Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00547
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2011
Parcel: 2S110BB01800
Jurisdiction: Tigard
Site address: 12395 SW CORYLUS CT
Project: WALKER Subdivision: AMES ORCHARD Lot: 7
Project Description: Gas fireplace insert with venting.
Contractor: T & K MECHANICAL Owner: WALKER, JAMES W & SHAWNA
PO BOX 116 12395 SW CORYLUS CT
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503 - 844 -9173 PHONE: 503 - 504 -6137
FAX: 503 - 846 -0195
FEES
Specifics: Description Date Amount
Gas Fireplace 11/30/2011 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 11/30/2011 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12% State Surcharge - Mechanical 11/30/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 11/30/2011 $33.29
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: 11116 Perm ittee Signature: , f /
/ f"
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.
11/29/2011 16:50 5036269138 HOT SPOT FIREPLACE PAGE 02/02
Mechanical Permit A nnlica it t r 1..(..R c op IA( l l ‘,11 n . 1 1
City of Tigard ,i' CEIVED ED / ,!s • - t xo : --(051-i
13125 SW Hall Blvd., Tigard, OR 97223 Plan Phone: 503.639.4171 Fat: 503.598.1 r V 2 9 2011 Date/By: °" t
• 1 I r. ; A N) Inspection Line: 503.639.4175 Date Ready/By; la See Page 2 for
Internet: www.tigatd.- or.gov CITY OF TIGARD
N°" : Stpp�nd Information
• TYPE i ' , COM1ItE CIAL FEE* SCHEDULE " - vsECIIEl'K•IST
•
❑ New construction ( XAddition /alteratino/replaceme -rt Mechanical permit fees' are based on the value of the work
performed - Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other _mechanical materials, equipment labor overhead. and profit. _
CATEGORY OF CONSTRUCTION Value: $
Catnil dwelling [] C otuunercial/industrial
RESIDENTIAL RQUiPMENTJ SYSTEMS *
1 -and 2-
y t ag ❑ Accessory building
For vela' miformariou use checklist.
0 Multi - family 0 Master builder 0 Other: Description Qty I Ea, I Total —
JOB SITE INFORMATION. AND LOCATION l;IeatinQhpoling
l a3 c t'S' SLR (Q( {4 u 5 C Air conditioning
Job site address: U
(�e ante 1aa showing placement) 46.75
City/StsueIZIP: '7' j Q r d M , q7 e a Furnace 100,000 BTU (ducts/vents) 46.75
Suite/bldg./apt. J q Furnace 100,000 BTU ( icn/vents) 54 -91
dg apt no.: Project name: Heat pump 61.06
Cross stteet/directions to job site: Duct work 23.32
-- -- Hydronic hot water system 2332
Residential boiler (radiator or
hydronie) 23.32
Unit heaters (fuel4Ype, not electric),
in -wall. in- duct, sa dekete 46.75 ,
Subdivision: J Lot no.: Flue/vent for any of above 2332
Other 2332
Tax map/parcel no.: Other heel appltauecs -
DESCRIPTION OF WORK • Water heater 2332
- _ Gas fireplace LL / 33 -39 3e7 OM. � V, o-�C- =mini i tammA i uf m. Flue vent fur water heater or gas
x_PROPIRTY / OWl!t1i?lt I Q TENANT other /
fireplace 23
.-- - _ L og Ughtcr (P ) 2 332
Wood/pellet stove 3339
Wood fireplace/lasefireplace/lased 23.32
. Chittlney/lixter/Rue/vent _ 23.32
2332
Name: jet vv 1.1) ,ii, Envlronmeataieabauat and ventilation
Address: /a Rmige hood/other kitchen
d Ll ' r equipment 3339
City /Stat&J'LIP: Ti go," 0 07,9-J $4 Clothes dryer exhaust 33-39
' + [ e ! toilet exhauSt
Phone: ) Q 1 Fax: ( ) toilet comparbwcrd*, utility roams) 23.32
A_ArrucAIV'I' fl CONTACT PERSON . Attic/crawlspacc tans 2332
/ Other. 2332
Business name: �D� Spill r YP p /a c -. -. - Fuel pint . T -
Contact name-
' • , h IIP i „ � Si4.15 for first four, 5403 for cinch additional
Address: -- t _ j ,l 14 (10 t4. `7t)0/1 Oa
•
Gas heat . .1 i
City /State/ZIP: y O O P ✓1 Y � . 0 WalJ/suspendedhmit heater
`�� d Water heater _
Fireplace (SO ( (t jO � Fax! ! ) l.3 —
Phone: E - mull: [I CI J` 1- - cx v-e b c� a (444-14y1.1 . e 0 w1 Range .. _. - .
P -
- . CONTRACTOR • Barbecue
•
Business name: 7,t K' _Il c l/1 A i r � Clothes dryer (gas)
Address: . • .. x ! r . MECCHANICA,L PEitADT FEES*
City /StatcrZlP: ' j ye e GiVolm- Or I� I Subtotal ,
i Minimum permit fee ($90.00) 7 Q '-
Pho (5 3) 3,x`7 _'76,A / Fax ( ) Plan review (25% of permit Lim)
CCB l ie.: IOlil e5- State surcharge (12 %ofpermitfee) /a
- TOTAL PERMIT FEE I /6
Authorized signature: • / � - J
r / This permit application expo if a permit is net obtained within 180
days after R has beets accepted as complete
Print name: " a . ♦ Date: r /-- 4 ! q i/ - Fee mctOOOlogy set by 1tt- County Building Industry Service Board
L.'19uitdiosTecmitclIEG4 ..' • 10/01/09 440.4617r (l i!0?/ctImm