Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00194
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2012
Parcel: 2S114BA01400
Jurisdiction: Tigard
Site address: 16185 SW GRIMSON CT
Project: GREENE Subdivision: PICK'S LANDING NO.2 Lot: 125
Project Description: Gas fireplace and wood fireplace installation with venting and gas piping.
Contractor: FIRESIDE DISTRIBUTORS Owner: GREENE, JEFFRY L AND
18389 SW BOONES FERRY RD MARY CELENE
PORTLAND, OR 97224 16185 SW GRIMSON COURT
TIGARD, OR 97223
PHONE: 503 - 641 -1919 PHONE:
FAX: 503 - 620 -5699
FEES
Specifics: Description Date Amount
Gas Fireplace 04 /19/2012 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 04/19/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Wood Fireplace /Insert 04/19/2012 $23.32
Stories: Chimney /liner /FlueNent 04 /19/2012 $23.32
Fuel Piping 04 /19/2012 $14.15
12% State Surcharge - Mechanical 04 /19/2012 $14.10
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $131.60
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By` % /01101111 Permittee Signature: - - �� •
L�
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.
04/17/2012 09:18 5036707905 WIDDOWS PAGE 01/02
Mechanical Permit Application tt)8 01,-Fi :t; usl; ONi,Y
City of Tigard RECEIVE i ' -' eAccelBivedY: illiNiTI2 N ° : 1 " 1 - ' 4 - C a r ) t(" fqY
0 13125 SW Hall Blvd., Tigard, OR 97223 • Ian Review
• Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Oilier Permit'
T I G A It l� Inspection Line: 503.639 APR 1 7 2011. Date Ready/By: tan See Page 2 for
Internet: www.tigard - or.gov r T (�❑ Notified/Method: 7 t ( Supplemental Information
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' 1 i Mechanica permit fees' are based on the value of the work
❑ New construction Addition/alteration/replacement Performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
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�,�;y�';,� "� I�'i 'laljl'I!" ' I gip' ' 1 ',� � � ' I , ", Value: $
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if
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I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special affirmation use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Descriptior , Qty. I Ea I Total
'r• IIlln gP!.I;IaI it el' . �1 ,1.1I „ d 11i • !,1�'•,'1 !
i @
5�'I li I •, rh1. , 1.1 , .;;{gilIl O� 'I6>�J` lI )1f�Fd�l�i��Vt�'�`7Di'i: ,'�A Old. °
iI'14::' ':iii l��;�'� Heating/cooling
... .;. 11 ,..,11r1::• ; ,i111'; :. �;,�' .., �� ::..,. - , - , .., _ .., , ,.,.. ,,:... ,,. . ,..:. „ r 1 :. ,1 1 11,. r:
Job site address: 162 X 8 5 S & - m S 4 Air Tres ite p l a n
G k t , • (requires sit plan showing placement) 46.75
City /State/ZIP: T' ' D (Q. 6 1 - 7,-1..„2 4 Furnace l0),000 BTU (ducts/vents) 46.75
t Furnace 10'),000+ BTU (ducts/vents) 54.91
Suite/bldg, /apt. no.: P roject name: 1P , 6117,..,6,C.., Heat pump 61.06
Cross street/directions to job site: " � Duct work 23.32
Hydronic h pt water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heater i (fuel -type, not electric),
in -wall, in -.lud, suspended, etc. 46.75
Subdivision: `Lot no.: Flue/vent fir any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
!-� ;lil ii: -,� 'L,r.',:'iI!�iq' ^D d' '!; ,II '1111 il.:.; yi11111 },1 ; , gli ''ii�� I 1 i Water heat
gi!! 1 a1 ;•i,1 �, ,:I;' ' ni ';ul; 1 _ .0 ;N 1 41 . L:1; 1 ;.1;11;1,1. 1' .,., i1 e r 1 23.32
f ..h:I �� -��. 1 IZ� ,.. �:.'. � .1 :..;,. ,. r•:'. , I:I .,1(,,; i, 39 n: .. •� s it 1 .Ili i . I 1 I I, i:,.i.,::�., r, ' � i
Gas firepla: :e 1 ( 33.39 83,
I f1S .b et- S I C r, 9 0.S
Flue vent f Ir water heater or gas ,c �J
fireplace I 23.32 5. 12.
s L`:4 I r A s J • - Log lighter (gas) 23.32
V Q _n &t ■ if\ a i Wood/pelk stove 33.39
Wood fire (lace /insert / 23.32 2 ?.37
I li:_€ :16• IN'1 pill dq'` 1 _ •18.. l in, �n • q 1p' !Il ii!III�IPiiII Iii`i `i ' 11 ; `,(11 1`1!, : .11 1 1111;1 " 1;4 Iji Chimney/li ner /flue/vent / 23.32 ,23.6 �
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:�:!: i i ,
••� '' Other: 23.32
Name: je'cc. G ... p Environm':ntal exhaust and ventilation
Address: 17.? �` s n , Range hoc) I /other kitchen
5 uW] 1'x'1 l'�} C ST equipment 33.39
City /State/ZIP: 'T ,/ ® 4-7 Li-
Clothes ut er exhaust 33.39
Phone: ( ) toilet compartments, utility rooms) 23.32 dr
Single -duce exhaust (bathrooms,
Fax: ( )
:Ii a: 1! . :' i t ; ,' „i,: ,, Il i;,:;;y i iu ;fi I I I !q Ili L' I I ,: rYls •
0 I l $4134j' (r'L'I' 0 d, i• 1' 1 n �I}�” " *W 4 I� 1 ,, I Attic/crawl space fans 23.32
.•,1,1 : ,• .. •.� •�:-} � !i•L�! ..'r,.:. i �l! IIII,, , ,! : �6u•;�.';iliii, "1I�'�IpF 1`YI!' � �•��I•�1
�; Other: 23.32
Business name:
r `Y1Qy 1 �iG'� blfhe Fuel piping
7Fict- -/ Fe 3 gq 5l.k.) 'Rri.r.' 511.15 for first four; $4.03 for each additional
Address: ' P� in yt 0 r (1k Q ' 7 .t.t ,r Furnace, el .. i ri-j 1 Gas heat pimp
9City/State/ZIP: t-j) J W.., 11 )e)CDCA Wall/suspended/unit heater
Phone: (99)) 4 gSI3S� / Fax: : ( lo o 0 ,, 1, l ti Water heat*. E -mail: /n J � Fireplace , / S r . _ 3b/4.1,
n y � r ,, � ib y 11: 11..`.; -sin � { rC , Co 1 Ran
- ql` 1 r. 1 , +, 0. � 4 1 1 S 1'1 ,' ., ,•1'11 1 1•''
�.nii , �is , '� I li ;..l. , L I' I. !1'iin u ' � >•( i i . 1 : ; i h11 i ,111 isl •i:l l .: ;::ii 1 &lid °i ., B arbecue
.,t. �,:Sn � .. al I .::111 � 11'� !'��1;:`~"„� �i;fl 1 =� : r1i1i 1 Y ,
1 u l . ..:1,,, , , , , ,.:,,.,� : :b� 'I,sa';, 11'1 ,Iah
Business name: ir t�P r) b _ ,Lys �� Clothes titer (gas)
Other: p ry � � : s:u du
Address: 3' w / Q 'Cl ;J / � ! /, r s , '' ;lll!II ! I ' � ' ' `{ t l i ) iai P, 1.•n 1 I 1 ��D 1111 I,I ld t� 9 l! 1 p 1 17 1 [+: it I NF ;I ,i, . . -,
I ' ,dill 11 11r'411,.':''ih� inn iilMi)e 'lN1:1' • L ' r
City /State/ZIP: .t. _ o • I' Subtotal / • X17, 57) Minimum permit fee ($90.41 . -------• Phone: (0,, , os Fax: 2 ea _ Q 6
Plan review (25% of permit fee) —
CCB lic.: / 9 / ✓ ! State surcharge (l2% of permit fee) '/.IL)
TOTAL PERMIT FEE _ L�l
Authorized signature: d_ / � _ / This permit application expires If a permit is not obta' , • "thin 1: I /3/ ,
III -At 14 __
i days after it has been accepted as complete. J
_
/ , Date: 7 - a l , • Fee methodology set by Tri- County Building Industry Service Board
1:\ Building ,Permits\MEC- PennitApp.doe i0/01ro9 440- 4617r (I 1/ 2/CO /WEB)