Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00025
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/16/2009
PARCEL: 2S104AA -13400
SITE ADDRESS: 12410 SW 128TH AVE ZONING: R -4.5
SUBDIVISION: BELLWOOD NO. 3 LOT: 153 JURISDICTION: TIG
PROJECT: BOND
Project Description: Install woodstove.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
WOD 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES: 1
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
SUSAN BOND Description Date Amount
12410 SW 128TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 1/16/200. $72.50
[TAX] 12% State Surch 1/16/200 $8.70
Phone:
Total $81.20
Contractor:
FIRESIDE DISTRIBUTORS
18389 SW BOONES FERRY RD
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 684 -8535
FAX 503- 620 -5699
Reg #: LIC 40979
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: _.JU ` pl \ & O Y
Call 503.639.4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
01/16/2009 11:08 5036707905 WIDDOI,E PAGE 01
. .
;N ',.... c:irartical P encrat
AkiR. ECE1VED ' OFFICE USE ONLA'
Received
. City of Tigard IA 1 6 2009 N Date/B y: i Penult No.: ry‘ E c zocg
!,114 .. 13125 SW Hall Blvd., Tigard, OR 97223 ' . ' Plan Review
i M ' Phone: 503.639.4171 Fax: 503.598.1910, Date/By: Other Permit:
TIGARD Inspection Line: 503.639.41'75 CITY OF TIGARD Date Ready/By: luris: ra See Page 2 for
Internet: www.tigard-or.gov 1111u1ING DIVISION Notified/Method: 71( Supplemental Information
:10,0144AVTegigiOltAI:.;;X$,MtelWalili,Vaittrigl4rini,ilregiVA'ifOr 10.0.?,4 1,* ,titto 1 :VfkitwW*A**litt4:Wtfig:**.ftr
„'''''''''''''''''''''''"r''''''''"'''''''''''''r"' e ehe Valtle tbeWOrk
0 New construction ....„..- Addition/alteration/replacement
perfonned. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
'ii444 Value: $
(*ifit*Pg**:;m*.w.7,:1 ..,_,,,,,,, ,alUtg4; ./44kg*tikkgraiiii4A')J,ViViStialgaigi'+`,,::)01
:',R,',i3O_04M!77 f,NT),:.;;;ri7frnirilrittinfalrir3Ite,9Atejili;?411.1.
' and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For .special information use checklist.
ID Multi-family 0 Master builder 0 Other: . . Description 1 Qty. I Ea. .1 Total
,:i i ti,tC:' Heating/cooling
Aning or heat pump
Job site address: I 0 -S ki..) t '2". Av e- (requires site ir conditic ilan showing placement) . 14.(10
City/State/ZIP: - ift (2)r . 91 2:23 Furnace 10( ,000 BTU (ducts/vents) _ 14.00 ,
1 Furnace 10( BTU (ducts/vents) _ 17.90
Suite/bldg./apt. no.: '`. Project name:
Gas heat ptrnp 14.00
Cross street/directions to job site: Duct work 10.00 .
' Hydronic he t water system 14.00
Residential I toiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-dlet, suspended, etc. 14.00 ,
Flue/vent fa any of above 6.80
Subdivision: Lot no.:
Other. 10.00
Tax map/parcel no.: Other fuel sppliances
Water heatei
10 (10
-
10.00
_____,2i2 i/ aiaod 5742 dg Flue vent to, water heater or gas
fireplace 10.00
Log lighter ( ;as) 10.00
Wood/pellet stove — - / 10.00
Wood firepli ce/insert 10.00
[ ' - . i:..efI''''' ' • ', .vg Chimney/lin. r/flue/vent 10.00
'" :' 17,1,' ,pftcypii OWNER ' i ' '. , ,..‘ „,....,:',:;1 other
10.00
r
Name: ill Environmet tal exhaust and ventilation
_ k • _
, Address: k •z_t-k \(3 S)._.. . -iAve_ R e: i t:i g p e m h e w nt d/ ither kitchen 10.00
City/State/ZIP: k , 6rc • 1-. C I 7 2-13 Clothes drye exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: (5)* )5€30 — 68er Fax: ( ) toilet compaitments, utility moms) , 6.80
' '''''' .','• ''El' f2ONTA P
CT g0.8014iii AtticicrawlsE ace fans 00 i 10. ,
AP PLICANT .Y. ;.1 . ' , ..., - ., . .,. ,... :.,4.:1H.x.V!!! Othe
10.00
i Business name: K ¼i ■ t'S Q-a) Fuel piping
Contact name: \\I C - Ut.kne.. Ce-t ins 'i . $5.40 for first four; $1.00 for each additional
,;--, , Furnace, etc.
Address: ‘8F, S (A3 - Boorw s --- Ferr 1 <oa
Gas heat pun p
City/State/ZIP: ki- and e!'/-.- 9 771% Wall/suspenCed/unit heater
..j.,
1, Phone: (50) ) k853 ,....- 3- Fax: : ( ) Water heater
Fireplace
E-mail:
• . ,. .. Range
CON1'IIACI10,1Pines, $VI'X'iallin:: Barbecue
Business name: ' ' ' 1-
ta (91)V — - Cl dryer (gas)
Other:
Address: ' WOMOACt
-- --
City/State/ZIP: --414.-C7 Subtotal
Phone: ( ) Fax: ( )
Minimum permit fee ($72.50) 12
Plan review (25% of perniit fee)
CCB lie.: State surcharge (12% of permit fee)
_
VP. TOTAL PERMIT FEE 15 \ -- T V°
Authorized signature. a
--i cr ; 12
1 1111 01 • ,
..,
- rerrat-i Date: / -/6 .- 0 .7---- This permit al -piication expires if a permit is not obtained within ISO
51 tys after it has been accepted as complete.
Print name: 4
* Fee method( logy set by Tr-County Building Industry Service Board
I: \Building ll'ermitAMEC-PennitApp doc 0111' 440-4617T (11/07JCOMME11)
•
CITY OF TIGARD • 410
BUILDING DIVISION. PERMIT. #: MEC 009 -30025
13125 SW Hall `Blvd. Tigard, OR 97223 DATE ISSUED: 1116/2009
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 Ail'
•a
•
INSPECTION WORKSHEET FOR DATE: 3/200: TIME: 7 :00AM PAGE: 20
tip/ y v't' 043 4, . • SITE ADDRESS 12411 SIN 128TH AVE CLASS OF WORK:
SUBDIVISION: BELL1AW0OD NO. 3 LOT #: 153 TYPE OF USE:
PROJECT NAME: BOND
DESCRIPTION: Install woodsttove. -
OWNER: BOND, SUSAN PHONE #:
CONTRACTOR: FIRESIDE DISTRIBUTORS PHONE #: 603 - 68443535
Inspection Request Scheduled For: Date: 2/3/2009. - Pour Time:
Code # Inspection Description Confirm # Contact : # Message
699 Meth nicel final 080212 -01 503,595 -3738 411
Corrections /Comments/ Instructions:
PAS % PARTIAL. APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
G L
Inspector.: Date :2— Phone #: (503) 718- <. (�