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Permit CITY OF TIGARD MECHANICAL PERMIT y 1 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00121 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/07/2012 Parcel: 1 S133DA05500 Jurisdiction: Tigard Site address: 12880 SW GLACIER LILY CIR . Project: Lutz Subdivision: AMART SUMMER LAKE Lot: 77 Project Description: Installing fireplace insert, venting and gas line. Contractor: FIRESIDE DISTRIBUTORS Owner: LUTZ, CAROL ANN REV LIV TRUST 18389 SW BOONES FERRY RD BY ARTHUR A/CAROL ANN LUTZ TRS PORTLAND, OR 97224 12880 SW GLACIER LILY CR TIGARD, OR 97223 PHONE: 503 -641 -1919 PHONE: 503 - 524 -5698 FAX: 503 - 620 -5699 FEES Specifics: Description Date Amount Gas Fireplace 03/07/2012 $33.39 Type of Use: SF Flue Vent for Water Heater or Gas 03/07/2012 $23.32 Class of Work: ALT Type of Const: Fireplace Occupancy Grp: Fuel Piping 03/07/2012 $14.15 Stories: 12% State Surcharge - Mechanical 03/07/2012 $10.80 Minimum Fee Adjustment - Mechanical 03/07/2012 $19.14 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 dire uestiortcr NC by calling 503.232.1987 or 1.800.332.2344. Issued y: Permittee SignaturC , 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. • 03/06/2012 12:14 5036707905 WIDDOWS PAGE 02/02 Mechanical Permit Application 0 "4: 11S1.; ONLY of Tigard � � Received Permit No.: City g � FOR (►1 1( DatelBy: o� te, 1 all h a0/.?- co /02/ 7 C " 13125 SW Hall Blvd., Tigard, O'. 1- %1, Ph 503.639.4171 Fax: 5 i x` :' ' 9',r.. p Plan Review � V � DazeBy: Other Permit: I I C: n It D Inspection Line: 503.639 0 Daze Ready/By: Julia: Ed See Page 2 for Internet: www.tigard- or.gov ` �p� G � \ � P � \ O\v Notified/Method: Supplemental information @fIn.i ;;!'11'1;11 ' ;, I l 1 ;ill Ir, ' i't . ''!' ill ui' ''1; y C�` �,�� ` 10' ':." •; l „ • - , p • 0 W III If All rm1 g n I imp I! In II la n ry m , t n p l 'n la t. 0 I ! .:rl. IVI rri Idl i Mi l i agli: ilfl I �i "�jjalp10,,; - ii 5F 1`+a ' • ;;I ;11 �!'I;I• ., (. V fa : p',11 .. I I ! il. I d ; sF P' 1I ! .. L"I ; n1 'ra'�r !1. :ll , ..�1 '1 , 'il I ,�I':,,.,- ',.,�•- •,,,.,'„.I {I ' :lie d I'i {.L. :I, f I I ,.., n••�i I 1' Ic II, 1i o• YAI i I I��11 ns 9YI F. •i:..'::�. 'Id . a • � �i - - rIL,1y �.Nli, ■d 'i l Ita!I, y. � �.•� d Il ! 'l ifer �t: + .,; l �. .... • A111111111 ; • �:... Ill (,ninllillllm1rttn1r tr.>;nn ❑ New constructionAddition/alterati •.,t•( acement Mechanical permit fees* are based on the value of the work s performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. 1 'I !: ill., - ncl'alryil +C.`i ; !!;:; l;1 ! :: �.,n•II I•,I, y�1 1 ":I 11. I' `: 1.!i 1!.11 ii 0111 i L4 I ! �0�, �Il,i4,��,3Jv�,, �1�LV' !.,,�,I N;I I! : -° 811 ? 411.1 11 1 'i1i ::,!„ it 11 Value: $ L, I , I I . 11 �,,, T:' ^r :- • PI 0000 t I { u, !11:311.., ;ILaI l nn pn utti'I�pn, i numinm 1I n I n n rtio ul�v mr ... „ I .u.Ir.i:a�rl ,I,Y,,,,•, I, II nap lllhLi IA 11 �; ,h I I , �A I �I;. al�' "a ' I n il ,d ' l ,� , Oa 1- and 2-family dwelling wunlhl •:I:: M mmnnm n lilu u. 1u dawl i) l�ni n14I1 intinl �Lil _ :' J .' y g ❑ CommerciaUindustrial 0 building ' El ❑ Master builder ❑ Other: For special Information use checklist t!�, `� Description I Qty. I Ea. I Total •: l! :.:14; lyli I!IIIIIIIIr : y �, , ;�;` i t : � ,,� IN f1. 11.!.� q l• g . Illl'11 rl. iti$1 1I11-'•r' r ' ; ' r % °#0 ID �! . !. 4 id ':: ,I' ;,,: •�li�hl... �'I ,,u, ! .I � � , i;fi' P I • k�,l 1 Heatin eatinii/co.)ling ., hL , •Ili`�`ii,I�'rA11. � '�II,I�k'� ;I'f tt/ P Job site address: i) / �� / ` Air q conditioning Q� (requires site plan showing placement) 46.75 City/ State/ZIP: �e�'Ct/r -�t�/ r OR. Furn ace 1011,000 BTU (ducts/verlts) 46.75 3 Furnace 1011,000+ BTU (ducts/vents) 54.91 Suite/bldgJapt. no.: Project name: -y Heat pump 61.06 Cross street/directions to job site: C/ Duct work 23.32 Hydronic 11 water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heater. (fuel -type, not electric), in -wall, in-i tact, 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 :11!:71;o- "!j r jll 0!I 1 11r•' d!'! ,1 11 . Y , L '•1 i!t!!i''ai ' `1 ,ItC ' !,Iltil & , F , ij'' :`r' 111411. .. ,,I l l ^�1 jirll l'ki;;'' Water heater 23.32 :i.ur.,i::,r. ^,. •.I, ,:I 1 �`.; a .;?'.1•?ti+lfl lI I � y� . . ;; .:. ' : .11 1 . 1 I , t ... I ! 'I •'1.„ .,I„ r LI ''I`t,� ,'l. , IIII� ,,..,lLll 4,. P /1J'�f 33.39 /� / { ��Q Gas fireplace � f /"P p //),SP/4 t �h� fir r1.' Flue vent for water heater or gas (i /1 � r / fireplace 23.32 t'd 9cea -e_. Log lighter :gas) 23.32 Wood/pelle stove 33.39 'Wood fireplace/insert / 23.32 2,3 -1 ' ,N:' ' :Ii . ' I n:_ ;:? :I °;i�. 1 .,•r „ ; Ch im ne y /liretr /flue/vent / 23.32 3 .3 �,; P:,, . „ 0 i a' � ipiv:; , Other: 23.32 Name: ` F �` ! .I.• .� ' Environmental exhaust and ventilation Address: /� I Range hood 'other kitchen /�2ARa au C--I IQ�fQy' 2../1 equipment 33,39 City/ State/ZIP: 7 q 4 , pk, 9� Clothes dryr:r exhaust 33.39 `7 Single -duct exhaust (bathrooms, Phone: 2, (•� S _ 0-6 / n 8 Fax: ( ) toilet compl'rtments, utility rooms) 23.32 :ii( ;.j I'•I! I n , I lj r'1'� ' • FE•" il�i,,... ':i i� hil!i! }�til� i °i .,. , �'... •Pr ^r r, 1 1 Attic/crawls ii 1 ! ?;• : 011 1P I I. . . ,1.,I i i ,I 4� �; lti h pace f ans rl.i,., Ir„ ... ., 1WAl ,, �„ ' s l�z.,s�,�l�rw�IJ'(7J!t :plfll(ilI P 23.32 �. �^ Other: 23.32 Business name: lire V (LL- 2) ��,, JCI ?� Fuel piping name: / M JJ h Jeer $ 14 . 15 for first four; $4.03 for each additional Address: /, 1 J ' � .., 6�.,�,.. �� Furnace, etc. 0�4�111 l� { r � �j Gas heat pump City /State/ZIP: o r - -. / (,_' !' , k 9.7 Wall /susper. ded/unit heater Phone: (97/) 4 2 35-.... Q Sa ( IFFax:: ()V _.....0q9 Water heater. t Fireplace / /y,. /y ./T-- 4 /.t .. Y (?11.4...',c. > 4I . Range 'iv,i,' E-mail: I•�lii ,.. 1 i:�.,t"� I lil,'�w.1!Y i , p:,.r. '�wYY'"' v aa tl,ln , I ill I ;: s1. ; ;:Ii.l;r S 1; I i.) :,., 11; 7 a.,; © •�;' is t 0 a 9 I •i` . ,:'` rii i (Ill n it ball I ul'. * . al,11I!�i ,'.liii,.,g'.... ,'.1 ,•ILI,!, ..!ILI:,Ilyl . „I.. ;II! l,,, •� . - :; • . - • . - .,... �. t ;,t.: � i!' i1! x; I I ' i . ,d.nt�r I , r Barbecue I: ?s mall:-. 1d. ,�::. Business name: F1.1* � /' AO I /�, s Clothes dryer (gas) Address: / ? Q W � tn ,, p ' " •� Other L r g � ,a!�a�II�I u il i ` ' l 11352Hi�lm l cipf i{ CC�����77 !I m 1 � x �1 tlmnp `": : I i i, ' t: 4;fu11�1.1:: : I II Ill�rr>rIrtllliuJdoli /dlimfliii I IN.. �'� � ; i � , City / State/ZIP: 12- /. ' / /� 9- Subtotal ; .6 . 7 Q Phone: (�17/) 0235 - DSa I !•[ Fax: (f63) 26 4 Minimum permit fee ($90.00) QQ O. 1 O Plan review (25% of permit fee) CCB lie.: 41 79 State surcharge (12% of permit fee) /6 - TOTAL PERMIT FEE /00. $p Authorized signature: C �� n / Q_ � This permit application expires if a permit is 001 obtained within 180 T`-c.C� [ ���.••CCC y days after it has been accepted as complete. Print name: i)1� ,J/� ! . / j 10^ ( r Date: 3 - _-,,A ' Fee methodology set by Tri -County Building Industry Service Board I: 1Building \Permits\MEC- PemitApp.doe 10/01/09 440 - 46177 (11 /02ICOM/WEB) •