Permit „ CITY OF TIGARD MECHANICAL PERMIT
N 2 • COMMUNITY DEVELOPMENT Permit #: MEC2011 -00119
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2011
Parcel: 2S102DB06900
Jurisdiction: Tigard
Site address: 9169 SW HILL ST
Project: NELSON Subdivision: Lot: 0
Project Description: Gas fireplace insert with fuel piping.
Contractor: T & K MECHANICAL Owner: NELSON, DOUGLAS S /JEANNE M
PO BOX 116 9169 SW HILL ST
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503 - 844 -9173 PHONE:
FAX: 503 - 846 -0195
FEES
Specifics: Description Date Amount
Gas Fireplace 03/22/2011 $33.39
Type of Use: COM Fuel Piping 03/22/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 03/22/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 03/22/2011 $42.46
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 NC by calling 503.232.1987 or 1.81! 2.2344.
Issued B --vermittee Signature: t �! ' /
Call 56 ` - ` ° .6 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.
03/21/2011 15:23 5036269138 HOT SPOT FIREPLACE PAGE 01/01
Mechanical Permit Ap i deation I '" . ()I II( I : I. , r (. \ I 1
City of Tigard 4)1S) 3f ri► Permit No.: . - t - - v /
13125 SW flail Blvd., Tigard, OR. 97223 , Plan Rcv i c , v
P h 4171 fax 5 one: 503.639. Other
I I , ; 7, 1 , 1: , Inspection Line: 503.639.4175 \ � � Bey: Dail Ready/By: Aids: 121 See; Pape 2 for
Internee Www.tigard- or -goY 0 Notified/Method: j - > (. 3upptemeurallnformadoo
• TYP OF WORK • "Sr' • COMMERCIAL FEE" SCHEDULE — USE CBECKLLST
'1. Mechanical permit fees* am based on the value of the work
❑ New construction j Addition/alti 000/rep1acemeet performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: o mechanical materials. equipment, labor, overhead, and_profit.
Value: $
' •CATEGORY OF CONSTRUCTION -
' RESIDENTIAL EQUIPMENT / SYSTEMS. FEES:
6)(1- and 2 -family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist_
❑ Multi- family ❑ Master builder ❑ Other: _ Dt scription Qty. Ea I Total
JOB SITE INFORMATION AND LOCATION Retain/cooling
! \\ Air conditioning site atldre9S: (17 (p 5th/ ill (requires site Pfau allowing placement) 46.75
Furnace 100.000 BTU (doas/veoaJ 46.75
CIry/StatrJZIP: 7-2 Q Y Y `7r Furnace 100,00111- BTU (duels/vents) 54.91
SuitelbldgJapt. no.; Project name: 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) 2132 -
Unit heaters (fuel -type, not electric),
— in -wall, in-duct, suspended, etc. 46-75
Flue/vent for any of above 2332
Subdivision: Lot no.: Qtly, _23.32
Tax map/parcel HOE: Other fuel appliances _ • DESCRIPTION OF WORK Water heater 23.32 1
Gas fireplace i riSPY4 I 33-39 3 3, 3
gas 161 r v�el l C,s 1 .SQ ✓(L Flue vent for water heater a gag
fireplace / 23 -32 a 3,
Log lighter (Ens) 23,32
Wood/pelJet stove 33.39
Wood firepla reinsert 2332
Chinmey/lineriflue/vent 2332
A PROPERTY OWNER I Q TENANT Other-. 23.32
Name: 1 1.4 QO vk Environmental exhaust and ventilation
J Range hi dlodler kitchen
Address: C 9 J � (J I j i // Si- • , silent 33.39
City/State/ZIP: f el a /J q� Clothes dryer exhaust 3339
• ( Singie-duct exha►tst (bathrooms,
Phone: a3) (3 , - i 36 t > Fax: ( ) toilet compartments, utility rooms) 23.32 - H
APPLICANT ❑ CONTACT PERSON AMe /crawlspace fans 23.32
Other _ 2332 _
Business name: Fuel piping
Contact name: $14.15 for beat (oar; S4.03 for each additional
Furnace, etc. j
Address: Gas heat pump
City /State/ZIP: - WawVsus niledlunit heater .
'
Phone: ( ) I Fax: : ( ) Water heard
Fireplace / — /'V• i
E -mail: - Ra _
CONTRACTOR Barbecue
Clothes I = lc )
Business name: d K' wCYIQ VIl Cc0 Other
Address: D .•4 I ( i I b MECHANICAL PERMIT FEES*
_ City/State/ZIP: �o G voJe 0 III 1if, Subiota ( e)
Min perm fee (590-00
Phone: x 35'1 ' S�Lc/ 4 Fit: ( ) Plan review (25 %of permit Ie) _
CCB lie._ 10 1 1 & E State surcharge (12% of permit fee) /0, go
' TOTAL PERMIT FEE / U 0 , CSC)
Tins permit application expires if a permit B net °Warted withal 180
Authorized signature= . - J . , .i • i 4 -7Z — 1 I day, after It has been accepted as courpteoe
3", ■ I lrt,1 e 4th t✓ - Hare. ' Fee methodology get by tri- county Buildigt Indantly Service Bid