Permit n CITY OF TIGARD MECHANICAL PERMIT
- 2 � , ' COMMUNITY DEVELOPMENT
1 Permit #: MEC2012 00539
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/17/2012
Parcel: 2S 1048804000
Jurisdiction: Tigard •
Site address: 14060 SW LIDEN DR
Project: Cassidy Subdivision: CASTLE HILL Lot: 27
Project Description: Installation of gas insert, chimney liner & gas line.
•
Contractor: T & K MECHANICAL Owner: CASSITY, LORI A
PO BOX 116 14060 SW LIDEN DR
•
FOREST GROVE, OR 97116 TIGARD, OR 97223
• r
PHONE: 503 -844 -9173 PHONE:
FAX: 503 - 846 -0195
FEES
Specifics: Description Date Amount
• Gas .Fireplace . 10/17/2012 $33.39
Type of Use: SF Flue Vent Water Heater or Gas 10/17/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel•Piping . . 10/17/2012 $14.15
Stories: 12% State Surcharge - Mechanical 10/17/2012 $10.80
Minimum Fee Adjustment - Mechanical 10/17/2012 $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• s to c NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / /a_ 04 n Q / Permittee Signature J`
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.
Y
10/17/2012 15:09 5036269138 HOT SPOT FIREPLACE PAGE 01/02
Mechanical Permit A!plicRECEIVED i H i< ( i r r 1( I i.; 1 W.1 .1
City of Tigard n /ot �e Permit No.: i i t e, ,P- OO.S3?
13125 SW Hall Blvd., Tigard, OR 97224CT 1 7 rf 2012 P�Review
' • Phone: 503.718.2439 Fax 503.598.1960 Date/By: Other Permit:
r I c; : \ 17 Inspection Line: 503.639.4175 IG � RD c 'TV OF T Date Ready/By: J la See Page 2 for
Internet www.tigard. or.gov l 1 1 1J F��v Notified/Method: supplemental Information
BUILDING DIVISION _
TYPE OF WORK COMMERCIAL FEE' SCHEDULE - USE cRECKLIST
Mechanical 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, cquipmcn labor overlie:. and • ro1"im;
Value: $
CATEGORY OF CONSIRUCI'ION RESIDENTIAL EQUIPMENT / SYSTEMS Ms*
1- and 2- family dwelling ❑ CommcreiaL/induslrial 0 Accessory building ~ Forspedal information use dteckl&
g
Multi- family ❑Master builder 13 Other: _Description Qty. 1. • Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
r Air conditioning
Job site address; r //o 66 [. C) L t CL ey. '� l.- butanes site plan showing placement) 46.75
` ac Furnace 100,000 BTU (ducts 46-75
City/State/ZIP: f tyw I lI r O qi 2-P-3 Furnace 100 000•, BTU (ducurve ms) ■ 54.91 Mil
Suite/bldgJapt no.: Project name: Heat pump
•. hes site .taosbowin:.lacement 61.06
Cross sheet/directions to job site: Duct work 2132
"-- Hydronic hot water system 2332
Residential boiler (radiator or
bydronic) 23.32
Unit heaters (fuel-type, not electric),
in -wall, ire -dues suspended, etc. . 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: _ 23.32 _
Tax map /parcel no_: Other Ikea a 1 fiances:
DESCRIPTION OF WORK Water beater EMMEN
Gras 5replacelinsert 33.39 ill
/r' S ll in.Q Ci. t/1 la5 (1�Se VA Flue vest for water' heater or gas
lace 23.32
J g : li: - _ 2332
Wood/ • net stove 3339
Wood fireplace/inscrt III 23.32
PROPERTY OWNER 1 ' El TENANT Amer/flue/vent 23.32 . 3.3
f''� Other. • I 1 23.32 I
Name: 1 C I � Environmental exhaust and ventilation: cl i Address: �! loo C ..! ►�l 2-)„..,
. Range hood/other kitchen
equipment 3339
City /State2fP: +-� qL, rd / ov q7 . Clothes dryer exhaust 3339
Single-duct exhaust (bathrooms,
Phone; ( ) Fax: ( ) toilet compar utility rooms) 23.32 _
-
�: APPLICANT D CONTACT PERSON Attic%tawlspace fans - 23.32
Business name: e yr o - r ve lac _ Other: 23.32
- - r y i Feel Witting:
Contact name: • e_ K $14.15 for first four; $4.03 far each additional
Address: I / at � O l" Pomace, dum as
City /State ZIP: 0 ✓ed•Ov 6 ✓ q 7 Wall/suspended/unit heater
Phone 5 : K,v q . 050 Fax:: 7) "� Ti 3y- r heater
Water ace /1-1 /5
Eaooail:4 po-1� 7i�
i r « 0 herioia i I. LSO
f '"
CONTRACTOR Barbecue --
Business nam � r d . K t _ e c _ NLa 11 i Cam/ 7 Clothes 1 - ;as III
Other:
Address: ?e) 26/C L MECHANICAL, PERMIT FEES`
w 01/t �5d C - VotJ.e I/ • 7 /� . Subtotal
City/State/Z17: �,
Minimum permit fee ($90.00) I -1
Phone: ( ) I Fax: ( ) Plan review (25% of permit fee)
CCBlie.: t , /All& J 3 /7 ' State surcharge (12 %of permit fee) / / t
TOTAL PERMIT FEE /00
This permit ■pplicatioa expires if a pentot is net obtained withist 1,10
Authorized signs , • . _. . ;y, / 1 days after it has been accepted as complete.
Print name: a P . r ,/ ; e/ ii. D A /0 � a fee methodology set by Tti.Cvuety Building Industry Service Board
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