Permit �� I MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
� 0 44 PERMIT #: MEC2007 -00651
DATE ISSUED: 11/7/2007
TIGARD" 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S134DA -05700
SITE ADDRESS: 11315 SW 105TH PL ZONING: R - 4.5
SUBDIVISION: NODAK LOT: 005 JURISDICTION: TIG
PROJECT: JOLLY
Project Description: Installation of gas insert and gas piping.
CLASS OF WORK: ALT 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
STACIE JOLLY Description Date Amount
11315 SW 105TH PL
TIGARD, OR 97223 [MECH] Permit Fee 11/7/2007 $72.50
[TAX] 8% State Surchar€ 11/7/2007 $5.80
Total $78.30
Phone: 503- 430 -5410
Contractor:
FIRESIDE DISTRIBUTORS
18389 SW BOONES FERRY RD
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -595 -3738
FAX 503- 670 -7285
Reg #: LIC 40979
This permit is issued subject to the regulations contained in the Tigard Munidpal 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 OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503.246.6699 or 1.800.332.2344.
Issuled By: k Permittee Signature: /��yvV��•_�_
Call 503.639.4175 by 7:00 a.m for inspections that , sinew day.
. This permit card shall be kept in a conspicuous place on the job Bite until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. .
,.,
I -Techanica - it A.
igard '
.11W . ...,
, i- Received i
Date/By: // 7 e 7 /I,e Pennitho Heeoto7-e065 I
lig ,
.. 13125 SW Hall Blvd., Tigard, OR 97223 Ely
Plan Review
I - ?hone: 503.639.4171 Fax: 503.598.10 Other Pannit:
RD
inspection Line: 503.639.4 75 NOV 0 7 2007 . Sea Page
Date Reedy/By: Datc/By
TIGA ktr,f.,:--- 1:5 2 Mr
Internet: varw.tigarti-or.gov
Notified/Method: 7 / Supplemental Information
_______ Y kir LtuARD -
, ,,,,v. , ,r,, , , T :i.,„!, 0 .-., .,,., :ii.: :::.-:,, . r , - ,.. ;.,,,.::..:,..:„,„::,:: . ;S; ., '. Pi) I '' ' i ? : ' ''',.. t , ,;,.!, . i .! ' . i .!
pes* are e work
0 New construCtion 11 Addition/alteration/replacement mech3nicu1 permit fee based on th value of the
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other:
mechanical materials, e..u' .ment, labor, overhead and .rolit
01:...0010211;:.::V'41'..::..:M Vl
: :: ). ! ; ..0 ; - - ..... ‘ . aLic: $
. .
r...i!?....:1'.. liti " Stili*titiiiii0101*.tiO'4P`SiitgS*i.01:'''''
. - and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For :Pedal' Mformarion use checklist.
0 Multi 0 Master builder 0 Other:
Description Qty. Ea. Total
10tRikt4iEi'W....,i\ R^ 13 ' :i,,D„ , 1 &min , /coolin ._
, . I Air conditioning or heat pump
Job site addreSs: 1 1 t;:;- S \-A C1 ‘ "PIPCe.
_
re . nines site • len showi . .lacemert 14.00
City/State/ZIP: -- F - .1 . - Ale - C( , c34^ .. q7 2-21 3 Furnace 100 000 BTU ducta/venis 14.00 MEE
Furnace 100,0001 BTU (ducat/yenta) 17.90
Suite/bldg./apt. no..: I Project name:
. Gas heat .0 • 14.00
Cross street/directions to job sic: Duct work III 14.00 111111
Fi .rortic hot water s tem 14.00
_. Residential boiler (radiator or
hydronic) 14.00 .— i l
Unit heaters (fuel-type, not electric),
in-wall, in.•duct, su- • ended, etc. 10.00
Flue/vent yn of above 10.00
Subdivision: Lot no.:
Other . 10.00
Tax map/parcel no.:
Other fuel a tianeas
i'.',0.' i'i.'';'.4P:!0,QrniWitii' In..; OPOR#01 watTimmer 10.00 1111
Gas fi dace in erl i 10.00
1 01 .e„.. A F ipep (
CLc.e i rf--? Flue vent for wares heater or gaii
fire .lace 10.00
— LoLEFhter (gas) 10.00 11111
— Woodf•ellet stove 10.00
• Wood E . lace/insert 10.00 al=
Chimney/liner/nue/vent 10.00 .11
Imo
e-- ■,_ S 1.4 Environmental exhaust_ and ventilation
Range hood/other kitchen
kddress: j 13 is-- s t.4 j Los- pl
e . ui t 10.00
.
-.:ity/StateJZIP: T. 9 Arc _. Clothes . .. exhaust 10.00
— Single-duct exhaust (bathrooms,
hone: (Sb ) at 36- . 10 Fax: ( ) toilet co .artments, utili rooms 6.8.0
::: . . .... .- -...7n917,74 .,ki:!.,.:! it ir,.;..i 1 7.; 6 ,.7176,1E • • — Attie/ciawlspacc fans 10.00
,i'; 3 !!;;:t :.--ii.i c VAN.' PAMAIRK -^'''''':'''' .' .4.'"I'474.'"4 """''' ' '' E '''" : ' . —
Other: 10.00
iusiness name: re g,,p_ I a e...
Fuel . i . in
'.:ontoct name: \ (. i ,..... L o.tn i e A t r eenz rj ,__
$5.40 for first four; $1.00 for each additional
_ N
- Furnace, etc.
•ddress: Le 8 33 HO 0 rigi-s Pern.i
--- Gas heat pu .
Ity/Statc/ZIP: 7 - - • a 0, 9 1 ' — waMu . ended/unit heater EMIIIIIII.
hone: (5tA ) tz-9 ( -_, 3 - 7 , Water heater —
--- =-' -'
Fi dace
-mail:
Ranle
3 $V;,; Of.k:J:k.eq0;(:N Barbecue
Clothes d . as IIII.MIEMI.
usiness name:
Other:
ddress! ( 46') e.,. a< cA.,L 6 ir,e rit'.'•) ''''•:•,,..atv :14;214 . ..k,n , ::'km:or:
ity/State/Z1P!
— Subtotal EMIll
Minimum permit foe ($72.50)
lone: ( ) Fax: ( )
Plan review (25% of pcnnit fee)
13 lic.: o - 7 4 se. State surcharge (8% of permit fee)
P TOTAL patmaT FEE
This permit application expires If a permit ls not obtained within 180
ithorized signature! (....., L a , Th days after It has been am complete.
int name: \I u , , L L el .... ler n i — 1 Date: k k , • Fee methodology set by Tel Building Industr servi Beard
(timing \Perrnita \ MPC-PermitApp.doe 04/06/06 440.4617T (11/02/COMAVE13)
CITY -OF TIGARD _ ..
BUILDING DIVISION PERMIT #: MEC2007 -00651
13125 SW Hall Blvd., Tigard, OR 97223 , DATE ISSUED: 11/7/2007
Phone: (503) 639- 4171 °'a4 @� ii� @
Inspection Requests (24 Hrs.): (503) 639 -4175 i i . / C A607- 006
INSPECTION WORKSHEET FOR DATE: 11/19/2007 TIME: 7 :01AIvl PAGE: 12
SITE ADDRESS: 11315 SW 105TH PL CLASS OF WORK:
SUBDIVISION: NODAK LOT #: 005 TYPE OF USE:
PROJECT NAME: JOLLY
DESCRIPTION: Installation of gas insert and gas piping.
OWNER: JOLLY, STACIE PHONE #: 503 - 430 -5410
CONTRACTOR: FIRESIDE DISTRIBUTORS PHONE #: 503- 595.3738
` Inspection Request Scheduled For: Date: 11//92007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
810 Gas line 05992401 503-6M-8535 Y
Corrections /Comments /Instructions:
et u . ,a ■ .S - PCeato,t_/
/-'
PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: . i Date: //.— ?!9.--e2 Phone #: (503) 718 - Z4,g -----7/