Permit e n CITY OF TIGARD MECHANICAL PERMIT
1 , COMMUNITY DEVELOPMENT Permit #: MEC2013 -00159
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/21/2013
Parcel: 2S104BA02600
Jurisdiction: Tigard
Site address: 13916 SW CRIST CT
Project: Thomas Subdivision: COTSWALD MEADOWS NO.3 Lot: 107
Project Description: (1) gas fireplace installation, (1) liner and (1) fuel piping
Contractor: T & K MECHANICAL Owner: THOMAS, BARRY
PO BOX 116 13916 SW CRIST CT
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503 - 844 -9173 PHONE: 503 - 521 -8932
FAX: 503 - 846 -0195
FEES
Specifics: Description Date Amount
Gas Fireplace 03/21/2013 $33.39
Type of Use: SF Chimney /Liner /FlueNent 03/21/2013 $23.32
Class of Work: ALT Type of Const: Fuel Piping 03/21/2013 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 03/21/2013 $10.80
Stories: Minimum Fee Adjustment - Mechanical 03/21/2013 $19.14
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: , J 47
4 a Permittee Signature: � A - PPL-IC 4- T]ok)._
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.
Mar 21 13 08:59a T &K Mechanical 503 - 846 -0195 p.2
Mechanical Permit Applicattol4ECEIV D FOR OFFICE USE ONLY
City of Tigard Received �� ( 3 s� Pe�itNo. 6,,,20, 3 _ �,�p •
514 i' 13125 SW Flail Blvd., Tigard, OR 97223 MAR 2 1 2013 Plan Review
p Phone: 503.639.4171 Fax 503.598.1960 Date/By: Od�Permit:
"i' t G , R n Insnsppection�� 503.6 9.4175 CITY OF TIGARD Date Ready/By: �j ® See Page 2 far
BUILDING DIVISIO N atrfed/Methad: fir° Sappleme°tall °�"°""°°
. • . .. . TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
El New construction Addition /alttaation / replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
C1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special iriformalion use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. j Ea. I Total
JOB SITE INFORMATION AND LOCATION Heatmg/coolug
Job site address: 1`301 I co J (A ) 0 Air conditioning
r 1 (4 C �' (requires site Dlao showing placement) 46.75
City/State/ZIP: - r [ Q ill - G C �� a � 3 Furnace 100,000 BTU (ductalvents) 46.75
Furnace 100,000+ BTU (dncts/veots) 54.91
Suite/bldg. /apt no.: Project name: � b rvv , r 4:, heat pump 61.06
l Cross street/directions to job site: - - - -- _. Ductwork - -... _ . _ _ _ 23.32
Hydtonic hot water system 23.32 .
Residential boiler (radiator or
hydronic) 23.32
. Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 2332
Subdivision: I Lot no.: Other 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace \ 3339 33.3 °
C S 1 1 n Q (l, S , 4 . �p� '1 l f �C �_ Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
- Wood firep nsert 23.32
El PROPERTY OWNER { El TENANT Chimney in flurJvent , 23:32 d 3.3
I Other: 23.32 ■ Name: R 001 V-- '- (Mil � s Environmental exhaust and ventilation
Address: 1 " ` • Range hood/other kitchen
C` 4 eZ) i CL lr t j C k equipment 33.39
City/State/ZIP:: i v_ t�h l (: \ �c� a Clothes dryer exhaust 3339 athrooms,
Phone: ( sr, ) r j a y 9 :3-) Fax ( ) toild�compaitments, utility moms) 2332
❑ APPLICANT - ❑ CONTACT PERSON Attic/crawispace fans 2332
- �r•� f r Other. 2332
Business name: �4 �l l.4 C' t , c n [ (' ill Fuel piping
Contact name: 1� ± vv .. ‘ "' v $14.15 for first four; S4.03 for each additional
Address: !! y Furnace, etc.
Address: Il t Y' ^ Gas heat pump .
City /State/ZIP: V-CN- Q 5 G L. () v ..Q 97 r ( (p Wa[Vsospended/mut heater _
Phone: ( SW) ) r 5 4 LI . Fax i -l3 3 Fax:: ( 9:19 6 `-i LD 0 I etc Water heater `-I ,1 i
E-mail: Fireplace I Range
CONTRACtOR Barbecue .
Business name: —(, )L r7-si cJr a in i C a. 1 Clothes dryer (gas)
Other.
Address: P 6 B oNk 1 1 to ME( ANNJCAL PERMIT FEES'
City/State/ZIP: f/l e ' a 1 . )1-4 CA (V I l p Minimtan permit fee ($90.00) Ct L)
Phone: 0613) Qj y - C` ( t Fmc: ( t5(.4 t Q - 0 l 9 Plan review (25% of permit fee)
CCB tic_: x;11 l n 1 State surcharge (12% of permit fee) I {) .R
C t� f TOTAL PERMIT FEE 1 1 A 44 ` O
Authorized signature: Ibis penait application expires if a permit is not obtained within ISO
l days after it has been accepted as camctr
pt.
`Print name: t v LC 1 !` I ' 1 1 Date: �' . I �l I ' Fee met hodology set by Tri- County Building Indusny Semen Beard
l: .^•i!a` , ^ fnrn
-N=i mc m a ( ddn.0,17T CI 'rmrrnga'WEB)
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
13916 SW CRIST CT, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
03/26/2013 00:00
MEC2013-00159
PASS - No C of O
Violation Summary:
Inspector Contractor