Permit CITY OF TIGARD MECHANICAL PERMIT
! COMMUNITY DEVELOPMENT Permit #: MEC2009-00099
,TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/11/2009
Parcel: 25111 DA13600
Jurisdiction: Tigard
Site address: 8966 SW GREENING LN
Subdivision: Lot: 0
Project: Widdows
Project Description: Install gas fireplace and (1) gas line.
Owner: FEES
WIDDOWS, THOMAS A Description Date Amount
8966 SW GREENING LN
TIGARD, OR 97224 Gas Fireplace 03/10/2009 $10.00
Fuel Piping 03/10/2009 $5.40
PHONE: 12% State Surcharge - Mechanical 03/10/2009 $8.70
Minimum Fee Adjustment - Mechanical 03/10/2009 $57.10
Contractor:
FIRESIDE DISTRIBUTORS
18389 SW BOONES FERRY RD
PORTLAND, OR 97224
PHONE: 503 - 595 -3738
FAX: 503- 670 -7285
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
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Issued By: Permittee Signature: I • ' • 11 � iA
YI ` N '
Call 503.639.4175 by 7:00 a.m. for an inspection that business 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.
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Permit A licat►oni„ PermitNo 0 qiQ.0 0 CA '
e pe l Receiver} ,� . L _ a
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Date/ay: 3
• City 0� Tigard � Other Permit:
13 III SW limn Plvd.- Tigard, OR 91.23 2009 to See Page. 2 for
1, 'a 5Q3.598. , AR 0 9 si See Supplemental lnforrnanon
phone: 503,639.4171 Fax: 'vI Notill a /Metb
n Line, 503.639, pate R d/Mettiod
Ins cCtio � , • ir,
Ti'lir�t:[1 Int www, or -gov OF TIGAR y�' A ri�, a ; u' l I u :.i �'I"' i
ur C„ �l' }' I' �1t lt' , 'r , 1t C } h' 1( 'rI ' 'iili ij;h,li4i' 1� , . 4 : Ivl'ech y t c value of the work
,.., -,, 1 . , , ii 1' ' ' jorl' 4 "' m X1 ',' ril l vtti ,.,,, , „ t 0 , , }v}cchanical permit fees arc based on )
;;,''':.c• ;:i,;;'P' Ji ' ;P ,' r !, iy;;,i':h I!'v }i4,t ! , •, s
erformed. Indicate the valuc.(rou� a to o ea nearest and ollar) f a
construction
r dditionl�ltcrsttion /repl acomcnt mechanical materials. eiui mcnt,
New Con, ❑ J Value; $ _ �tl �' , �„ 4 � },iii �ii�
Demolition Other: 111 10V11 il iiJ iiiiy�,Il�¢} e l'It" .. 10 � i , ' , ;� t t � r1tT' t ni n'lir
[J Demo i },l, n „ i1.,, „ i,Y 1, lI, n,, , r l ill,° to r t a' . , ck* int> 1 § ■ itt
I I t Ia' c 1 , m '21p1'21 n n gl; t Y',' i',,:,,r,�,l ,11r• ',:; i r „ gl t ,In C ti •, checklist,
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;,ur'i:jl!i�;upsni�0U0rq liP1II'h' °,1'�mi�n(�iit l r IPI' I Y O P , 1' , • ll +`
!`ilcr ••,.�!" I "' i ii ni :1 Il}In',11 P l u." Accessory building For specie! Information use check Total
0 C ommercial /industrial ❑ Qt st
tut 2 family dwelling 0 Other. Description
El Multi- family ❑Master builder namn Hearin' cooth%
J� i' i °i; t815di' a,p'i „ r :in
t7 1 In :n l a ' inq,nu, J. it u.' r heat pump y` c :y a, , .. r ,,.,r, ,,,,�„ Airconditioningo P 14.00
';;� iurb•” r'y�to I t ttiii'S1'I1dr,.. ] ,, t I(nr T ,.., ... 1 _ t
u'! „ti� ��),Inu!ni'''' �I L,P�} ti.'In .lacemcnt
`'1 4 ' l� � reeno \ '
Job site address: [ /�'`f�� t� S.11:2 F urnace 100,00 67 U y ductsfvcnta 14.00 Mil 17.90 `11 • Furnace }QQ 000+ BTU (duets/vents lio
}Lt.QQ IMO
• Cityl5tate /7_I f + 1p bow 5
Project name: 3 10.00 •
Suitclbldg.Japt, no.: Duct worn 14,00 MEI
}; (Ironic hot waters stem
Cross street/directions to job site: Residential boiler (radiator or }4.00
h dranic 111111111 Unit heaters (fuel-type, not electric), 14,00 MN
in -watt in -duct, sus•cndcd etc. 6 0 Mil
Flue/vent for an of above 10,00
Other: MIN
Subdivision: Other feet r a 'lances
Tax
1 1 0 0 . 70
nr Watcnc�ater
TAX map/parcel n0.: O n p 0, 0 afi(u',': li lg ili ,l�r �1i
1y��{�r,I r r,rr',Y61y4 „�I1 s4�nli Palo• „ �,,,, ,, , , 1 � d,J
�I II ! 2.•11'1, I 1il�y�.W +�h�11 1i'I� ' f � ,� 111M
ti7„' ` } il2 Cl'�g T��ii 'Irf �' `i '� 1 i � S i , - -' , a „ I 191 h, .,, Oleo vent for water heater or gas 1(1 -QO
1,4 a-C�� fire. lace 10.00 MN
Lo:li•liter 10.00
Wood/ iellct stove 10,00 NM
Waod fire-Isce/tnscrt 14
+' , r r , ul Ir °1 I I i11pG MI 10 00
�� I r „ rl I �i Y11V t',1�fPd�ll,�lh Other:
u:,,e�rV r sun r n �'.rm+�;r � �- �. , .rn 9 I P �nir. I n lPl "on ta,t r,llrl,., t..'; nl, , 1
I nly�', a : l l P �, l n 1' u f.a ' ,,t5'" r''' f,,,, .....0 1}Ili}'1 P�,ni I Environmental exhaust and ventilation
Name: `moo tM `p Otis, $ Range hood /other kitchen 10 .00
• � f,e_ e ui.ment 10,00 Ell Address: 1 �� �1 1 •
Clothes d er exhaust MINIM
City/State /71P: — C - . cLr �� Single -duct exhaust (bathroomS, 6 g0
toilet com•artments, utili rooms l0.0D
�5 >ax:( ) f
Phone: (�� t 1 t'6 A „w!y iy r Ste .' it I +�i�l t i I ',PM lliM Attic/crawls ace fans 10,00 �� llr�}:rl,� .{{ r i Ct 11'; 'Iji }'rll�!��i 4TH ,'J,llipiil! .!'!+W„ . : , , R ,.lill� r ,
I u ❑� l . '� I i I rWI11 1 � t :'"A,,•,., 011 Liltir II Q.1 / . ..... Other: ^ ���TY� � tA� �s V 7 SI •
Business name: ll« t.� .IJ S5,40 for first Four. S1.00 for each additional
Contact name: �T� tr. - " - t
o err .. ��
Address: lg 3 $ � 0 h� S
Wall /suspendedlunit heater
City/State/1W: t y `p. 40 Z Water heater
Phrme: (SQ3) 59 5 3-135 Fax:: (5o3) - ,�_ .
� I 1 _ r t.( ) � Range I MI
r ill' ilBllp�r. }1'ilia!IlUl��' 1 1 '1 �I i i111 11 � i 1�� r ilfll l ��lll i V t dim l . r.a 1 0111 . I I' ilir�11 r tIl, i' lli i hr(411'i!ij%�!',4llil{I�rl�l;jj i!,' ,'T,��IjiI�I� �i� Barbecue
E-mail; -
-urr•„
. ,i... rl,,, 11.I�I,ufr
c1 ul• Clothes d r : as
Business name: Other:
e � �
e ( •+ hh y� J I
II I'�J� ((I ; r 1 liljl` +
Subtotal
Address: SS V17197. f.i��. rt tE�jm4t t i�fd • i ..... ' . a .!14 I I} ,,! L,.,
City /State /ZIP:
Minimum permit .fee (572.50) . 5.-D Phone: ( ) Prix; ( ) Plan review (25% of permit fee)
•
CCTj lie.: OQ ? q ` S tate surcharge (12% of permit fee)
TOTAL PERMIT FEE 3.1.
fh;e permit application expires it a permit is not obtained within IRO
Authorized signature: t l t7l Q , days after it hnx been accepted p” complete.
Print name: V t t_ l 4 - r�71 t” Date: Q j _ ” Fcc methodology set by Tri -County Building Industry Service Board
rin„ i7 dinn2rermhstMEC•Pcrtr01AOn,Aoc OU •• 4M10.4C1 /07JCOMIWE9)