Permit q CITY OF TIGARD MECHANICAL PERMIT
74 n ! COMMUNITY DEVELOPMENT Permit #: MEC2010 00402
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/11/2010
Parcel: 2S103CD05300
Jurisdiction: Tigard
Site address: 11660 SW TERRACE TRAILS DR
Subdivision: TERRACE TRAILS Lot: 14
Project: Petersen
Project Description: Gas fireplace and 85' of gas line.
Owner: FEES
PETERSEN, DALE STEVEN & TRACY A Description Date Amount
11660 SW TERRACE TRAIL DR
TIGARD, OR 97223 Gas Fireplace 08/11/2010 $33.39
Fuel Piping 08/11/2010 $14.15
PHONE: 12% State Surcharge - Mechanical 08/11/2910 $10.80
Minimum Fee Adjustment - Mechanical 08/11/2010 $42.46
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 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: ` . 2 _ e __c-� -- Permittee Signature: " i
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.
Mechanical Permit Application , , , Foa ohhlcL 1.lsl. ()Nu
City of Tigard , ` , QA0 Ejew R • 13125 SW HalI Blvd., Tigard, OR 97223 1 � ( (d L� �� >a Pl
Phone: 503.639.4171 Fax: 503.598.19 0 �C? Other Permit: / �L ^ u
Da
l' 1 G A it ll Inspection Line: 503.639.4175 . ,"i Date Ready /By: ® Page 2 for
Internet: www.tigard -0Ggov , � ; Notified/Method: KM Supplemental Information
IC :? ; .! .);IiCe hh ". ; f .�.. .,. „e � l.. i ' tl` I !'I • r i . , ,
I'�'.,L ..,i t 1 .:.� ; l,• :1Pi ii; .,. .i� - r• f Hill i:: {I:p .;,. I .I . !I,' i , : .. , , , qd ..v i' ,„ �,�, Pa
1 ' 1 j ?In I li,lu'p �,j g �1 0 (4 �;w i� l! �,qµ iril4 E � uil r 1 ,II ,11 f ,., l i y I ,jt7�(�!' yyy ,,, y �� jAr j � 7 f 1 1��', {/9�'iifd �ty�,t� ,. )j�'
... �' '1 ! i' , . , Il I � .III P'TI .�!F �!r -^.i 1 14 �I 1 1� � , �! �� i, 1, ,4. Il I i � (jlli 11 f r•�1nT I�IrI111I1�1'filrl� II t' I^•,_"
Mechanical permit fees' are based on the value of the work
❑ New construction ;I Addition/alteral ion /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
.'!,':14'. , . ,, ,.. „
c 1 � , e „ ""1�ti1'!'"(,1I�tY i!S!1F' �14 h' I, ;';' i !jIIIIIiI Value: $
1- and 2-family dwelling ;.,'; 1 . f e t . r. ' °�d6Cul " ' oilialtie °. 1? i111 L
y g ❑ Commerciallinc ustriat ❑ Accessory building
❑ Multi family 0 Master builder For special information use checklist.
❑ Other. Description I Qty. I Ea. 1 Total
( � { , ,. ,g ,, .. r + f 11 it ill � � � t111 '!i
1 t , t, JQ3 ST r I1�t ,00.11 j?l'I'p AND LQC,k1 I,OiN' I , il � 1; i� i . 1 Heating/cooling
r p _ /h� ` Air conditioning
Job site address: 1 f 4Lp tJ r L ) rt�4 u ice. • a, /.. ! 5 j Or (requires site plan showing placement) 46.75
City/ State/ZIP: f l q y- I(r h � 2 7 a 3 Furnace 100,000 BTU (ducts/vents) 46.75
' Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldgJapt. no.: Project name: J 34,1_5, ji 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
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map/parcel gno.: Other fuel appliances
+ ,, ,n {iill3 ` v �1i� I d�:' � j i e : 1 pint " :d:,. ,rpnFn po- a.� .,, ,,� { a l }:9;;; _ ,r i,
',1r v'y!:111�1,I ,I, IIL . "�t��l l l11!II! »M y,* i.Pali i` 1!n !; . l.i. .n!I. .
, i � ,, ,'N7. - � _��' ",•jit, ,1 �'' '' �dl,ll, -:� ,. igl,i , . . ;.i.i� � �1. 9
1 /� Gas Waterheater fireplace 2332
1 33.39 3
1 n 5 ././ q .2 . S 'Fl rs p /2 ('+P Q d f5 t Flue vent for water heater or gas
fireplace 23.32 2-3, 32
U-P cite s b :ii A ' Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
" R`4'+���� I� ' T '' . !Ih ,. Chimney/liner /flue /vent 23.32
;1
rl0 .`,' 0e0,; f:!II1 .0* t { , � . EN+1 ';lira! . ,lI,;.Ir Other: 23.32
Name: ( ")Q ) t° I ra_e_ii ""1--P4 err stn Environmental exhaust and ventilation
Hie �/J tS Range hood/other kitchen
Address: LL ) � el ee [ r� 7 5 ! - equipment 33.39
City/State/ZIP: 77 rC i e4 973 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (5 • } � �p�� Fa c: ( ) toilet compartments, utility rooms) 23.32
•'p''1i` , ' A , { �.1 1 �, - �! I , t , If t
1 l i I { Attic/crawls ace fans 23.32
l ' : 4. 1 0 ,.?1i+ "'i!, , ' j. , ii14: ,• ; !t R�!` ,, , 11,i„ p
Business name: F r - , de, o t I. L , Cc c2€
Fuel piping
t in 23.32
P g
Contact name: i_h 1 1 e.., 60 S14.15 for first four; $4.03 for each additional
Address: if , 9 5i.0 1nhr -.�J �i-t Furnace, etc.
� f �� Gas heat pump
City /State/ZIP: ? ? .e._61_, L -Z!j i Q �t YJ 9 ✓� ?( r 1 7 Wall/suspended/unit heater
Phone: ( 503) 5 s - 3'7.2 3 Fa c: ( .5; � e 70 _ 7 s Water heater
�
+ Fireplace 1 / - +f
E -mail: r
-
re ''t �T° d C� • Co
I I (':il "iIl I , . :_•:� tP' ol, ,.n, • .,: ' Range
. ::
1 ii , II!° ;11 I 1, I 1{ r l l, ! I!I' ,4 i '.:: At1 , . Barbecue
lai,lil• tl., i III Ill+! ',i1�1!'.:r,t.q lfl, , ti. � ". 1'i�'�,',���'� , ,u . j�.lLI+ . .I!s,,!h p
• Clothes dryer (gas)
Business name: t re Si cvco 4) '51._ . 0,9 �. Other:
Address: / 8 3RD Sco /3 or) r. 5 r� L, ° i , .i;; �' II" l?;I 0440 0144 f,{ � I gig MN ij! lil
City /State/ZIP: porz. 14fi /. Q/2 9'2 Subtotal <7e. FL" _ --7 Minimum permit fee ($90.00) , q� _DO
Phone: (57)3) $ _ 3 ' . -7 Fa ': (S } /o7 - /w? 5 Plan review (25% of permit fee) •7/1,
CCB lic.: .e1/619,7 9 State surcharge (12 %ofpennit fee h 9. Re )
TOTAL PERMIT FEE /017 • 7,
"�,�� This permit application expires if a permit is not obtained within 180
Authorized signature: < C,1e
Z ._ y` This days after it has been accepted as complete.
Print name: �-�
j am/e. _ 4 - 1'.2 - l 1 I Date: $ /6.... /a • Fee methodology net by Tri- County Building Industry Service Board
1: 1Building\Permiu\MEC- PermitApp.doc 10101/09 440- 46I7T(11 /02 /COM/WEB)
O 39dd SMODUIM 506L0L9E05 b5:L0 0ToZ /0T/80