Permit y ,� CITY OF TIGARD
MECHANICAL PERMIT
1 COMMUNITY DEVELOPMENT Perm it #: MEC201000627
TIIGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2010
Parcel: 1S 134AD09400
Jurisdiction: Tigard
Site address: 10765 SW 106TH AVE
Project: Long Subdivision: WINDSOR PLACE Lot: 31
Project Description: Log lighter installation with fuel piping for fireplace.
Contractor: FIRESIDE DISTRIBUTORS Owner: LONG, JERRY
18389 SW BOONES FERRY RD 10765 SW 106TH AVE
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503 - 684 -8535 PHONE: 503 - 314 -7211
FAX: 503 - 670 -7285
FEES
Specifics: Description Date Amount
Log Lighter (Gas) 12/03/2010 $23.32
Type of Use: SF Fuel Piping 12/03/2010 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/03/2010 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/03/2010 $52.53
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
c
Issued By: '4� � ^� Permittee Signature: - —dr..-
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
12/03/2010 08:36 5036707905 WIDDOWS PAGE 02
Mechanical Permit Application FO Or' lc 1 usI O. .
City of Tigard 0 Received 3
III
u Date /By: � . Q �" Permit No.: ! r t� (.�111�� a m p ?_ . 13125 SW Hall Blvd., Tigard, OR 97223 `,� tP
' Phone: 503.639.4171 Fax: 503.598.1960 �J Plan Review Other Permit:
by
Date Date/By: TFG:ARD Inspection Line: 503.639.4175 w Date Read B orr
.. Internet: www.tigard or.gov J y y m See Page 2 for
.
O� G Notified/Medwd
�, a 11 /111-4 Supplemental Information
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.. :ul ; , ,.;;i ±,{I,•,.,,: ''!i ;, TYPE, �F` ig71,1 IC ii , S " I,' 1 - : :. : „• •I . I ' . .. 1 111 - .I2Ct 10 ,, I ,••∎ t ' , ',A , ,1• - `n , 1, . •
El New construction g Addition/alteration/re. I , , . I1•• t
Mechanic s1 perm fees* are based on the value of the work
performed Indicate the value (rounded to the nearest dollar) of all
El Demolition Demolition Other: mechanics' materials, equipment, labor, overhead, and profit.
1 P n I ( 3T�{GJOi !' El �E i 11 IIII Value. $
•
C El O CCi1----'-""'"•'"'"•''''' Ttill , . - „ !;, i t „ �
1- and 2-family dwelling , 1•11 , .• ;oi� �,.1 ,. ;,, I J14 { ,'i' ,. ` , , •• a t, �, :�' Il , t l
Y g ❑ Co mm ercial /industrial 0 building � ����'�� "�� ��
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Descriptiol, Qty. Ea. I Total
. li , I t ° �y 1 ' jq' r t , , „ I , ' 1 r t
�! +�. I. � , h +`�� r (,, 'I'Cb1� =, i Xl, �'�u,TY !I� f Ililtz 1'If: } _� , ::,.. Heatinglcroling
Job site address: Air conditioning
' D7� :5.1_0 I 0 c C - , (requires situ plan showing placement) 46.75
City /State /ZIP: 7--t-et i Op_ q z...9, 3 Furnace 10 0,000 BTU (ducts /vents) 46.75
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 54.91
L.Dnot 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 heater; (fuel -type, not electric),
in -wall, in-duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent f, it any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances
, 11 a: ,IN ,11�, III I �� ,, +r- !�, � 11 ,
�; 4;; , !•" ' , '„, ! 1 ' SCIt�Ahli01N ,' ,+,InN1 . 1 ,,jl pl1 11 1 +1 Water heat( r
�, . ,� ,�d! � 1;i! ,, 23.32
L �
Gas firepla 33.39
1 n 5t Q .0-4-.0-4- if l ot rS Itm_AQ , le..42..., 1 d 1 A .Ltvo, Flue vent fir water heater or gas
91- L h p_ fireplace 23.32
/ C Log lighter (gas) 1 23.32
Wood/pelle: stove 33.39
Wood firep ace /insert 23.32
y Chimne /lit ter /flue /vent
1.20t2
110`I`Y,IW�V1�'1+'.R , !a ',, , I.,. :., ❑ T, 1�T{��G*614!111 , Y 23.32
I, 0I
Other:
Name: D � ,
23.32
`° `. `'"' . 19 Environmental exhaust and ventilation
Address: /17(.0°'Y- "( ,,� i r 6
Range h nt /other kitchen
tl � � equipment 33.34
City /State /ZIP: 12q aat_et. ,
eve 9 w9,�2,5 Clothes dr exhaus 33.39
Phone: (1 Sin -duct exhaust (bathrooms,
(.52,&' 3 6 ,_/_ 7 j f Fax: ( ) toilet compurtments, utility rooms) 1 23.32
14 �li , h 1= . f= 1,ii:Of x0 `N�'(I "r ! d i 1:1
�.,. 1 r� 16 4,10:0,E11F*0bN, {, i I ! Attic /crawlspace fans 23.32
Business name: Other: 23.32
r� DJ s.YLYr K / J ,../07,,,,
Fuel piping
Contact name: t / Q..4 . 7,te ! j / p M,..?),J r 514.15 for first four; S4.03 for each additional
Address: /85g 9 SLR 061.)17,,,,,A 061.)17,,,,,A � �� J fed Furnace, etc.
1 -__-_ , -
'� "' Gas heat pu
City /State /ZIP: F0r-,, //it
I n� 97e 40 Wall /suspended unit heater
Phone: ( /) , }5/_ 65-02. / Fax: : ( , 76 _ . Water heate.
/ L�C' LLj �• yPt5e,4 i � -o/ ` r�� Range
, ! h ace t
E-mail: h I'! I ,L. � 1 l h. ■ ! 0 pp . life I �,I I I ! fill! , ��f 11 � �: ,:
,�'i;r', I ,� ,,, �, o il 1 l ,i! fjl Barbecue
Business name: / L 4 , 4.5 i 7 4 f G ��� Clothes drys r (gas)
6/ L Other
Address: �S • -gyp n.1.011111,1111# �t i(r• `
�<7 ._5•S f c�� Br7J /)/e.S l°' /'/ c :,i!;, ,, I I '!V1( r >A� ,. ,' E `: I �,i ''' .�.
City /State /ZIP: ��• p J,;:,''
�', G'f�- y,l� Subtotal
�f �� Fax Minimum permit fee ($90.00) �1G9 , i�
a .' e:):55---c:52 / ( 528 & 7d -7,9.,� v
Phone: (
Plan review (25% of permit fee) f"
CCBlic.: 416 74. State surcharge (1.2% of permit fee)
/J TOTAL PERMIT FEE / j ..
Authorized signature - A .,./4.4 1,4_ �'Cd' This permit :,pptication expires if a permit is not obtained within 180
(// lays after it has been accepted as complete.
Print name: ,t 14 fie/lP_ ( Date: /./�% /e „ * Fee metho, ology set by Tri- County Building Industry Service Board
I:1Building \Permits \MEC- PermitApp,doc 10 /O1/09 440-4617T (11 /02 /COM /WEB)