Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00432
° �J I� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/6/2006
PARCEL: 1 S135DB -10000
SITE ADDRESS: 09405 SW NORTH DAKOTA ST ZONING: R-4.5
SUBDIVISION: MAYFAIR LOT: 004 JURISDICTION: TIG
Project Description: Gas fireplace install, flue, piping and outlet.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS: •
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
RICHARD NICKERSON Description Date Amount
9405 SW NORTH DAKOTA ST
TIGARD, OR 97223 [MECH] Permit Fee 9/6/2006 $72.50
[TAX] 8% State Surcha 9/6/2006 $5.80
Total $78.30
Phone: 503- 443 -2047
Contractor:
G P 8 W SYSTEMS INC
732 MARBLE RD
WASHOUGAL, WA 98671 -9601 REQUIRED ITEMS AND REPORTS
Contact #: PRI 360 - 835 -3516
FAX 360 - 835 -5716
Reg #: LIC 108176
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center.. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: "
Call 503 - 639 -4175 by 7:00 a.m. for inspections 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.
Sep 05 06 11:28a GP &W Systems, Inc. 360 -835 -5716 p.1
I.
Met aaical Permit App p100,I FOR OFFICE USE ONLY A .
City of Tigard `�.-ir /OG 66 PcNa �y�/�.p���
13125 SW lisp Blvd ,Tigard, OR 97 71A ` , -
Phone: 503 - 639.4171 Fax: 503.598.1960 20 �. ,.. .,. ,. :„ Dauwny: Othcr Peemit
06 �
Inspection Line: 503.639.4175 SO) ..-..!... .1 I I Date Ready/By: lois: BI See Paso 2 for
Internet www.ci tigard.or.ns T Notified/Method: Ati Supplemental Information
' �t . °t . T "
• �f(onie • COMMERCIAL FEE' SCHEDULE - USE CHECKLIST
New construction arrow on/replacement Mechanical pmt fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S ) IMO RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
1 and 2 family dwelling ❑ Commercial/industrial ❑ A ccessory building
❑ Mnla- family ❑ Master builder ❑
For special information use checklist.
Description I Qty. I Ea I Total
JOB. SITE INFO LOCATION Heating/cooling - _
lob site address 9 V W 405 +IL' Air conditioning or heat pump '
(requires site plstr slowing placement) , 14.00
City/State/ZIP: "j do a4 p � 1*2Z3 Furnace 100,000 BTU (dncts/veets) - , 14.00
1 Furnace 100,000+ BTU (ducWveau) 17.90
Suiteibldg.fapt no.: I Project name: Gas Beat pump 14.00
Iiydronic hat water system 14.00
• Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision Lot no.: Flue/vent for any of above 10.00
Other. 10.00
Tax map/parcel no.: Other feel appliance
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 7 10.00
N eerier u.- Wad, V1 ikt ..AcL- 1Pkt O Flue for water heater or gas 10.00
C ■ t% % N CT Log lighter (Ras) • 10.00
Wood/pellet stove 10.00
iWood freplace/insert 10.00 ROPERTY OWNER 1 ❑ TENANT Chico u nt 10.00
. Other: 10.00
Name: R \ CIA- Skin.", r4 tC (E._(s4 Environmental exhaust and ventilation
Adddress:9I4 D SEA) 0 a lly es. S equipment hood/other kitchen
equipment 10.00
City/State/ZIP: e„rel 1 Oct._ g-4-2Z3 s s (ba 10.00
Phone: (540 Writ �- abL{'} Fax: ( • ) toilet compartments, utility rooms) 6.80
APPLICANT . . ❑ CONTACT PERSON Aniek awlspace fans 10.00
Business name: 4 F 4- LU S�srr ms Z�
Other: 10.00
Contact name: LVILTIVE 15.40 for first four; $1.00 for each additional
Addresx -73 a /1? etc
I . ' '`� y � y ,, / ..}/ Gas hea pump
City/Starte /ZIIPP: £i) tie 7 L zuA- q o/ WaU/suspendedhmit heater
Phone: 00 .3• Was* I Fax: : ( ) '5W4 _
Fireplace 1
E -mail: Range
/+ CONTRACTOR Barbecue
Businemnan= 6 Pe-A-1 Sys4e ,JA.C.. Clothes dryer (gas) -
Adthess: '73) yy 4A, Oz MECHANICAL PERMIT FEES*
City /State: WA—MC/6U 6 - 4a A ` to71 Subtotal ; tic
Minimum permit fee ($7250)
Phone: ( 1 - 35' /(p 1 Fax: S4/6 g3T"' C Plan review (25% of permit fee)
CCB lie.: /OM& alyle /a 39S.--- � State surcharge (8% of permit fee) S. "a
• TC(TAL PERMIT FEE IS 3D
Authorized - r ' . • . ` ' p �after ft been accepted as complete.
atehfe 180
I Print name: 1,V --54 • SA I Date: pet. OS" OZ. I • Fee methodology set by Th. Cerny Building Industry Service Board
CITY OF TIGARD • .• •
BUILDING DIVISION PERMIT #: MEC200600432
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/6/2006
Phone: (503) 639- 4171 Ake
�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/25/2006 TIME: 7:01AM PAGE: 14
SITE ADDRESS: 09405 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: MAYFAIR LOT #: 004 TYPE OF USE:
PROJECT NAME: NICKERSON
DESCRIPTION: Gas fireplace install, flue, piping and outlet.
OWNER: NICKERSON, RICHARD PHONE #: 503 - 443 -2017
CONTRACTOR: G P & W SYSTEMS INC PHONE #: 360. 835-3516
Inspection Request Scheduled For: Date: 9/25/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 037112 -01 360- 772 -6328 N
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 9- - -6 Phone #: (503) 718- 7116
CITY OF TIGARD • . ' ' _
BUILDING DIVISION PERMIT #: MEC2006 -00432
13125 SW Hall Blvd., Tigard, OR 97223 i. DATE ISSUED: 9/6/2006
Phone: (503) 639 -4171 Inspect ion Requests (24 Hrs.): (503) 639 -4175 iliM
,
INSPECTION WORKSHEET FOR DATE: 9/22/2006 TIME: 7 :02AM PAGE: 3
SITE ADDRESS: 09405 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: MAYFAIR LOT #: 004 TYPE OF USE:
PROJECT NAME: NICKERSON
DESCRIPTION: Gas fireplace install, flue, piping and outlet.
OWNER: NICKERSON, RICHARD PHONE #: 503 -443 -2047
CONTRACTOR: G P & W SYSTEMS INC PHONE #: 360 - 835 -3516
Inspection Request Scheduled For: Date: 9/22/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 037054 -01 360 - 772 -6328 N
Corrections/Comments/lc ruc ons:. . . ,,c. ....(..c
,01
,,
_.
jI 'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
t\ ft) u t t )
Inspector: Date: t V 15 Phone #: (503) 718- '1) A