Permit II a CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00162
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2012
Parcel: 1 S134DB04200
Jurisdiction: Tigard
Site address: 11105 SW 109TH AVE
Project: Luza Subdivision:4HAN'S ADDITION TO THE CITY OF TI Lot: 4
Project Description: Install gas fireplace insert, venting and gas line.
Contractor: FIRESIDE DISTRIBUTORS Owner: LUZA, MICHAEL P
18389 SW BOONES FERRY RD 11105 SW 109TH
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503 - 641 -1919 PHONE: 503 -684 -8535
FAX: 503 -620 -5699
•
FEES
Specifics: Description Date Amount
Gas Fireplace 03/29/2012 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 03/29/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 03/29/2012 $14.15
Stories: 12% State Surcharge - Mechanical 03/29/2012 $10.80
Minimum Fee Adjustment - Mechanical 03/29/2012 $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 OUNC by calling 503.232.1987 or 1.800.332.2344. c.
Issued By: O/ /G�' l. U Permittee Signatur (64----__
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.
03/29/2012 06:33 5036707905 WIDDOWS PAGE 01/02
CF I:012 OFFICE USI ONLY
Mechanical Permit Applic • � �'` l
Received M // Permit No.: // /' DMA '06/6 .2
City of Tigard Date/By: �.
Al 13125 SW Hall Blvd., Tigard, OR 9722 R 2 9 2012 Plan Review Otter Permit:
4 ' Phone: 503.639.4171 Fax: 503.598.19 Date/By:
kris: Fa See Page 2 for
1 1 G n I: u Inspection Line: 503.639.4175 ^ i edn d: Supplemental Information
Internet: www.tigard-orgoNotified/Meth Supplemental OF TIGA ID Notified/Meth
p UJI_DING DIVISION y� ns q Imu
.p, ? .. 7 klJ!ta . nrQI(l' a +' m u�urgy�nlmffr �I,�n, r.�p 1 �ill,,v rmmmpvlt {� !II •0' rt. �' 6•
I p v u• I r ' + +' :i 'm,a 7ri' irr`,�,,�y�+'' it °' � iyi willi!e u{II 4IR�!iiviilr Sr., :i i 1 4lii ' ; u . NII� , I, n 'f " , i i .I i T !'.: n Y i� "+Rt 619.1 Gl. , "MI MI
, ..,,:,::'II;k:CI,+ t� i�'IRf( r:' 1:',i:,:r X411, ,rd.l(Il,,, .. ,,,,,,:; :i,., .. ';r ?,,,„ iii 'QafBt�rt ill Inf.., .;:a,_I tl lY:iil!e3;i:lil:: w.., �llllp' T ,...,I, r1 a,.r i '
Mechanical p•:rmit foes' are based on the value of the work
0 New construction 0 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical n aterials, equipment, labor, overhead, and profit.
r m :r.t ., -. ,... ..• ., .............. ., l ...,,;",,,; rr..'r , -r,! , .. , i i Value: $
.:;:,,; ;, „ :r4 1 y; ::r , ,; • • ?„ :1 , ( 1�..iyyy��) �irr,ii��ee'�rr,,v.r� f�; Ir1 rl1,,. I1!! Il, 0l ;I: I I!IIII?� : r.; .� : I(h' iillrhi " P!11191r,..rv;r ' mt u : iwr}r<aunAIllinuR[our m u t ll !m' +'m11�tW na � l � •I' .'
"'' .r . , u . III'dr,. , ,I I I dI.!"}Y'�� �!s'I . ,p�tr,'?'u'?. ; -6, •rrrr,.r Ir. , , .ur..r'.. ,(1 I 1 '111 n �, : i (I P
4 ^^ , • �` Iall9lUlllahl�Fa II {N ,'� I ,.
' ,� ; � � � 9�4ii1r17illi . r -:• t I m(lilr r : I U n i I���'
El 1- 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
:Irl;Itiu! 'lll+!i.li: � !._ ,r�� .r,'� 2iItl�j; rt; `? l�l, �r�J(y Ni; ,••,•,0110,,,,,,•, ∎, ;!!PI•kr'-:Ir';�lif�7;; t,l Heating/cooling
` -.. 1....'0.. -: {:le • ' 5`.° l Ei(;4i7K " °;.°.'1 -,, g f` r „. . : dT If4 i.„
Air conditioring
Job site address: pip r 5(43 /O q If-A ", ,M ueJ (requires site p an showing placement) 46.75
City /State/ZIP: •7' ' ,,,,. r OQ, 9 709. 3 Furnace 100.300 BTU (ducts/vents) 46.75
Furnace 100.000+ BTU (duets/vents) 54
Suite/bldg. /apt. no.: Project name:1....44.344_d Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic ho : water system 23.32
Residential toiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent fo' any of above 23.32
Subdivision: I Lot no.: Other: 23.32
Tax map /parcel no.: Other fuel appliances
r ,.:,I,,,. _ ,,:. „ y� � •;till; , I0!!`..;;.ii�i ie. Waterheate'• 23.32
,.I'' I I `' 1•! I II ,
i f : ,, , l II
I ' r���'11 � at•1 .. . ` 1, .L I + 1'll 'r. I.r. ll:; � ., n
; ; i'I ?I�tl,:dl [I Arib; ' ,r;l!�!a = 1!!t ?k5?p':�r.,n, ,i ...usliL! - ' „�...iR +.,.:, ,.,r5:a,!itl'�. I Illrl;::.rei p I 33.39 3'3.'� !
.�;, :. ".,':; n Gas6re lacy
Jrntet (� � gi D i.. B L v4. 1 I Flue vent for water heater or gas
fireplace / 23.32 iA 3 .3'1.-
V-e--1. h 4,1 r titQ , ' -Z./ ae ,t Log lighter "gas) 23.32
Wood/pelle.. stove 33.39
Wood firep.ace/insert 23.32
�'��,�{ ��{ C r .,, 1 ; i'❑:' -a+:., .. r,: , .r.,nrar,., cal;!?t(1 Chimney /liner /flue/vent 23.32
;i ii , R, ...I;.f :;. .
!i;" I ii!i i i „ : , , ._ l _ I . tl '
ar,' . ;��'ir'l'F;U'��Q'�!G;��'I�'r��l ;1;.
; rrii :...:i'��. r.,irr.'(p;a;:;d.'!: _ L ? €r. � ' + 1'i(,'.r,r other, . 23.32
Name: J/yl/ X� 7/� - _ Environmental exhaust and ventilation
/ / �"' Range hoof• /other kitchen
Address: /MO s 5+ ) /0 di ,Le . equipment 33.39
City/ State/ZIP: Toil r o , e , 9 -Aa a3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (5 (J97 78'75- Fax: ( ) toilet compartments, utility rooms) 23.32
+t r r ( I;IIYr , - , d.; I _'j ' !?i ('I il!il �,, `II!: •r !:� I;' Attic/crawl space fans 23.32
!!. ._I� : I! :p (I!i l.. ,'JrIC'"1:,, ;nia�i +I,,. r'1; I, r ��;• C L ry y ��y''�t171!li ,:
j�u�' ,.f r , . i I : r.�,. r y [� ..1 , �a� "� %�•. . �• "S"Il+''.,il.
;' .. - Other•, 23.32
Business name: r; . / _ ..l, e_ D 5 , � _5 Fuel p ipin;t
Contact name: , a•/� � / a ii' r ze 1 - f ^ 7 I S14.15 for first four; $4.03 for each additional
Furnace, etc.
Address: lg3g 9 S 13 ( 5 .2.1'/' c/ ,freal . Gas heat p Imp
City/State/ZIP: P -L ( 7aa WaWsuspended/unitheater
Phone: (5 &$L!' 4 5 , 5 - 33 -- I Fex:: (.52 (0o20 Water healer vrP99 Fireplace / /y /s /1. /S'•
E -mail: i zit „ /4 .6 ,.. i A, ,,,, Range
'il;: i I 51 � `: ..�I Ir l :l " `J�: ; I I'., ;I L t^ r v j r
i ; �' ;'r :,.. ly''j l:i; '
,�!' i;'.17 i'1 , I 1
L1 ", 1. , y4 ,., ! .r� ; 0 Y L „ I,i, li ' ,..: ' i'.6.1It(Il i I ;i. r r r'
Barb ecue '
` ''.•':!:!:-., :'. � Clothes dr /er (gas)
Business name: ��,6 �s fC��j��1 Other.
Address:
r r l 9' I - : llnll tut I t I pG.v l � lu i'i ,1 * ', ni
� 9f bQ 5) A� F"P G1111h I tI zr''�Ili�j:r' :Ill
J .� D / I 5�.1. li��lll�l�Iii1P� I i I�. r. al b ��7 R '���rt��iilit 't - I ,`.: ± :•� !':
City/State/ZIP: toi - >Al �r r)/e 9,2'1 Subtotal 7D.
(5pP Minimum permit fee ($90.00) go. cur) 9.9 Phone: � '- f .. ' • g .,„-- Fax: (2 _ ,5 Plan review (25% of permit fee)
CCBIic.: x/0 State surcharge (l2 %of permit fee) /).
TOTAL PERMIT FEE /DD .%SO
Authorized signature: ,_ This perm' it application expires it a permit is not obtained within 180 l /
g V � days after It has been accepted as complete.
I Print name: s i e , j , 10 //, L. z 4... ) 66 ,d I Date: 3.,.2, 9 /.2., . Fee met hodology set by Tri -County Building Industry Service Boar
l:Viuiiding\PennitsVit4 .C- PermitAppp.doc 10/01/09 440-46111(11/02/COM/WEB)