Permit CITY OF TIGARD MECHANICAL PERMIT
° ` COMMUNITY DEVELOPMENT Permit #: MEC2011 -00517
Date Issued: 11/16/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S112BA03200
Jurisdiction: Tigard
Site address: 14070 SW 80TH CT
Project: Sandlin Subdivision: WAVERLY MEADOWS Lot: 22
Project Description: Install Osburn wood fireplace insert.
Contractor: BURNING BUSH CHIMNEY SERVICE Owner: SANDLIN, JAN K TRUST
350 SW 7TH ST. 14070 SW 80TH CT
GRESHAM, OR 97080 TIGARD, OR 97224
PHONE: 503 - 329 -0831 PHONE: 541 - 915 -8797
FAX:
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 11/16/2011 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 11/16/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/16/2011 $66.68
Occupancy Grp:
Stories:
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 503.232.1987 or 1.800.332.2344. /
Issued By: �l/ Permittee Signature: v' V j9 //0L.�� -7o"
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.
11/14/2011 19:26 FAX 5036202787 LakeOswego al 001/002
Mechanical Permit Application r n.H
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11111 City of Tiga -►���� �,t5 (/ 1 ' r � arma E71 A/
r 13125 SW Hate Blvd., Tigard, OR 97 22
• Phone: cction L Lire: 03 b39.417503.59R. 0 y 5 '1 0 1 Other mil:
Ins
f I G A Ii I..) p I •' 1 n il Daze ReadyftSy: la lice Page i for
Internet www.tigard- of.gov •
0 ��,c ` P R t, • cdmldt�: sappimeotal information
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TTY OF 1`i'�
Mechanical permit fees* arc based on the value of the work
❑ New construction 0 Addition /altetation/replacelnent pinned, Indicate the value (rounded to the nearest dollar) of all
❑ Demolition D? Other: mechanical materials. equipment, labor, overhead, and profit,
CATRGOERY OF C�Oty -rRU 'flC, Value: 5
lin i- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building For spectalInformation use checAftsx
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. J E.a. Total
:,` ,S1Cf�:B DR1 310411 Mi@.1C CA>Ef0li . He+tiwJ :
Air conditioning
Job site address: 1 () 1 0 S v3 cr (requires site plan showing placement) 46.75
? ^ Furnace 100.000 BTU (ductalvcnts) 46.75
City /StatefLlP:
— fit G L D t 012- Gi - 7 22 4 _ Puma= 100,0004 BTU (ductr/vsrm) 54.91
Suitc/bldg. /apt. nn.: [ Project name:
, mums site plan showing anent) 61.06
Cross street/directions to job site: Duct work ---. 23.32
4�Plp C.-12. _ k J cc Residential hoe wafer (radiator 2132
ReSidentiel boiler (r3dielor Of
hydronic) 2132
Unit bade$ (fuel -type. not electric),
ic),
in -wall, in -duct, sus ai alt. 46,75 _ _
Subdivision: t V �. ' D Lot no.: /7_ Flut/vcnt For any of above 23.32
Other: 23.32 _
Tax map/parcel no.: Other fuel appliauetn:
3 [6IeF `4Nr WQ�dic ; 232
Waller heater ,3
Gas fireplace 3339
Flue vast for water heater or gas
06 , ■ 2E,Z
fireplace l te r 23.32
• Wood/pellet stove 33.39
Wood fireplace/Mien 23.32 •
" 1 `:I'kitcb OWN* 3. '. d ilicil 1VT ' ' Chimner/lirrer/lluelwatt 2332 •
l Other: 23.32
-
Name: , . S-P. -. D1-11 Envirotnncn ethane,. and ventilation: —
,- Address: (L j, o f o S` _ 90 C---r- eq m Kwdlrnitrs kitchen 33.39
City /State/ZiP: '� a. c/ `7 iZ y Clothes dryer exhaust 33.39
Single-duet exhaust (bathrooms,
Phone: ( 4 ) 9 6 --- S 7 9 . 7 Fax: ( ) toilet compartments, util y mums) 23.32
4P41 1 ' ' • J] C! R TACT MOON Attidcrawl fans .1 2132
Other: 23.32
Rusincn5 name: —' I
— .,,... Fuel piping: _
Contact name: T" - 4,4,d4. _ $14. 15 for first rtmr, 54.03 for each additional
Address:
Furnace, etc,
Gas heat pump -.
City /StatefZiP: wall)
stsperrdedrunit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
(range _
•
L1QNl'RACdoA ,` t • Barbecue _
Atu• mess name: ) lr-.r41 va • tir N ' M . f--‘1 L + 17 Co L LI N,- Clothes dryer (gas)
Address: 1 +1 odor ft.
City /StaterLIP: • x..41, A 03‘2.... -1 `r(S V t) Subwlal
Minim :urn rn permit fee (S90.00)
' : (-11)3 ) :2,Zt. - ®i 31 Pax :( )
Plan review (25% of permit foe)
( CC'S lie.: (,) C 9 I (o /2. PI II State surcharge (12% of permit fee)
/ TOTAL PERMIT FE 4 CVO . WI
/ This permit ipplie.uon expires If a permit is not obtai n within lad
Authorized signer / days after It has been accepted rai mamma_
Print name: , ai 1 { ®iErr t Fels methodology set by Tri- Comnly Building Industry Service Board
r:luuildina\i ennitOMLC- rannhApp.dse oomono 440 -4617r (I l /o2/COM/Wt B)