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Permit CITY OF TIGARD MECHANICAL PERMIT 71 1 : g ' COMMUNITY DEVELOPMENT Permit #: MEC2013 00245 'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2013 Parcel: 1 S133DD15100 Jurisdiction: Tigard Site address: 11711 SW 128TH AVE Project: Orr Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 188 Project Description: Replace gas fireplace Contractor: TOM BISHOP CONSTRUCTION Owner: ORR LIVING TRUST 4578 SE 103RD AVE 11711 SW 128TH AVE BEAVERTON, OR 97005 TIGARD, OR 97223 PHONE: 503 - 644 -7868 PHONE: 503 - 524 -9428 FAX: 503 - 626 -9138 FEES Specifics: Description Date Amount Gas Fireplace 05/09/2013 $33.39 Type of Use: SF Flue Vent for Water Heater or Gas 05/09/2013 $23 32 Class of Work: ALT Type of Const: Fireplace Occupancy Grp: 12% State Surcharge - Mechanical 05/09/2013 $10 80 Stories: Minimum Fee Adjustment - Mechanical 05/09/2013 $33.29 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 ions • a UNC by calling 503.232 1987 or 1.800.332.2344 lss ed By: g 1 of Permittee Signature: O � 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. Mechanical Permit Application F012 OFFICE USE ONLY Cl of • Ti and Received / Permit No.: I ° 131 Hall Blvd., Tigard, OR 97 ■ Plan Review �� ' l 60,09 Phone: 503.7182439 Fax: 503.598.. 9 o Il = Date/By: Permit: TI G A R D Inspection Line: 503.639 Date Ready/By. kris RI See Page 2 for Internet: www.tigard - or.gov MAY 0 2013 Notified/Method. Supplemental Information TYPE OF Ag 1 IGARD COMMERCIAL FEE• SCHEDULE - USE CHECKLIST DIVISION COMMERCIAL 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, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES' ❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For spedalInformation use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: /1 ! ' l 5 \J ( ( 9..s.sk 4y-e l (requires site plan showing placement) 46.75 City/State/ZIP: �'\ J ■ t 4 12 ) O trad 3 Furnace 100,000 BTU (ducts/vents) 46.75 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldgJapt. no.: I Project name: © r r Heat pump (requires site plan showing placement) 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 heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: I Lot no.: Flue/vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 B � , [ r N Gas fireplace/insert / 33.39 :?../, , .:?7 ke � `&CPVM e ln�- 8 6 [' eX (Si1 M1C( 3 �S - -∎ %- f ( c' f � Flue vent for water heater or gas 23.32 2-I 3 � IY (`O 0 J fireplace 23.32 1 Lo lighter (gas) Wood/pellet stove 33.39 Wood fireplace/insert 23.32 / ' PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent ` 23.32 Other: 23.32 Name: ro Ly p i . r Environmental exhaust and ventilation: Address: Ili 1' 5-w /a j Aver Range hood/other kitchen equipment 33.39 City/State/ZIP: ct,1 © 1 7a,3 Clothes dryer exhaust 33.39 ( r03 5 if ^ 4 . Single-duct rtm ent (bathrooms, rooms) Phone: � ) Fax: ( ) toilet compartments, artments , utili lity rooms ) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: - - Fuel piping: Contact name: $14.15 for first four, $4.03 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range CONTRACTOR . Barbecue Business name: To , J\ s V\0 a c bl0W ," VCLI 0 H Clothes dryer (gas) Address: I 5 ( 6 S� / Q ? f -Q Other. MECHANICAL PERMIT FEES* 0 r Subtotal City/State/ZIP: � Q V t V � [ Minimum permit fee ($90.00) 'f3 ,— Phone: ( O) 6 Y ( -- 7 �6 7 " Fax: ( ) Plan review (25% of permit fee) CCB lic.: ' 5 .5 6 7 / State surcharge (12% of permit fee) /O.9 TOTAL PERMIT FEE /OD. C7 Authorized signature: O �� This permit application expires if a permit is not obtained within 180 I — t days after it has been accepted as complete. Print name: O 4. K IC Orr I Date: 5 ///.3 • Fee methodology set by Tri -County Building Industry Service Board I.\Building\Permits\MEC- PermitApp doe 03 /07/12 440 -4617T (11 /02/COM/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 11711 SW 128TH AVE, TIGARD, OR, 97223 Residential - Mechanical 699 Mechanical final 05/17/2013 00:00 MEC2013-00245 PASS - No C of O Violation Summary: Inspector Contractor 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 11711 SW 128TH AVE, TIGARD, OR, 97223 Residential - Mechanical 699 Mechanical final 05/17/2013 00:00 MEC2013-00245 PASS - No C of O Violation Summary: Inspector Contractor