�axdS
r�='�"',/ (( (' ` J Flue veto for water heater or gas
add qc Muse 1d/" k see (ICI cit. { \sse Ut G'1A fireplace 23.32 -_---
Log lighter(gas) 23.32
..0tr1. 1 t'1it, Si Jbrvss\te-1 perm -1) t- z'-005 ZZ Wood/pellet stove 33.39
It Plec. .e t„1Q()(0,7/te_ S. c fvs t.lt . Wood fireplace:insert 23.32
Chimney/liner/flue's/en( 23.32
1d
Ocher: -`------ 23.32
#- . . BROP':RTI .:; -
_. } T'il'AkISt'l':
•' Environmental exhaust and ventilation:
Name: , Range hoodiother kitchen
_— 1 -� -- equipment 33.19
Address: �- 4
Clothes dryer exhaust 33.39
V
City/State/ZIP: Single-duct exhaust(bathrooms,
___- toilet com arttncnU.utility rooms) 23.32
Phone:( I Fax I I Attic crawispace tans 23.32 _
APPLICANT -i 0 CONTAC` _ ER.; .S... Other,i,in 23 i`
Fuel
Business name.
1, I ___— ____________ -_- .___ _ -._-__ _ $14.15 for first four;$4.03 fnr each additional
Contact name: Furnace etc.
Cias heat sum,
{ Address: Wall/suspended/unit heater
Cif' State/ZIP: Water heater
•k Phone;( ) 1
Fir laceI
— Range
tt F-mail u Barbecue — _ _
COIN I Ra )R Clothes dryer(gas')
,
A/0N .�/A' /^ob , terO
Bu the s na c:
--ME�C MECHANICAL PkiMITFES
Address: ' `jc-- cSl) 11, / a/2
Subtotal
— —
City St l,- (�
1 .(u AS 6 ,)01 Minimum pcmut Mc($90.00)iO
Plan rewew(25/o of permit fee)
Phone.(7,,)�6 — GO Fax:( ) State surcharge(12°f)of permit fee)
2F GO
CCB lie.. L/cfy& _ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
_ i days after It has been accepted as complete.
Authorized signature: _..._.,._.. ' Fee methodolotry set by Tri-County Building Industry Service Board
( Print name: '5}L .,if Ltd dIsCt.yvvj Date: VV..el/7I.
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