Permit CITY OF TIGARD MECHANICAL PERMIT
- '- COMMUNITY DEVELOPMENT Permit #: MEC2011 -00574
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2011
Parcel: 2S109DD09400
•
Jurisdiction: Tigard
Site address: 15576 SW RAPHAEL LN
Project: Gill Subdivision: BELLA VISTA Lot: 24
Project Description: Install gas line, gas fireplace & venting.
Contractor: FIRESIDE DISTRIBUTORS Owner: GILL, BRIAN & YVONNE
18389 SW BOONES FERRY RD 15576 SW RAPHAEL LN
PORTLAND, OR 97224 TIGARD, OR 97224
PHONE: 503 - 595 -3723 PHONE: 503 - 590 -8525
FAX: 503 - 620 -5699
FEES
Specifics: Description Date Amount
Gas Fireplace 12/14/2011 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 12/14/2011 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 12/14/2011 $14.15
Stories: 12% State Surcharge - Mechanical 12/14/2011 $10.80
Minimum Fee Adjustment - Mechanical 12/14/2011 $19.14
Fuel
Fuel Types: Natural Gas
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 questi NC by calling 503.232.1987 or 1.800.332.2344.
Issued Permittee Signat. re: / .I.
r
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.
12/12/2011 17:02 503675 • WIDDOWS PAGE 02/02
C EIVED • Mechanical Permit Application .. Folz I!SE:ONL
City of Tigard DEC 1 3 2011 Received t i 3 W o/ /- 57 4
Date/By: 1 11 ^ �_, Permit 14o.: �(
II 13125 SW Hall Blvd., Tigard, OR 97223 R ���
Phone: 503.639.4171 Fax: 503.5 ti S. Plan Review
OF TIGARD Date/By: Other Permit
T l 6 A R U Inspection Line. 503.639 BUILDING DIVISION Ready /By:
Internet: www.tigard- or.gov Date Read B Curls: 10 See Page 2 for
Notified/Method. ) Supplemental information
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❑ New construction iwg Addition /alteration /replacement Mechallica i permit fees are based on the value of the work
❑ Demolition ❑ Other:
performed. Indicate the value (rounded to the nearest dollar) of all
1 ;n mechanica materials, equipment, labor, overhead, and profit.
G ,lei lii!ilt �:, i
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I- and 2- family dwelling ❑Commercial /industrial ❑ Accessory building ' ' ''� �� ��
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other:
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i� ,nits, _ -,, :. ,.,I „IlapF. , . a ','�EI,p:.j.i,. �Il,,l!dt� • "r . Fleatin cooling
n;n
Job site address: /5 1�
Air conditioning
�� ...- (requires site plan showing placement) 46.75
City /State /ZIP: j i a .- + e q /e 'v Furnace 10i 1,000 BTU (ducts /vents) 46.75
Furnace 1011,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: X121-_,e, AI key/ 6f 5
Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic bit water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in- t-uct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue /vent fir any of above 23.32
Tax map /parcel no.: Other: 23.32
Other fuel appliances
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8,p :a;ii; '.i•�',p u � ii'i�'I i � { „1!,. Water heater ' n,` , iicj'.i.' : „ ..,, ,u. "• QN;,;I)F'1'+;!�� .I , r .,, ^ � , , .. , ii'1P;. eater 23.32
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4 // �J , M 1 . Gas fireplace , 33.39 3 .39
5 2 ... i/J q4 4i i X / ( q Flue'vent for water heater or gas /
r6 , / ` fireplace / 2332 0 " / : 3 • , 3?
1.10 . � L _, v .L it/Y1I Log lighter •gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
il;i'i ,,,,: iii:':i ,ii; u; Chimne
,' ii: i,i;' lif r ',,, Ypllb'+�vr R `a i:11i' 1, ,,1! . Ii ;:II ail, ,1;; ,, I'; y /liner /flue/vent 23,32
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Other: 23.32
Name:
! 4 vo..nil e1 Environmental exhaust and ventilation
Address: /s-------.7 T
C A � /']/„ i.? Range hood other kitchen
Lt �/ICt , equipment 33.39
City /State /ZIP: / G] � �� Clothes dryrr exhaust 33.39
3 toilet compartments, utility rooms) 23.32
/ Single -duct ;xhaust (bathrooms,
Phone
( 5 ) s a g - c.'� Fax ( )
: / gull' i.ilil ' i• l ii , ,i,a;' ill ` :li ii(PC1.,7 n it41,,i,1,:
1;.11 11l .i : " ` . ,ia e.' 6N i':CO ;. " ul! / • Attic /crawlsaace fans ,,, ,��i�'., ,... ,j; P1 °Lt�•�'�';11�)�, ��I�'�;ii; �IIIi I. ans 23.32
Business name: �F3 f J ' 1 Other: 23.32
4 !.S . rr I Fuel piping
Contact name: • D� .4 ,1, 7 $14 15 for first four; $4.03 for each additional
l�
Address: e J/� � d / Furnace, etc.
/ q II Gas heat put tp
City /State/ZIP: p i O o Wall /suspen: led/unit heater
Phone: (5"03) S-Gi 3 3 Fax: : (5 ) b,� ., 5-6 7 Water heater
`_ , ,� Fireplace / Pr! /S
E -mail.
e l / i f P li f It ct Range /
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Iiihl!illli; ;; IIl'Ii: ;i . M0i , :,0* 'J<ittO*,: $.:;;i LI u,: i.:I , J::: p l l ::
tai:`, .p., si.�:Lhl .. ,'. .� -� .., •� .J,i :;:,,.r- NZ: '
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Business name: - • _ Clothes drye • (gas)
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Address: ! u ,, i '
or,/ - .Ayr .,-/.41) - ,
City /State /ZIP: 4: ;:'lniii'iiiii, ii,: Y' dnt( .so ;iiiilv!,,..h. l,.i!!ljlil�i,4j1 i : F e �a , / !
"` 7 �� (D
Subtotal
Phone: ( ) 513 S 3e) Fax: (56'7) ` ,_ Minimum permit fee ($90.00) 1 -?b ,
CCB lic.: ,w �j �I Plan review (25% of permit fee)
_ • State surcharge (12% of permit fee) .4).,P6 y TOTAL PERMIT FEE /4.),,,,-
Authorized signature. • L / i / / x This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: '
_ _- . / • I • _ _ adio f D a t e: ai - i Fee method - logy set by Tn County Building Industry Service Board
l:\ Building \Permits \MEC- PermjtApp.doc 10 /01 /09 440.4917T (11/02 /COM/WEB)
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