Permit CITY OF TIGARD
MECHANICAL PERMIT
f 1 DEVELOPMENT SERVICES PERMIT #: MEC2005-00797
ee 1 r,. DATE ISSUED: 12/5/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103DB -04100
SITE ADDRESS: 11190 SW NOVARE PL ZONING: R -4.5
SUBDIVISION: GENESIS NO. 2 LOT: 039 JURISDICTION: TIG
Project Description: Install fireplace insert.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Owner: FEES
KENNETH GROSSEN Description Date Amount
11190 SW NOVARE PL [MECH] Permit Fee 12/5/200: $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 12/5/200: $5.80
Phone: 503 849 - 0687 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045
Phone: 503 - 557 - 2220
Reg #: LIC 72623
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through O R 9- - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 0- 332 -2344.
aetem ed By: t)'• Permittee S' nature: -�J
CaII 503 - 639 -4175 by 7:00 a.m. for inspections t usiness 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.
Nov 28 05 01:05a Tri Count Temp 5035570919 p.1
M e ccl anpca _ ermit Applicatio>
City of Tigard f. �. Received FOR OFFICE USE ONLY
13125 SW Hall Blvd., Ti r O 3 Date/By: /-& 5 c' Pent No.:) -• Oo
Phone: 503.639.4171 Fax: 3103 �g Plan Review
Inspection Line: 503.639.41 _ ii �i�i Date/By: Other Permit:
Internet www.ci.tigard.or.us "�t6 ~` _., 1 I Date edJMet y: 1°'i� I 0 See Page z for
co-(' Notified/Method f' A I
+- c Supplemental information
i S u le
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�, C0�41MERCYAIi FEE" S LISECHECKtiIST
❑ New Construction A�ltlt)1�7t€Dlacemenr ,. Mechanical permit fees` are based on the value of the work
❑ Demolition III �� ? performed. Indicate the value (rounded to :he nearest dollar) of all
5 ` r• s i CATECO.RY OVCONSTRUCTION mechanical materials, equipment, S labor, overhead, and profit.
1 eq a'or dad r
:. Value: S • )4l- and 2 - family dwelling [2] Commercial/industrial ?tESTD '' -" .EQUTP; •FEES'
❑ A cc essory building
❑ Multi- family ❑ Master builder ❑ Other: For speciel information use checklist.
Description I Qty. 1 Ea. I Total
•
.
J OB „ NFORbI`ATfON' AND LOCA'I •
I `0 V Heating/ cooling
Job site address: IV ®V .. n v D , n /I Q Air conditioning or heat pump
`^^ T IM�� (requires site plan showing placement) 1 14.00
City/State/ZIP: -- nn 1^ et Furnace 100,000 BTU (ducts/vents) ; 14.00
Suite/bldg./apt. no.: v ' � l l +Project name: Fumacc 100,000+ BTU (ducta/veacs) ' 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work
14.00 •
Hydronic hot water system 1 14.00
Residential boiler (radiator or
hydronic) 14.00
, Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00 1
Subdivision: Lot no.: FIueivent for any of above 10.00
Tax map /parcel no.:
Other: I 10.00 .
Other fuel appliances
,. - ;. } i DESCRIP.TION OF WORK ..: '.4..,'..• -' ” Water heater 10.00
ir � r
l e ps ��p, 1 �'yo Gas fireplace ' n50- - -E
10.00
r �!! llJJt��..JJII // 111 ��..JJ���� �� Flue vent for water heater or gas
fireplace , 10.00
Log lighter (gas) 10.00
1 Wood/pellet stove . 10.00
Wood fireplace /insert 10.00 j
y _ .NPROPER'FY O _,. ". . : :: '. Chimney/tiner /fludvent 10.00
y� �j �jq L�yo� TENANT '
Name:
Ken l x.1/1 V�W 1 Othe : 10.00
( �� yy �� Environmental exhaust and ventilation
Address: ea 1 �1[� Range hood /other kitchen
equipment 10.00 I '
City/State/ZIP: Clothes dryer exhaust 10.00 l
Phone: ( -� r ] Fax: ( ) Single -duct exhaust (bathrooms,
e �� till I r toilet compartments, utility rooms) 6.80
Q ;APZI :, " E ,ERSON Attic /crawlspace fans , 10.00
Business name: Tn Ccwity Tc CC' -tl' 1 Other. 1 10.00
�; A 111 Fuel piping
Contact name: I(u S5.40 for first four; 31.00 for each additional
Address: (, j l5 3 S. C 1 / (� n ; r n It 5 D i �! ; j � 1 ' { ,t Furnace, etc.
Gas h
l ll t� U ( C l J IV /� / L ' V / 11 eat pump
City/State/ZIP: 6 en 0 e i.z c(70 � I '
City/State/ZIP:
Wall/suspended/unit l
Phone: ( O. ) 557 )20 Fax:: ( ) 55 1 Water heater
E- mail: q Fireplace
,> Range
: :5 -.T , � ' , ; K - . ,:CO t1, CT(7R ti r� ,.
' - - �; ; b, Barbecue
Business name: I r+ (� Temp C 1 Clothes dryer (gas)
t i)10 C QCi( � 11 1 A fl Other: _
Address: s C• 1 t (� (J �! t ��
' lIEC1 #.41YICF.'):%'.PERIOIIT.: @EES*''
Ciry /State/ZIP: OI '(C) 0 C_ cf-A Subtotal
Phone: ( ) 55-=2 29 () Fax: (G03 ss 7. -ne-i I(/ Minimum permit fee (572.50)
Plan review (25% of permit fee)
CCB li.: 7
State surcharge (8% of permit fee)
a TOTAL PERMIT FEE �$
Authorized signature: a ,� �-C p , ac Tbis permit application expires if a permit is not obtain w
days after it has been accepted as complete.
Print name: , Ndr ma 30/) I Date: ) 2421 1 • Fee methodology set by Tri- County Building Industry Service Board
i seading iPemrits\tvfEC- Pertoitapp.4 12/03 440- 4617T(IIi02tCOM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005.00797
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/&&200;,
Phone: (503) 639 -4171 It lu�,TIlI
Inspection Requests (24 Hrs.): (503) 639 -4175 _..' -. _—
INSPECTION WORKSHEET FOR DATE: 1/1W2006 TIME: 7:01AM PAGE: 8
SITE ADDRESS: 11190 SW NOVARE PL CLASS OF WORK:
SUBDIVISION: GENESIS NO. 2 (_60p LOT #: 039 TYPE OF USE:
PROJECT NAME: GROSSEN
DESCRIPTION: Install fireplace insert.
OWNER: S�; f
i�E��),_ � FN, KENNETH PHONE #: a0,, -849 i3t„i7
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 50 5p -722O
Inspection Request Scheduled For: Date: 1118f2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 025139-01 603-557-2220 Y
Corrections /Comments /Instructions: l�� �' ��`��
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069 t
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PASS
PARTIAL APPROVAL 111 CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FO INSPECTION ❑ ADDI IONAL FEES ASSESSED
,.. 1
Inspector: Date:! Phone #: (503) 718-