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Permit CITY OF TIGARD MECHANICAL PERMIT Il l 8 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00186 Date Issued: 04/30/2009 T [UAR.o 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103DC04700 Jurisdiction: Tigard Site address: 13855 SW 114TH AVE Subdivision: VIEWMOUNT Lot: 35 Project: Vaternick Project Description: Install gas fireplace and gas line. Owner: FEES VATERNICK FAMILY TRUST Description Date Amount 13855 SW 114TH AVE Gas Fireplace 04/30/2009 $10.00 TIGARD, OR 97223 Fuel Piping 04/30/2009 $5.40 PHONE: 503-639-9661 12% State Surcharge - Mechanical 04/30/2009 $8.70 Minimum Fee Adjustment - Mechanical 04/30/2009 $57.10 Contractor: FIRESIDE DISTRIBUTORS 18389 SW BOONES FERRY RD PORTLAND, OR 97224 PHONE: 503 - 595 -3726 FAX: 503- 620 -5699 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue Total $81.20 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 applica . will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of is ance, or if work is sus nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Jtility Notification Center. T. ;- les are set forth in OAR 952 - 001 -0010 through OAR 952- 001 - 0100.. u-f#ay obtain a copy of the rules I ued By: I I Lam( I Permittee Signature: / c ' ;, j�'" ( (2 Call 503.639.4175 by 7:00 a.m. for an inspection that b'ustness day. 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. 64/28/2009 08:50 5036707905 WIDDOWS PAGE 02 • Mechanical Permit Application IF r FOR {lrrl(E l sr. ONIA' Received Permit No : H D a 9 l City of Tigard APR 2 8 Date /By: MO 13125 S W Hall Blvd., Tigard, OR 97223 2 00 9 Plan Review 111 I Date/By: OtherPermir Phone: 503.639.4171 Fax: 503.598.19 T I c : A I' I) Inspection Line: 503.639 � �� OF 1 Date Ready/By: J a' WI See Page 2 for Internet: www.tigard or.gov BUILDIN C ARD Notified/Method: / Supplemental Information r ' r r 1 ' DIVISiO I I I" i {III! 'Eil {P) I lli �o! ngr9 } n "Ij l q: p PI n n nuu n n rm�t rmt r a I n m n 7M ,. I ; g111 s r l ni oIilli�'P qt+ ��tr Fy(IN(l i)` i ;� l iEl l , , g I i . ' �vf ou 141 1 � I l'N� I fli IAN I 4 r i l � °'>I a:>r i� p li . �, , l l ,alb, '' !I! r i r 'E , IIjil.tGll �,',. .IIIIIi: rltu�.:r jI I:III..l ' �xG�NMI I, r nrt u mt mr NJ Mechanical )ermit fees* are based on the value of the work ❑ New construction ❑Addition /alteration /replacement performed. I idicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical I naterials, equipment, labor, overhead, and profit. r r i 1 1 1 11011 I� "I illii ,t i ilgill llll ,,: !Ai Value: $ ju 1 '': Iii! ,� Si ! !! >4r!' ri:Iill „ 1 1, - I ill.l a ;i ' u .1!III/ i... , IN p x {ml ; un I :p i iR,qipera rplavr ii I� r �m� x II I , „, ©1- and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building I1hi ! ,' ° I n ti l l �I� < n I! i iti naddil 17n " siiw n J , . . For special Information use checklist. ❑ Multi - family ❑ Master builder ❑ O ther: Description I Qty. I Ea. { Total IK I 1, : ,11 . lit (1 S tl�01 l'ItI0N,� h� , 0 I ti j ` II I �' I "' 1 ' I� ;I� 111111 Heating/cooling IIII �� J!l it ill, n3 == ":. 104., c' P ,� r� r•:� )�. -� r , I . . i., , u ..i. rL II, 1 11 .. C • `', ) ^ Air conditio or heat pump Job site address: 13 t 5 5 w ) I LI + A '\/ t (requires site plan showing placement) 14.00 City/State/ZIP: ad () R a1 � Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100 ,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: 1 Project name: Gas heat pulap 14.00 Cross street/directions to job site: Duct work 10.00 Hydronic hot water system 14.00 Residential - toiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -Duct, suspended, etc. 14.00 Subdivision: I Lot no.: Flue /vent forte of above 6.80 Other: 10.00 'Fax map /parcel no.: Other fuel appliances I 1'1 l i 1 1 ,ll>•y' U1 l} r r . f+il1 1 I nln�aiwin 43.: i ..,',11 a l ii , 1 ,1111, 11 I i I !` .; l I I ill Water heater 10.00 ,J..I ,1;1!11 'It.. �I 1 � blid i I h1 litid . I I 1t MAIL in) ., R^ a ., ., , '.6 : .� - � � li lli l l l w E I ! I lllliti 'MIL. ' t Gas fireplace f 10.00 1 � 1 1\Q and £ 1 S . ..cit. - Q._ �Q._ 0 � Flue vent fc r water heater or gas fireplace 10.00 Log lighter 10.00 Wood /pelle stove 10.00 Wood firer ace /insert 10.00 , 1 ' ' � of Ili ' ' ' ' ' 1 1 I 1 i Chimne /lit ter /flue/vent 10.00 ■ ' i I , I� i ' 1�> 7 I ' ,; Il; 1 ', F { II . 1 ' ! '':' ' :� Other: y 10.00 Name: p.ecei vaa. RA )yam Environmental exhaust and ventilation Address: ' 3 0 5 5 5- w- /) I-Ph h A v_ Range hoot /other kitchen equipment 10.00 City/State /ZIP: - iziCu O q 7 Clothes dryer exhaust 10.00 1 Single -duct exhaust (bathrooms, Phone: (� (� Fa ! �l �c I III 1 compartments, utility rooms) 6.80 (5 3 ( ) toilet comp ;11 1I 111 III I I X !'1 " ! t ! I` I R �' Attic/crawl pace fans 10.00 ,.il: },, , lull. �. 1l , -li < 111 Other: 10.00 Business name: R r p S 11j p i s+ n ' 0 re` C D n Fuel piping; Contact name: A l �� 11 $5 .40 for first four; SI.00 for each additional Address: 1 X32. el 5� gO, nES �on� f � Re Furnace, et;. M Gas heat pump City/State/ZIP: PO � ` + , n t 1) fi J Wall /suspe ided/unit heater O Phone: (6 t)' 5 q 5.3 f a W ` Fax:: 5 D3 to 5 u ! n of Witter h t , E -mail: Range II I i 1 I' 1L1.' Ii l 9t 1 1 11 ;1; l ,,, 1 {{' t ��y!((;„��}j�f�,� t' 1'I, a 1 uli1 i 11 ' I i '11� .,Llt i „ „ n, ,.! f 1 ll`t`a i11 ri �II ■ � ! �111iirt ",Il , , • ; :11,111' ! t 1 „ :,gulag �IhJI �i r,!,. 1 �1 1. l Barb M Business name: �S lt�N S O r Q t� D Clothes dr er (gas) Address: 114Pp l �, I I ....____C:3 �curn P GZS rxbp v to pl I, , I����±k�i�';� ?���, Il ill' '.1 1,.,, City /State /ZIP: Subtotal Minimum permit fee ($72.50) Phone: ( ) Fax ( ) Plan review (25% of permit fee) CCB lic.: Li 0 ei 7 State surcharge (12% of permit fee) (kilOya.a TOTAL PERMIT FEE S 1 , aD This perm t application expires if a permit is not obtained within 180 Authorized Signa /l days after it has been accepted as complete. Print name: f1m /4 t o s 'f [? fO I Date: -V O / • Fee methodology set by Tri -County Building Industry Service Board 1:\ Building \Permits \�.EC PermitApp.d01 /119/07 C 440.4 (I 1 /02JCOM/WEB)