Permit - , � CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00551
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2011
Parcel: 2S 111 C D05000
Jurisdiction: Tigard
Site address: 15985 SW BRENTWOOD CT
Project: Cathcart Subdivision: SUMMERFIELD NO.9 Lot: 509
Project Description: Install wood stove insert.
Contractor: HAVEN SPAS AND POOLS Owner: CATHCART, JOHN C & ELEANOR J
10560 SE HWY 212 15985 SW BRENTWOOD CT
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 655 -9440 PHONE: 503 - 806 -1658
FAX: 503 - 655 -9514
FEES
. Specifics: Description Date Amount
Wood Fireplace /Insert 12/01/2011 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 12/01/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/01/2011 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types: Solid Fuel
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, , we suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility 'notification Cente . Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir-ct questions to OUNC s • n. 03.232.1987 or 1.800.332.2344.
Issu =d By: /
y. . I Permittee Sig ` ���
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. T /L/�
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 ApplicaiRECEI V ED lOR t)FI.CIs t SE ONEI
N OV 3 0 R �7�� Permit of Tigard 2011 .:
�.r i 13125 SW Hall Blvd., Tigard, OR 97223 Date/B l� .. -__/ C, O •-21'%' r ' Plan Review
„ y .: Phone: 503.718.2439 Fax: 503.598.19¢f1 � O TIG� D Date/Fly: Other Permit.
Ti G ,� D Inspection Line: 503.639.4175 �I Iii See Page 2 for
Internet: www.tigard- or.gov Note a y y Allis_
BUILDING DIVISIO Notified/Method. Supplemental Information
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.
toll ,. .. , ... _ Value. $ a °'
Al - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. I Total
Heatlng/cooling:
G Air conditioning
Job site address: 1. ? (� X' 5 �'W ey `: (requires site plan showing placement) 46.75
City/State/ZIP: ` q w t �
t r �l Furnace 100,000 BTU (ducts/vents) 46.75
) `' ( ' `. q 1 �ILI.�
` L 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
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
. Water heater 23.32
N Gas fireplace 33.39
�- ; ` 1 �� / �,� . - , :.� Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert I 23.32
Chimney/liner /flue/vent 23.32
Other: _ 23.32
dfi L R1.wA a I,- Environmental exhaust and ventilation:
Address: ,� 5 W ^ > d -- Range hood/other kitchen
�` ^ s * v r � ' ' t equipment 33.39
City /State /ZIP. 15�d I • q 7 2, 1,. C lothes 4
��"" dryer exhaust 33.39
Phone: 63) 1 ■ 5 • Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
> toil
Attie/crawlspace fans 23.32
- {.
: Other: 23.32
' : I `' R ' n ��� I Fuel p
Contact name �- d a& . A� . i; j 1 _ l
, , O / $14.15 for first four; $4.03 for each additional
Address: 1, a0 S E 1-Fw ZI Z Furnace, etc.
City/State/ZIP: //�� � Q Gas heat pump
,t1!l l ... , 170 Wall/suspended/unit heater
Phone: (503) 1D • lb. _ f"TQ I Fax:: (503) 465 -g5 Water heater
E -mail: 6er i i 1 * 1 t hearth • Cam
Range
: ;... -,_ - Barbecue
Business name: ( S\ �'V p Clothes dryer (gas)
Other:
Address: • e .:.g ' 11. 41.'Lii1
City/State /ZIP: Subtotal
Phone: Minimum permit fee ($90.00)
( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: /(�,2 I ' g 2 () State surcharge (12% of permit fee)
� T TOTAL PERNIIT FEE ((Q , O
Authorized signa i v This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: t 21 41)1. j(,(k p� Date: 1 j • 30 - ` J • Fee methodology set by Tri- County Building Industry Service Board
I :1BuildinglPermitsV�C- PemritApp. oc 09/09/10 "' 440-0617T(11 /02/COM/WEB)
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Clackamas 503 -655 -2900 Aloha 503- 649 -2201 Vancouver 360- 574 -0135
10560 SE Hwy 212 20945 T.V. Hwy 2009 NE 117 St
Clackamas, OR 97015 Aloha, OR 97006 Vancouver, WA 98686
FAX 503455 -9514 FAX 503-649-5242 FAX 360- 213 -1265
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