Permit (
iq CITY OF TIGARD MECHANICAL PERMIT
. ' r' ° COMMUNITY DEVELOPMENT Permit #: MEC2009 00632
T I 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/25/2009
Parcel: 2S103BB03100
Jurisdiction: Tigard
Site address: 12188 SW 125TH AVE
Subdivision: BROOKWAY Lot: 31
Project: Horne
Project Description: Install wood fireplace insert.
Owner: FEES
HORNE, CALVIN Description Date Amount
12188 SW 125TH
TIGARD, OR 97224 Wood Fireplace /Insert 11/25/2009 $23.32
12% State Surcharge - Mechanical 11/25/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 11/25/2009 $66.68
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Solid Fuel
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 Notification 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 direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: (') krx it Permittee Signature: C /1/4) "/�
"`C
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.
IF
1VIwcnical Permit ApplicationRE a City CE� FOR OFFICIO Use ONLY •
Received W � Permit No.: 1 • �y� X00 =
`� of Tigard
g Date /By: V. v i
•
1312 SW Hall Blvd., Tigard, OR 97223 Plan Review
III
° Phone: 503.639.4171 Fax: 503.598.1960 NOV 2 5 2 0 09 Date /By: Other Permit:
T I G A It D Inspection Line: 503.639 Date Ready /By: MI ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition /alteration /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.
CATEGORY OF CONSTRUCTION Value: 5
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ Multi family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / iffy �� /��y Air conditioning
�/ (requires site plan showing placement) 46.75
City/State /ZIP: 7 - �" &4 R 0 / o 12 9 7z 2 3 Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name:
Heat pump 61.06
Cross street /directions to job site: 99 iii TO WALtiu 7- Duct work 23.32
t - /i9.S % ,2 L E rL �TIz/-� 9 E S'U l bb L • M4 K I Hydronic hot water
boiler ( system 23.32
(radiator or
K.1 D.tJ /. ,sr � /-T oti /t!, t 7#1 - 'WF hydronic) 23.32
Unit heaters (fuel -type, not electric),
t- 6 PAS x490 4.�bOwkQn SciA . in -wall, in -duct, suspended, etc. 46.75
� Flue /vent for any of above 23.32
Subdivision: Lot no.: 3 I
Other: 23.32
Tax map /parcel no.: 2 6' 630 6 _ Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
--; ( A A EW GI)O t7 P s7) cal= Flue vent for water heater or gas
; ,- - ) _ c/t r o � p, prgt c fireplace 23.32
' 1 2.r or- [J% ,, / Log lighter (gas) 23.32
�JV �.t���� 2.�_o L. �,�� _„Z / / 1.// L Wood/pelletstove 33.39
11 r T�_ / 6 / (/ `7 .i , Wood fireplace /insert ' 23.32
G PROPE OWNER 7 J / I ' ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
' � w ' t 1 (� ,, r
Name: e�v //V a M () /v A .\ (Q, Environmental exhaust and ventilation
Address: 1 Z19b� f ___(" /7.1-re Range hood/other kitchen
equipment 33.39
City/State /ZIP: )1 p, o R' 9 ?Z 23 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (v 3Q - , Fax: 366) ?5-b... 3 �3‘ toilet compartments, utility rooms) 23.32
AP y PLICANT / ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping
Contact name: S 6 Me": (is S7 R 0 -c-, J $14.15 for first four; $4.03 for each additional
& C� Gas etc.
Address: Gas s heat pump
City /State /ZIP: WalUsuspended/unitheater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:
�, Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: S ubtotal ?j•� 2
Minimum permit fee (590.00) O .0 6
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) bbb
CCB lie.: State surcharge (12% of permit fee) '.. �0 0
�
TOTAL PERMIT FEE 1
Authorized signature: ` A/01,14-, 1This permit application expires if a permit is not obtained d witit hin 180
/ T I , days after it has been accepted as complete.
Print name: CAL v ic� �/ /` �J v RN f. Date: //' / 7 - ._c * Fee methodology set by Tri- County Bhilding industry Service Board
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1:\ Building ermits MEC- PermitApp.doc 10/01/09 440 -4617T (11 i02 /COM/WEB)