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Permit CITY OF TIGARD MECHANICAL PERMIT 111 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00050 TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/01/2011 Parcel: 2S114BA02300 Jurisdiction: Tigard Site address: 9810 SW SERENA WAY Project: EVANS Subdivision: PICKS LANDING NO. 2 Lot: 116 Project Description: Gas fireplace insert, chimney liner, and fuel piping. Contractor: FIRESIDE DISTRIBUTORS Owner: EVANS, PETER J 18389 SW BOONES FERRY RD 9810 SW SERENA WAY PORTLAND, OR 97224 TIGARD, OR 97224 PHONE: 503 - 684 -8535 PHONE: FAX: 503 - 670 -7285 FEES Specifics: Description Date Amount Wood Fireplace /Insert 02/01/2011 $23.32 Type of Use: SF Chimney /Liner /FlueNent 02/01/2011 $33.39 Class of Work: ALT Type of Const: Fuel Piping 02/01/2011 $14.15 Occupancy Grp: 12% State Surcharge - Mechanical 02/01/2011 $10.80 Stories: Minimum Fee Adjustment - Mechanical 02/01/2011 $19.14 Fuel Fuel Types: 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 503.232.19; . ='r '. 344. Issued By: _s _ - Permittee Signature: ∎ Call 503.63 - . .y 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. 01/31/2011 10:05 5036707905 WIDDOWS PAGE 02 Mechanical Permit Applicat CE D FOR OFFICE tl5l< ONI,1 City of Tigard 0 Received F .� Date/By: Permit No.. /G _ ,cam t 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review f " qi� 1 �l.C�r Phone: 503.639.4171 Fax: 503.598. l96 C IT Y OF TI GARD D ate/ Other Permit: Re T I G A R I) Date Ins Li 503 Ready/By: )arts: 6i See Page 2 for Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: 3- Supplemental Information �.' .,,. : �N f jp itii ill'll 11 Ii,(� I� I i;! , w . t : F � I � , ' ,It i l tt� „ � r e i�u�aili jllb�1f' + 1e lac ' N , t .... ,�, � . ,, ❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanica materials, equipment, labor, overhead, and profit. I; II l il II II I .ttoL OIEtit <;0 Co14 ` i4110i i i I}IIji ' I I f 1 l` 1'p; ,, . Value: $ . ... ., i�J tea - IIII oast P i 1111 fIIIN 1 - and 2- family dwelling ❑ Commercial /industrial dt`il�i ..,A Ili " �t ❑Accessory building I i x.. El Other For special information use checklist. ❑ Multi family ❑ Master builder Descriptim I Qty, I Ea. Total I1 , Il I Sl I'I INFOR]ATO VIIN 1 D LOCA I !II III ,l . 4 � ., I - Heating/cooling Job site address: Ole /D ...5.9 , � � Air Tres sti pl �`�"S��°l '� � r i'Z > (requires site plan showing placement) 46.75 City /State /ZIP: - . 0 e __ 97 Furnace 10),000 BTU (ducts/vents) 46.75 Furnace 101,000+ BTU (dncts/vents) 54.91 Suite/bldg. /apt. no.: Project name: v`�� Heat um P p 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic h )t water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heater.; (fuel -type, not electric), in -wall, in- luct, suspended, etc. 46.75 Subdivision: Lot no.: Flue /vent f r any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances i i'E7SCRIPTION I1 ; WOR ( i id ! I p I i1i�1 ' i i' ( Water hear r 23.32 (� j / Gas fireplace ,L 33.39 LL./' / (1I-' I)1r)Pij f 1 ry).f' 1"' Flue vent ft r water heater or gas +,� 7/o g25 1 /75 p- ., fireplace /L 0 23.32 Log lighter (gas) 23.32 Wood/pel le : stove 33.39 Wood firep•ace /insert 0 23.32 I i I l i iI . `t b / - l II 4 lII I iiiiit j I Ii Chimney/lb lerlfluelvent 23.32 � i Other: 23.32 Name: per g Environmental exhaust and ventilation Address: l ei? Ls Lt_) 3 r a. Li ) _� q e o�ctother kitchen 33.39 City /State /ZIP: I Lg a r\ Q /� r�i 1,2 Clothes dry :r exhaust 33.39 Phone: F— � Single -duct exhaust (bathrooms, 7 ( ✓b0 . 1-I O- r3 /QUf Fax (4,,,,/,/,) / to compartments, utility rooms) 23.32 1 1 14 1' r1Ptifit 1VT ; ' +i+l t m 4elirr j ..gON iI Attic /crawl_s pace fans 23.32 Business name: _ /� c Other: 2332 rids 1 �' e' (t [3, Fuel piping Contact name: Jare_i 6e.--- L c d $14.15 for first four; $4.03 for each additional Address: 1R' 3f t, 0 T yvpre j F:::, Furnace, etc. c J I" Gas heat pu np City/State /ZIP: '—i4 ' r� Ll_ J'� d�- l Wall /suspended /unit heater Phone: ( —'] 5'_ R .2223 Fax: : (9?]i) 4a 1/ ? 5.-65-C2/ Water heate �r f Fireplace f E-mail: , , " r'I'} ! ie z4) e ; ei c(e1 (_' _ /e Range ` , ::'C rteAc1 'I .1 ,,n _(1 !!1 Barbecue Business name: l r -e 51 de D s4rl .6L1` r-c ©,� Clothes drys r (gas) / 4 r 3g Other Address: / (� u� ei °� P P �I' I!1!M IIIIIIII I�, j ! v� 4 0 ? 1 **I!I ' �!IIi;ijilli! City/State /ZIP: or / L ,, _ _ �, , O n q , Subtotal 4,0. j 1 Phone: O 5;91- 3 � 1 � Fa Op_ / &7 "'[[[�� Minimum permit fee ($90.00) p () 7O 7�� Plan review (25% of permit fee) 9 °ta.-$�- CCB lic.: /71* e ' State surcharge (12% of permit fee) /J ),,, „, A TOTAL PERMIT FEE , . rb Authorized signature: - 4 `.. 4 -• ” �� \''� , J 'L� /�I This permit application expires if a permit is not obtained within 180 {i ," t TCT ( days after it has been accepted as complete. Print name: 1 C ,) lc L, >YYI Date: /._ 3 j ._ j f " Fee metho.Iology set by Tri -County Building Industry Service Board 1 ' \Building \Permits \MEC- PermilApp.doe 10/01/09 S1 440-46/7T (11 /02/COM/wEB)