Permit - J - v CITY OF TIGARD MECHANICAL PERMIT
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' . ` : ° ; ,_. COMMUNITY DEVELOPMENT Permit #: MEC2010 00072
sr� Date Issued: 02/17/2010
III cAR. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 S133DD10500
Jurisdiction: Tigard
Site address: 11894 SW 125TH CT
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 142
Project: Rueck
Project Description: Install gas fireplace insert.
Owner: FEES
RUECK, GREG D & DORSEY J Description Date Amount
11894 SW 125TH CT
TIGARD, OR 97223 Gas Fireplace 02/17/2010 $33.39
12% State Surcharge - Mechanical 02/17/2010 $10.80
PHONE: 503 - 524 -3642 Minimum Fee Adjustment - Mechanical 02/17/2010 $56.61
Contractor:
FIRESIDE DISTRIBUTORS
18389 SW BOONES FERRY RD
PORTLAND, OR 97224
PHONE: 503 - 684 -8535
FAX: 503 - 670 -7285
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
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 Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di ct questions to • UN •y calling 503.246.6699 or 1.800.332.2344.
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Iss ed By: • 41 , mw Permittee Signa /� (,
I I
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
RECEIVED
Mechanical Permit Applicati n' FOR OFFICE USE ONLY
City of Tigard FEB 16 2010 Received
e.R 2 / / Permit No.: N
II
• 13125 SW Hall Blvd., Tigard, OR 972:3 G /D - - o?OlD� 0 00 7.'L
Revie w
>a Phone: 503.639.4171 Fax: 503.598.19(�.m TIGAR PlaDaln Dale /By. Other Permit
TIC3ARD Inspection Line: 503.639.4175 y y r BI SeePage2for
Internet: www.tigard- or.gov BUILDING ➢�IVI�I ®N of fed /Metthod: 7f !o' • Supplemental Information
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❑ New construction (Addition /alter ation /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
V:Y t ii: lit,
4 �, � -& '- 4 p# 'il 3.4:5,40.6.tQ1N" , jx , . value $
R. a - � t: n x 7 5r Y••i•9 •+xy�„Mr• r
y dwelling � "1'
and 2-family
g ❑Commercial /industrial ❑Accessory building • �
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
f x s, y ., }„ Description Qty. Ea. I Total
z f ! ?1Ss t ��,'Si iji ,MI. ' e4 ,CI', 10 , Y - A V. _ Heating /cooling
/Job site address: � Air conditioning
r p q 7 n �a `5 Ce (requires site plan showing placement) 46.75
t / City /State /ZIP: j L0 cia. i Op_ Q 7a,a3 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite /bldg. /apt. no.: Project name: t, u e"e Heat pump _ 61.06 _
Cross street/directions to job site: Duct work 23.32
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
Subdivision: Lot no.: Other: 23.32
Tax map/parcel no.: yy Other fuel appliances
h' g,' {ft ^ 15 ( F r 1 .r/ • 1'y ?FV )l ii i I 6. T C t
,,'N' , r ., .•1} t tl Q`F ; , . 1 - • Water heater 23.32
.. l Gas fi / 33.39 q 3 , .39
(hs,{ 1) gip 5 ,a v-e ,n I Q,n k P L , Flue vent for water heater or gas
r fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
t .+ . ( r of a Chimney /liner /flue /vent 23.32
S > 'R R'19Y ,W �tk Y•I< I,.$.0 ll�`' P Other: 23.32 _
Name: Great /�LPn, Environmental exhaust and ventilation
/, n Range hood /other kitchen
Address: p
1 1 Q Q (./. i. 5-1-4--. c l equipment 33.39
City /State /Z1P: '� t it) 9' '4,2,2 3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( 5: '`p 36, i / 5:7 1, f ax: ( ) t toilet compartments, utility rooms) 23.32
tl i .. e4r e r Y IT _ ', )fit ' : t",1.,...'. v , •?.631\1 j,,y 1 q� )1 0Nf ',.,., r = Attic /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: 514.15 for first four; 54.03 for each additional
Address; Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax :: ( 1 Water heater
E-mail: Cd el 4
x P' T �1 Y„ P L. i� ( , j, ,..5. 1- ' Fireplace
Fi
R
', ,p; .)t'1•�. ',e�J;.lr °�, Mot:.. ot:. sa l t '40i.r . ,s t t`r _ Barbecue
r Clothes dryer (gas)
Business name: P7 ?tp 51 • _ e. D ! 5 b - ∎ Other
. � \ 1 4 4 i{ J M1 Y l
Address: 3 [ sta..) f el a� . fr4.4 1 I�f. , w 11, 7 G '.� r ' ,-,1 4
City /State /ZIP: n l() (71 f ) r 0 Subtotal i
h t Minimum permit fee ($90.00) '9C'. Qp
:
�d
Phone: ( i) 8 _or5 S Fax: (5 3) `, Plan review (25% of permit fee) - ' I
CCB lic.: 41 Dg70- 9 State surcharge (12% of permit fee) , °�,, -.k1 I /
TOTAL PERMIT FEE ftt?O.) ,
f /J This permit application expires if a permit is not obtained %rain 180
Authorized signature f� days after it has been accepted as complete.
Print name: 11 / Y nPJi� L ��` ` Date: �� hd ' Fee methodology set by Tri -County Building industry Sen -ice Board
1 \Burlding \Permits \MEC- Permit App .doe 10/01/09 440- 4617T(1 I /02 /COM/WEB)
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