Permit •
CITY OF TIGARD MECHANICAL PERMIT
• I'1 s
• COMMUNITY DEVELOPMENT Permit #: MEC2013 -00112
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/25/2013
Parcel: 1 S135CA00101
Jurisdiction: Tigard
Site address: 11145 SW 95TH AVE
Project: Gray Subdivision: MEADOW VIEW Lot: 2
Project Description: (1) wood /fireplace insert and (1) vent
Contractor: GO SALES INC Owner: GRAY, DEAN P
14210 SE STARK ST 11145 SW 95TH AVE
PORTLAND, OR 97233 TIGARD, OR 97223
PHONE: 503 - 256 -3473 PHONE:
FAX: 503 - 254 -1011
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 02/25/2013 $23.32
Type of Use: SF Chimney /Liner /Flue/Vent 02/25/2013 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 02/25/2013 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 02/25/2013 $43.36
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.
I
Issued By: IALSby &(04- Permittee Signature: bM H-Pu Q [ l e 4-` 7- /O ,&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.
Feb . 22 . 2 013 02 : 2 0 PM PORTLAND FIREPLACE SHOP 503 254 1011 PAGE. 1/ 2
RECEIVED
Mechanical Permit Application O 5 2013 FOR OFFICE I S I . 1 0 \ IN
City of Tigard ce4 DI 3 dOltd—
1,1 • .3125 SW 110 Illvd., Tigard, OR 97 gITY OF TIGARD FEW a-5 13 sr Pernik N° _
' I
• Phone 503.718.2439 Fax: 503.5111fILDING DIVISION Plan Review DatcJ13y: Other Permit:
i) InsPxtion lino: 503.639.4175 Oats Itundy/By: illlils: , 13 See l'ap 2 fur
Intent& WWw.ligArd-Orgov NotilludiMulhod: ---y 10 Supplemental InAwmadon
I
_—. -...... _............ . . ... .
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
_____ ... ._. ............. . - Mechanical permit f euss are based on the v0100 of the work
0 New construction Ej Addition/ulteration/replacement performed. Indicate the value (rounded to the nearest dollni of all
0 Demolition 0 other mechanical materials, equipment, labor, overhead, and profit.
Value: S
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
ISI
I- and 2-family dwelling El Commercial/industrial ID Accessory building Fur special information use checklist
0 Multi-family 0 Master builder 0 Other; j ption i_Qty. I Ea. I 'Isotal
Ileating/cooling;
.108 SITE INFORMATION AND LOCATION
Air conditioning
lob situ address: 11145 sw 95th Ave (rtjayem mite pinn shaming placement) 46.75
Furnace 100.001) 11111 (ducts/vents) 46.75
City/Statc/ZIP: Tigard, OH 97223
Furnace 100,0004- rat I Mums/ems) 54.91
Suite/bldg./apt. no.: Project name: limit pump
(ruquirus situ plan howing plueenteni) (,t IX,
Cross street/directions to job site: Duct work 23.32
-- -....--.-- —
Ilydrunie hot water system 23.32
Residential boiler (radiator or
, hydronie) ..... 23.32
Unit halters (fitel-type, not - electric),
in-wall, in-detit. sUspertged. etc. 4.75
...
Flue/vent for any of above 23.32
Subdivision: I I 0t no.:
(ther: 23.32
Tax map/parcel no Other hid appliances:
DESCRIPTION OF WORK _Walef heater 23.32
._.._..... . ...--
Chu fireplacc/iTen 33.3')
Install Wood inert and venting .......... -- Flue vent for water heater un- ens
fireplace 23.32
Lug liglact Cams) 23.32 _....
Wood/pellet stove 33.39
Wood fireplace/insert_ I 23.32 23.32
[8] PROPERTY OWNER F ID TENANT Chinumillinerilluervent
Chher 1 23.32 23.32
Name: Dean Gray Environmental exhaust and ventilation:
-- -- Range hood/other kitchen
Address: esuipmmt 33.39 - ._.....
Cily/S tute/ZIP: , (.."49thes dryer exhaust 33 39
_... .......... _ ...—
• ••- __..... . - -.-. - • .• . -- Single-duct exhaust (bathrooms,
Phone: ( ) __ Fax: ( ) toilet compartments. ulilituuquis) 23.32
_ -
0 APPLICANT 0 CONTACT PERSON Attie/crdwIspace fans
..„......... 23.32
_.......... —..,_
( hher: 23.32
Business name: ___.....
Fuel piping:
Contact name: 514.15 for first tour' $4.03 for each additional
Furnuee, etc.
Addrusn:
(ins heat pump
(Illy/Slate/ZIP: Wall/suspended/unit hunter _
Phone: ( ) I Fax: : ( ) Wuta heater .._.....
Fireplace
E Runge
..-_. ___.... . -
CONTRACTOR Barbecue _ • . „ ....
_..... . -- - Chiles dryer (gas)
Business name: CO Sales Inc.
Other:
Address: 14210 SE Stark St. MECHANICAL PERMIT PEES°
City/State/ZIP: Portland. OR 97233 Subtotal 40,64
Minimum peons fee ($90.00) 91t.o0
l'honc: (503)663-7454 I -- Pax: (5113) 254-1011 _ Man review (25% of permit fee)
• • .------ ..... „.. .... .....
CC B lie.: 194285 State surcharge (12% of permit fee) 10.80
..
g- -- — ft TOTAL PERMIT FEE 100.80
This permit application expires if a penult In not obtained within 180
Authorized signature;
days after ha. lien .cceptrd MN wookte.
Polo rtamc: Kristin Gentry I Date: 2/22/13 • F modindulogy se' by 'fri Building Industry Serviuc Doan!
1:01uildinearnitA1CC•Pumii ARA.: 03/07/12 44044171 01/02/COMAVE13/
• •
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11145 SW 95TH AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
02/27/2013 00:00
MEC2013-00112
PASS - No C of O
Violation Summary:
Inspector Contractor