Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Q I � MI MECHANICAL
MEC2012 -00449
T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 (� S �� I Date Issued: 08/27/2012
Parcel: 25111 CD03000
Jurisdiction: Tigard
Site address: 15630 SW 98TH AVE
Project: Knutson Subdivision: SUMMERFIELD NO.9 Lot: 540
Project Description: (1) insert gas fireplace , (1) flue vent, (1) gas log lighter; gas line to (2) fireplaces
9/5/12 REPRINT to complete address
Contractor: T & K MECHANICAL Owner: KNUTSON, GENE
PO BOX 116 15630 SW 98TH AVE
FOREST GROVE, OR 97116 TIGARD, OR 97224
PHONE: 503 - 844 -9173 PHONE: 503 - 307 -5065
FAX: 503 - 846 -0195
FEES
Specifics: Description Date Amount
Gas Fireplace 08/27/2012 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 08/27/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Log Lighter (Gas) 08/27/2012 $23.32
Stories: Fuel Piping 08/27/2012 $14.15
12% State Surcharge - Mechanical 08/27/2012 $11.30
Fuel
Fuel Types:
Gas Pressure:
Total $105.48
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 DAR 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 1.800.332.234.4.
Issued By: Permittee Signature:
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.
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 00449
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/27/2012
Parcel: 25111 CD03000
Jurisdiction: Tigard
Site address: 15630 98
Project: Knutson Subdivision: SUMMERFIELD NO.9 Lot: 540
Project Description: (1) insert gas fireplace , (1) flue vent, (1) gas log lighter; gas line to (2) fireplaces
Contractor: T & K MECHANICAL Owner: KNUTSON, GENE
PO BOX 116 15630 SW 98TH AVE
FOREST GROVE, OR 97116 TIGARD, OR 97224
PHONE: 503 - 844 -9173 PHONE: 503 - 307 -5065
FAX: 503 - 846 -0195
FEES
Specifics: Description Date Amount
Gas Fireplace 08/27/2012 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 08/27/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Log Lighter (Gas) 08/27/2012 $23.32
Stories:
Fuel Piping 08/27/2012 $14.15
12% State Surcharge - Mechanical 08/27/2012 $11.30
•
Fuel
Fuel Types:
Gas Pressure:
•
Total $105.48
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 OUN by calling 503.232.1987 or 1.800.332.2344. /► f � / � /l �/� -�/ ' '
Issued By: /
/�'�� ,/i �yJ� ," ' Q Permittee Signature: t/J A T Lf[ £4- (l 'DL
Call 503.63 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.
08/27/2012 15:07 5036269138 HOT SPOT FIREPLACE PAGE 02/02
i i
Mechanical Permit Application ,.,,,,„,_,,,
City of Tigard '
II - .- 13125 SW Hall Blvd., Tigard, OR 97223 AUG 2 7 2012 p 1:1' ge---UlaP" 6
. g .
Phone: 503.639.4171 Fax 503.593.1960 Darefk3y:
1 ■ f . I ) Inspecticao Line: 503.639A175 crry Of TIGAR t Date Ready/By: I '- : . if see Page 2 tor
Internet www.!igaraor.gov .,... , eltud; rg 0 flapplaarartal lotboaatioa
BUILDING DIV1S' -
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E OF WORK
TYP : . . • . CICL
. a i MbiER tv . r SGEIEDULE - USE CEIEIST
.
. _ •
.1. . eril ■ - . ''t - -.: are Wed oti tbe value of the
U New construction N Addition/alteration/replacement
, . - , . ,. . icate , .- value (rounded to th work e nearest dollar) of all
0 Demolition 0 Other:
_ . CATEGORY OF CONSTRUCTION . 11111111111111111 Value: S
11
' ' ' . - I' 1 ,.. I isiarrois FEES*
14 1- and 2-Emi1y dwelling 0 Commercial/industrial CI Accessory building
For •, - • 1 brfiOnettilvi use dtiwkl 15/
00 Multi-family 0 Master builder 0 Other: I ,. ptiva , 'Qty. I Ea. I Total
. _
. . JOB SITE INFORMATION AND LOCATION ' . jthisc,'..
• 1 conditi ins
Job site Waren: 15 $0 ao dfi 4 u 1 2.- 46.75
City/StaterZ B ¶ 6A ar .8 0 ,,, qq,124 _ ....,100.i.Biu- •- vents) 4615
I
: ■ , • 100 1 1 0 B (ductsivetas) 5491
WM/bldg./apt. no.: kj J Project name: 61.06
Cross street/directions to job site E.. wo& 11•1110711
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23.32 i
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Name: ( .9 ....XP(- 50 l''‘ n "rim: je tal mint .. t andvendlidon
Address: / .-z 30 54A) '7S-LL Aoe_ 3339
City/StateJZIP: e n gia r d ,0 0,.. p al 2' - ' = exhaust : 33.39
Phone: (3) 0/- .61‘1,5' Fax: ( ) RiF 1;; ;; ":.“"'
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Contact name: lb ■ S4.03 for each additional
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City/State/ZIP: 1 7 yi k i , 6 e" 4 712vs - E=nrilrrill11111111
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Business name: / 4.- e ,t.. .,,...,.
Address; 0 x iel --.- : . 3 -
City/State/ZIP: FO r j_ G. Or- q7ite, . Subtotal
. ,.. permit fee ($90.00) eiV, / 9
Phone: ( ) Fax: ( ) . Plan • • • of (25% of permit fee)
cat lic.: A. / 6.S 6 1 /it(
State , ... :, • (irh of walk fee) 10
1 TOTAL PERMIT FEE i in5. or
1.. permit ppikadon , - - if 2 pursuit is nut *bared within ISO
Authorized - sgnature: Ark d r , 6 di__ __/ , .. • _4 don Ow ; Ito l+p acre en as complais
Print name: , p 0 .4 c _ Date: 8y 7 ha . Foe methodology St' Tri-County Building Industry Sorvico Bond
madame - ' MAMA 4404517T 0 unocosvwern .