Permit CITY OF TIGARD MECHANICAL PERMIT
7 111 • " COMMUNITY DEVELOPMENT Permit #: MEC2012 -00279
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/31/2012
Parcel: 2S 103DA04000
Jurisdiction: Tigard
Site address: 10860 SW PARK ST
Project: Epeneter Subdivision: DERRY -DELL NO.2 Lot: 37
Project Description: (1) chimney /vent
Contractor: FIRESIDE DISTRIBUTORS Owner: EPENETER, FREDERICK J & BEVERLY
18389 SW BOONES FERRY RD 10860 SW PARK ST
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503 - 641 -1919
PHONE: 503 - 639 -6468
FAX: 503 - 620 -5699
FEES
Specifics: Description Date Amount
Wood /Pellet Stove 05/31/2012 $33.39
Type of Use: SF Chimney /Liner /FlueNent 05/31/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/31/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 05/31/2012 $33.29
Stories:
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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4,1 Permittee Signature: (fA/ �/ / (9
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.
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05/30/2012 06:43 5036707905 WIDDOWS PAGE 02/02
Poe Mechanical Permit Applicati �' ' ' I p� Fu OF'
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111111 'I City of Tigard " g cI c Received permit N
13125 SW Hall Blvd., Tigard, OR 97223 MAY 3 D a t e B y . /�I -'��a -ava ?9
m Phone: 503.639.4171 Fax: 503.598.1960 2012 Plan B y: Other Permit:
r I Ci n It n Inspection Line: 503.639.417 Date/i.e
Internet: www.tigard or.gov on 1,9 - l Date Ready/By: turf 0 See Page 2 for
TIP ; !l
dGARD Notified/Method: �� Supplemental Information
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❑ New construction Addition /alteration/replacement Mpc ii sed l f th
❑ Demolition 11 Other: performed echani Indicate permit the fees• value arc ba (rounded on the to va the ue n eares t o e dollar ) of all
emolition
,;:<I;D, : . i I i„ mechanicrl materials, equipment, labor, overhead and profit.
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lj;ll {. nl!' I:i. ;A:-II:, Ill : 1i, I ..1.'Itlw' I'.� I,,. L
:a;, 1 111:7 i•.? '.;;;( . l {{I { {,... Value: $
' u , .. , �. . I,I ::1,9il , : III a ,.n 1;µ��4 � r r 11 I ' 1,.,I In 1 11 1 " :
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building 'li 'llhl� h,I L I ' ,i ;itl i it??ltf� �` I1 � l l � ll l' IN '
11:1 Multi-family For special information use checklist.
y ❑ Master builder ❑ Other:
�'`` 111 " •ili l'' {i 1-,, r"! ! 1 N t: Descriptio t Qty. 1 Ea. I Total
�I yt� ,,ti,,� ,(�.t '�'�{J4��}y�ua: 0!':;:':77
Ij ;fi�' ni . ,,;il• tit!, Y�i! l'I, FO '1 " t�!!�EI'�+'c•: !�!al'JtV ` alill�l' ; , I Heatl og/e,loling
Job site address: t � � / `, 1 /� �(/ Air conditioning
8 V 5 c'V j 1 �4. , (requires sib plan showing placement) 46.75
City/State/ZIP: 11, �j a, y J 1 ha /C
q "1 !•l 3 Furnace 100,000 BTU (ducts/vents) 46.75
Suite/bldg. /apt. no.: � G, I ir Project name: t p ,� ad,e.4,- Furnace 100,000+ BTU ( ducts/vents) 54.91
Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
• hydronic) 23.32
Unit heater r (fuel -type, not electric),
in -wall, in- iuct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.:
q Other fuel appliances
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q I 1 111!
I �:�,,, (YF. ,�'jO �{. .: 4 t -: III : ,I, • 1 a .. ; ';,, ' I Wa heat". .. ••,l � : I D>�;4GGit �I 1.1 II �• . , : ,11, IIUGI II� 11.I:q,h� :;I�: ��d'iI1R11l111I!! 23.32
Inst al� l Gas fireplai a 33.39
�`9 ` l� � - S Vp� �f- I /P n -� Flue vent fi rr water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pelle:stove / 1 33.39 93.34
Wood firep ace/insert 23.32
T !1 1 " .'i;. "': .,:In ,C ;Id, :f. �;,4mpl c •
{i i i ; ; f I° 11. '1 b ]ZP ,i',l ; ii :iil 1,,11111' !`' li'`'r•1,•, ,: i ., ,,. ,,, il Chimney/liner /Flue/vent
r.+ „; �; ';iJ , 91 11 {t 1' 'r li I 23.32 ^ ��1
.i
: ; ,; 1, 7. : ,.I�n. .. 'fi; �i,. �71''I`I� �: lll�ll %.I�II''lilIr,IIIh ,'t•'1� { itl I;,I�In d �•a"i��'
1:r Other. 23.32
Name: 1 /P arter
Environmental exhaust and ventilation
Address: ! Q cA / � Filt Range hood /other kitchen
equipment 33.39
City/State/ZIP: -r;' Qj`611- ftV /t ? aQ 3 Clothes dry :rexhaust 33.39
Phone: ( Fax: ( Single -duct exhaust athrooms,
n ! �� � y y . ) toilet comps rtments, b
morns) 23.32
:� Ala : u'I % •' ' 1 .J14'� i !�'�I 1 ' �? �I Itll alit '`': i1i I`!'L� ���"�I +I��. i �i i/ -' ,. ,�., .
,!' ,,,� 1., ,,,, : n:,. 1; t 1 '.IEii;iA' i,11.0 �!',:, Y„ `0,1:,', - lYlf' i10A9.i 1111;1 , l ,II Att1C/crawi5 ace fans
i Illl,lh. 4! ,•,1,� n it;. iilnlllntl P 23.32
Business name: 1�'� G 1 _/ e . / i , / r1 y , t _ 1 es ^ Other: 23.32
r Q 'I` �✓ (jZ� /�fl Fuel piping
Contact name: � iv C . t `i �,� l i ,�^ $14.15 for first four; $4.03 for each additional
Address: /O gg Q 5!,(i " nC7 � •Ii �; f Gas heat p ic
City/5tate/ZIP: � �/ ,/ ! Gas eatutnp
or 2.rtd t 04, 47aa J/ WalUsuspen.ied/unit heater
Phone: ( r 1 0 ) 5-.4.-..., 3j 7 4 3 Fax:: ( 404 e) ,. 5 i/p � Water heater
E - mail {o /(� a•�^ �� Fireplace
' li;l,.rl i.i,y ,,,ij i i' ` l; . ;!! „i i 4 e, r, -4,4/ ^ .u ' !J i T '1.r.•Ir 1 !!4e „o ,.� 1 r :.p, 1 Range
I : i 'r i;, , .:,. 11,: :u "a•! is.� }�' I /1041Pr I ,I ;,, , =:111111 yy 1 f 1111!.` i t Barbecue
:`t`/.. i, dr:. Ir,: „i:d�:r::f;ila ' n
P:LIJ . a t1�1,
Business name: X2 0.a� Lo h _ /)` / A £ r5 Clothes drye' (gas)
Address: / f JLJJ
Other: j �j to
} Slate / Rag9 t ann .� / , i a , 4 1 Il�lr'ill ' i':. I,`, ,1 . 1, i ,.. 'tR!fw' 4'l;{ 10j1,,t,g I io!iI
City, 7hrrI a.i -- I f 42 Subtotal Z,r7/
Phone: (5) 5 s 3 7a� ax: (52)3) l n� Minimum permit fee ($90.00) 9�,�f
,,R6B I/69 Plan review (25% of permit fee)
lic • 74 �� `f State surcharge (12% of permit fee)
/ TOTAL PERMIT FEE /�, 8
r l ays after it
Authorized signature: c � �J aQ 4L 9S17--) This permit application expires if a permit Is not obtained within 180
f y has been accepted as complete.
Print nam - • / l Date: J 40 • Fee method )logy set by Tri -County Building Industry Service Board
J a •
1 : 1 BuildingTermitAMEC -PermitApp.doc 10/01/09 440.46177 (I I/a2/COM/WE8)