Permit CITY OF TIGARD MASTER PERMIT
o COMMUNITY DEVELOPMENT Permit #: MEC2010 00536
1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/28/2010
T
Parcel: 2S103DB03900
Jurisdiction: Tigard
Site address: 11285 SW QUELLE PL
Subdivision: GENESIS NO. 2 Lot: 37
Project: Jameson
Project Description: Gas fireplace and gas line installation.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: First: sf Basement: sf Left: Parking Spaces:
Height: Bathrooms: Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: sf Right: Detectors:
Total: sf Value: $0.00 Rear:
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Catch Basins:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures:
Tubs /Showers: Garbage Disp: Water Heaters: Water Lines: Drains:
Bckflw Prevntr:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers:
Natural Gas Heat Pump: N Hoods: Other Units:
Fum <100K: Vents: Woodstoves: Gas Outlets:
Fum > =10OK:
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr:
Ea add! 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 401 -600 amp: Ea add! Br Cir:
601 -1000 amp: 601 +amp- 1000v:
1000 +amp /volt:
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet
Owner: Contractor, Required Items and Reports (Conditions)
JAMESON, DAVID H /PHYLLIS A FIRESIDE DISTRIBUTORS
11285 SW QUELLE PL 18389 SW BOONES FERRY RD
TIGARD, OR 97223 PORTLAND, OR 97224
PHONE: PHONE: 503- 684 -8535
FAX: 503 -670 -7285
Total Fees: $100.80
This permit i- ' - . _ i - • •' -ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with = ..roved 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. ENTION: Oregon law re. ' -- you to follow the rules adopted by the Oregon Utility Notfiicati nter. Those rules are set forth in OAR
952 -011 -0010 through OAR 952 -001 • 00. o y obtain a copy of the rules or direct questions to OUNC by callin 3.246.6699 or 1.800.332.2 • • .
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, ...4....M.,‘ _ By...4....M.,‘ _ Permittee Signa re: / /' i '
10/26/2010 13:14 5036707905 W I DDOWS PAGE 01
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• .:'' . ., _ .. • .,. Phone: 503.639.4171 Fax: 503.598. i 960 pateay: . Other Penn&
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l , 2 ,, 111) Iitspection Line: 503.639.4 A l-
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.. • . . .. : • , 1ntemet: wWW.tigard-or.gov
Okd ' Notifi rie ed/Method: Soppienientat informa
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, [3 New construction A6Acidition/altemtion/rbIaCtinent • Mechanice .pemiirfees°' are based ori the value of-the work
perforrited. Indicate the Valiie (roimiled to thc iteniest dollar) of all
0 Demolition 0 Other: mechanical materials, equipraent, labor, overhead, and profit.
Value: $
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41- and 2-family dwelling 0 Commercial/industrial 0 Accessoty building 4. , ........t-to...,40:1 J ,u'.1 .
, For Spe,C i1 use OiCklfri,
0 Mb 4i 0 Master builder 0 Other.: . . . . ,
Description .• • 1 oii. 1 I . t.6iiii .
L T -,. ... '-': :;.. :: 1: Heating/cot ding
Aifeentlitieiing or heat pump
Job site address: ',ail 5iji 4,2,0A.% c....... . (requires site. Ilan iliowing platement) 14,60..
City/State/ZIP: Tz , Furnace 10C ,0011, BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg./apt. no.: Project name: Oia-MeS^r) Gas heat pui np 14.00
Cross street/dircctions to job site: Duct work
. . .. .
Hydronic be : water system 14.00
Residential! oiler (nidiater or •
• .hydrenic). , . : , . .. .. .14.00
Unit heaters fuel-type, not electric) . •
in4alt,..iarthict suspended, etc.. 14.
.
•
: . ... .. .
., Flue/Vent for any of above 6.80 ... .
Subdivision: Lot no.:
• Other . 1 0,00 .
Tax map/parcel no.: Other 'tact a ?ponces . . .. .. .
. .
.W.f•::?•; Water heater 10.00
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Gas fireplace / 10.00
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Flue vent for water heater or gas
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gA, fireplace
ix Jitist Incr. . es) 16:06
, Wood/pellet t Mite 10.60
Wood: fireplace/insert . 10.00.
chiindey/line /flue/vent 10.00
• "..!' .. ... - : : ':',..,:', 4. 140i.jii . SitftWIld.WROiriN,a54;:ii';:tgS1..;t;11Tri,...':?1‘,41.11 1 40fAiltt0:a...'....f1=0' .
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.. . .
Name: Ph li .5 (Ia..,73e .cryn Eirdriminieiii el exhilust and ventilation . •
Ringi
Address: /11 LI Z 14 e jk, c.....
eilnipfnent , 10.00
City/State/UP: 727:94A ne Cicith ea dryer. tiihaust. 10,00
,
sikgukNa 0 lutist (bathrooms,
Phone: („52)3) /pa° -- g 4, 5--9 Fax: ( • ) toilet cOmparhnents ,. utility rooms) 6.80
AtP W4Alig10% Att'ciraw'sPax fans 10.00 ..
Other 10.00
Business name: tfrit... ta lp . D,... ap. z! ,,,,
Fuel.piping
Contact, name: Li IA ji oc , _____d
. . . $A.441 for first four; $1.00 for each additional ,
Furitace, etc. .
Addreeir 4 c,7 . 4 1/Lf , i e j el
Gas fietit puinp . .
City/State/ZIP : pnoyez ,e,,e, 9 2-V
/ WallfsuspendeVunit heater
Phone: ( 6 •3 Fax ' ( /t17Z3 - -18.5 Water heater
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Fireplace
E-mail: . )4r - . to-,,--) Rang
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Clethes dryer (. i as)
Lus_in_es_s n_atn_c__Li,:i D,, A ,,, ef_
_ otnc
kddi-ess: /233sq 640 Boo Jd ,.....- ;:...,:. • PtItktiANIteig:.,Phighlithl.At ,. , ., - ..... ....,..
:it State/ZIP: _if3t_dt(z.l ")., SubtotAl
5 79 S" _.7..-3 ..% •=. I Fax: (grIt 2) 1 _'''',.. ...._"7V1 ---------- - ($-- 'I . 476 LI°
o- _'.____..s.. v rLv Jew (11.57. of per mit Yee)
:CB lie.: 4 7Ci S.
ac surcharge (12% of perinit lec)
. _
TOTAL PERMIT FEE .. ,M /00i. FrO
,uthorized signature. ee,...494, This permit appl cation expires if a permit is not obtainer' in 180
day! after it Ems been accepted as complete.
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rint name: r) Ae, ... ....:. . Fee methodoloi v set by Tri Building Industry Service Board
Build ingTerra us \ MEC -Perm i L A ppdoc DI/ Z 9167 440-46 i 71' (11/02/C011:WEB)
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