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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2011 -00112 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/17/2011 Parcel: 2S110DD09000 Jurisdiction: Tigard Site address: 15840 SW HIGHLAND CT Project: Noel Subdivision: Lot: 0 Project Description: Install gas fireplace insert Contractor: BIRDS CHIMNEY SERVICE Owner: NOEL, ROBERT M & NANCY E NOEL 6604 SE CHARLES ST 15840 SW HIGHLAND CT MILWAUKIE, OR 97222 TIGARD, OR 97224 PHONE: 503 - 653 -4999 PHONE: 503 - 336 -0489 FAX: FEES Specifics: Description Date Amount Gas Fireplace 03/17/2011 $33.39 Type of Use: SF Flue Vent for Water Heater or Gas 03/17/2011 $23.32 Class of Work: ALT Type of Const: Fireplace Occupancy Grp: 12% State Surcharge - Mechanical 03/17/2011 $10.80 Stories: Minimum Fee Adjustment - Mechanical 03/17/2011 $33.29 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 stions to UNC b calling 503.232.1987 or 1.800.332.2344. Issued Permittee Signature: 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. Mechanical Permit Application 1 OR (1I I I( L l s I O' l III City of Tigard may_ o3 mHm Permit No: f�'nili- po / /a • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • Phone: 503.718.2439 Fax: 503.598.1960. Date/By: Other Wit: 1 1 , . \ , 1 , Inspection Line: 503.639.4175 Date Ready/By: Juris: B See Page 2 for Internet: www.tigard -or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees' are based on the value of the work ❑ New construction Addition / alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: S CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES' ® I - ❑ Cotnmercial/mdustrial ❑ Accessory building For pedal information use checklist ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: / 5'1 iD S. Li. /7/...7 lr l4 r/ d ti (requires site plan showing placement) 46.75 Furnace 100,000 BTU (ducts/vents) 46.75 City/ State/ZIP: r / a* ,Q 0 ©'4? 2 7 2 y Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: I Project name: Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 • d i e er dpi v$ T'p Hydronic hot water system 2332 0 'A l hydronic) 23.32 Residential boiler (radiator or /1'�lC�l 67 - 7" /J /6 �'c 4 /4•,/a a..--, o ,S 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. 2332 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 Gas fireplace Z Z, 5e / 33.39 Flue t gratC 1 fiyatesror��s /` / y . //� 23.32 lighter (gas) _ 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 (1 PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent - 23.32 Name: Other. G Arc p o e t 145Fa . 2332 �od e<-f /y, >< /f r e2'Vey , ` . , 4, Environmental exhaust and ventilation: y � / // Range hood/other kitchen Address: lj S� 49/ /4,7 C f equipment 33.39 City/State/ZIP: j -/ 94.-4e v/ r 72- 2 9 ' Clothes dryer exhaust 33.39 - Phone:152)3 ) 33 . U Fax ( ) Single-duct i t compartments, s (bathrooms, rooms) s, �/ � 'tmn utility ro 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 Business name: ' Other: 2332 Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat pump City / State/ZIP: Wall/suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace • E -mail: Range • CONTRACTOR Barbecue Clothes dryer (gas) Business name: V/1 C___% /flff7e y e6 S G Other: Address: 66 dy s (r42< /mss ..1 MECHANICAL PERMIT FEES' City/ State/ZIP: Ai / ,' k t elf 972 2 Z Subtotal Minimum permit fee ($90.00) Phone: (Sd3) ‘53_ 4/9g7 Fax: ( ) Plan review (25% of permit fee) - CCB lic.: f 55-h/y 1 6/gin State surcharge (12% of permit fee) 1 TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. •+ . .� _ � . —s, I .. . / i / • Fm mwh.vinlnm• ,.t h.. T.;1`n..nh� R..:I.i:nn In.i..cfn• C..nriro Anor i