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Permit CITY OF TIGARD MECHANICAL PERMIT s COMMUNITY DEVELOPMENT Permit#: MEC2013-00595 Date Issued: 10/09/2013 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 114 BA01500 Jurisdiction: Tigard Site address: 16200 SW GRIMSON CT Project: Cline Subdivision: PICKS LANDING NO.2 Lot: 124 Project Description: Install gas boiler and gas piping. Contractor: FIRST CALL HEATING&COOLING CO Owner: CLINE,JOAN D REVOCABLE TRUST 1650 NE LOMBARD ST 16200 SW GRIMSON CT PORTLAND, OR 97211 TIGARD, OR 97224 PHONE: 503-231-3311 PHONE: 503-318-1588 FAX: 503-286-5194 FEES Specifics: Description Date Amount Residential Boiler(Radiator or Hydronic) 10/09/2013 $23.32 Type of Use: SF Fuel Piping 10/09/2013 $14.15 Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 10/09/2013 $10.80 Occupancy Grp: Minimum Fee Adjustment-Mechanical 10/09/2013 $52.53 Stories: Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ji447677—c___ Permittee Signature: f i17/),ve_1—//0,\I Call 503.639.4175 by 7:00 a.m.for the next available Inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Ftorn.Fi rsl Call Heat 503 2©0 5194 10/04/2013 09:17 #440 P.001 /002 .- „k\,\ . .. . . Mechanical Pe! it=Appiica `r, �` `\ —��.� FoR(OFFICE? USE ONLY City of Tigard g -IRA,,u ;h 1 Received O �Wi� 14 q 13125 S V�'Hall phi Tigard,OR i7:t•: .(` Date/By: Permit N.. re c,24 Phone: 503.718;2439 Fax: 503.59'.196 �� Plan Review 3 D��� TIGARD inspection Line: 503.639.4175 y( Date Re Other Permit: Internet: www.tigad-or.gov orgov `f��. ,f Ar, ” DateReady/By; runs: \4, NotifiedlMethod: ® See Pent l for t� 4AQAJ' 1 Supplemental Information r : N� ;q�v °i'r!K J 'iyr' i �` { `,s� '.y":: - .. '-: - ew construction ❑Addition/alteration/replacement Mechanical Indicate the value(rounded to the nearest dollar)of ❑Demolition Other: mechanical matrerial s,equipment labor overhead and profit• s frQrf ' ) .,�r { 'it Value:$ ry 1-and 2-family dwelling []Commercial/industrial ❑Accessory building '`%' ry g For speclq!lnJonrtallon use checklist. Multi-family ❑Master builder Other ❑ Description - n "'_`° t�$eSk$E�i y q a-. Qty Ea. Total - Hearin coolin r '= �'• .. --.�,hF' ', s) �Ga t�y.. ,l:s�• . _ � "tea � �� Job site address:t192 _Q �j S w / — Air conditionin• Hsu rn-�Q c.._, Furnace 100,000' BTU(ducts/vents 11111 46-75 City/State/ZIP: '�-` q (—� R ‘1.12.2,..1 Furnace 100,000 f BTU(ducts/vents) 46.75 � Heat.um. 54.91 Suite/bldg./apt.no.: l Project name: 61.06 Duct work Cross street/directions to job site: H dronic hot waters stem 23.32 Residential boiler(radiator or 23.32 111111,1 • h dronic Unit heaters(fuel—type,not electric), 3s in-wall,in-duct,sus.ended,etc. . 46.75 Flue/vent for an of above _® Subdivision: Lot no.: Other: 23.32 Other fuel a..fiat nces: Tax map/parcel no.: .._.a� a -<•>:>> Water heater _ -1 �s:> i.;.K�T s1)ii., •t� ; V~ Iflf „ ��-•- ,.',° ' Gasfire.Iace/i 23.32 . .: .....-4 -_ �:., , �- .s 3 r"„?;:_„ a 3ra pater 33.39 Flue vent for water heater or gas \ 0 et 5 . l l ' C" -1 fire.lace 23 • Lo:li: ter as . 2332 Wood/. Bet stove 23.32 Wood fire.lace/insert _ 33.39 23.32 _ Chimne /liner/flue/vent _ L, ,_.,.. IR•r 't jnt 2. fS1,:k �,.,1, 3 �;.,, •.y Other: _ 23.32 w g"`" "` Environmental ex haust and ventilation: 11321_ Name: `"CD 1 OA\n Range hood/other kitchen •ui.ment Address: l G s `rev$ O r..1, rL le— 33.39 Clothes d er exhaust 33.39 City/State/Z1P: `^ • a 2.->4 Single duct exhaust m (bathrooms, MI co .artments,utili rooms Phone: v 3) ! -0 Fax:( ) 23 32 _ Attic/crawls.ace fans _ s R[,IA, . f f:7 zns °' �- 23.32 % � y Other. ""� �" �`°� 23.32 Business name: Fuel .i.in•• S14.15 for first four;$4.03 for each additional Contact name: Furnace etc. __ . Address: Gas heat .um. �-- City/State/ZIP: Wall/sus.•nded/unit heater Water heater Phone:( ) Fax::( ) Fire.lace E-mail: Range = .. 'pr�y{ra. Barbecue ,t 3 ."�-?,'L.,,„- ,, ''_ ` ..4 .•,S`a+t5%�s 4'i<-, f' ,a.-"%S.+n .i-" :;._ las MN -a• «a �...__ � - _ ,y ., `"h r�'�zs Clothes d er Business name: f r— L `f ! Other: v eG,�-4 LOC�It-■.5 _ �.so 1,3 Address: (O r-,L� - 31L!Tf (j! = r. ,3a Subtotal City/State/ZIP:P�rte(r��, ^ Q al /L Minimum permit fee($90.00) a.0 Phone: C LFax:( P1art review(25%of omit fee (c�3 2��-33�( 1 Sod - 2.g - 5( . -I p ) ��/ State surcharge(12%of permit fee) . CCB lie.: 0 2_ 7 .b a e73 Is TOTAL PETIT FEE 1 p �/ ! This permit application expires if a r • V days after It has been acre permit 1s not obtained within IL Authorized signature: GL'�' o`-✓J Fee methodology set by Tri-C pdin as complete. Print name: L(/U d A S s �S Date: , y ounty Building Industry Service Board tMuilding\PamitaMEC Permit App_040113 doc 440-46171-(1 I/02/COM/WEB) ,5 e�s�T�5}Lli-\` , CD er)