Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
: COMMUNITY DEVELOPMENT Permit#: MEC2015-00196
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
El, Date Issued: 04/07/2015
Parcel: 1 S133DD07700
Jurisdiction: Tigard
Site address: 12761 SW DANBUSH CT
Project: Fireplace install Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 116
Project Description: Install fireplace and run gas line. 5/13/15,reprinted 'for additional gas line to kitchen range.
Contractor: FIRESIDE DISTRIBUTORS Owner: LINDA BLACKMORE
18389 SW BOONES FERRY RD TIGARD, OR
PORTLAND, OR 97224
PHONE: 503-684-8535 PHONE:
FAX: 503-620-5699
FEES
Specifics: Description Date Amount
Gas Fireplace 04/07/2015 $33.39
Type of Use: SF Fuel Piping 04/07/2015 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 04/07/2015 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 04/07/2015 $42.46
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N 'cation C- -r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir t questions to OU • • Ilin• 503.232.1987 or 1.800.332.2344.
Issu d By: , Permittee Signature: ^
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
05/11/203.5 10:04 5036205699 FIRESID PAGE 01/01
Mechanical Permit ATp"catiltECEIVEP 1.(-)r:(ill Ii 1- I si ■,),,I 1,
City of Tigard Dit:;135, Cifffilliffl l''''''tlie.09d/67-66 PO
. ..„-- . 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revien.
Phone: 503.718.2439
III
Fax: 503'598.196°MAY 1 1 2 0 15 Date/By: Other Permit:
Date Ready/By: lurk 0 See Page 2 for
TIL,\III' InsPectim Line: 503.639.4175
Internet: www.tigard-or.gov . Notified/Iviethod; Supplemental Information
CITY OFTIGARD
, ..- -,..4„,... v.,..1..'.6 -,-, ,.. • g ■1',1)....).7^7,7'..--.. .1n7;.-6.5LT-7,e OZTO177.710
- ',"-•gt;' %-'''''''' - '''''"''''' Mechanical permit fees,'are based on the value of the wodc
P New construction 121Addition/alteration/replacemcnt performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials :,.ui.men labor overhead and orofit
1=1 Demolition 0 Other: Value;$
.oz',,: ..:c.' ,,kaireVaTaFtiUM VW.:_cllei.. ;)":,4;;Ar''srg41414.&,,,A,-,,, ':, '',,ii,;.-:,,,,,,-.t*i, ;'•,''..,-,, 'or•:',17,71.,:$,4j15
n 1-and 2-family dwelling D Commercial/industrial D Accessory building For special influmation use checklist
ID Multi-family 0 Master builder 0 Other; Description I Qty. I Ea. I Total '
,..rjosetv,„:k.•s•,,...7%1.ir , .. ,,..k...: ,,"1...::.1..,),14-AFO4ririVittr Beating/cooling:
'`.° .-1'"-.*Pl ""4".,..:4 "... ...--''- '' .'1. '''''''''',, '''t*wr"."'" Air conditioning 46.75
Job site address: I 2:1 i.0 Li, CU'l 1100Q1 ( f. — — Furnace 100.000 BTU(ducts/veots) 46.75
Furnace 100,000+BTU(ducts/vents) 54.91
City/State/ZIP: —IT c Cird i 9(2,.. 47112.17-2, _ Heat Euttin 61,06
Suite/bldg./apt.no.: Project name: — — Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
h dronic 23.32
Unit heaters(fuel-Met not electric),
in-wall in-d •s .ended etc. 46,75
.. _
- Flue/vent for any of above 2.3.32
' .
Other; 23.32
Subdivision: Lot no.:
_
Other fuel appliances:
Tax map/parcel no Water heater 23.32
.e.,-A4 - -,01?„44.0-4,,,,01:,,,7avitodoitaINOtittAr4ciineLW.V.07r;-• 4- Gas fire.lace/insert 3339
for water heater or gas
0 TO Vocis-rOci ' i2 --aygep fit .lace 23.32
oja,S hfrq 110 s. /1---- ill F—t wood/pellet stove 33.39
Wood fireplace/in.sert 23.32
4 - Chimn• diner/flue/vent 23.32
-11-r-.20.0,.:•.a, . ,"...,..,..q.y,'tile,4.1
' 4.112. •al.,'
.‘',.. ",.,! :1A,.',..511-La '4,:ti. .1.14,'''r. .:ji.:..'.:.;'`..q...."44.-,/,..1 •"" ..4. 1. •1' .' --A- 4 '-, Environmental exhaust and ventilation: 23.32
Name: - A 1 1, I; ,aelnat Range hood/other kitchen
equipment 33.39
Address: 44./fitt.' . Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
City/StateJZIP: collet compartments,utility rooms) 23.32
Phone: .., ) 51 /-citi-c Fax:( ) Attic/crawlspace fans 23.32
Other:
01,0aVOIkitgo ,. .....*. - 23.32
Fuel piping:
Business name:
514.15 for first fottri$4.03 fur each additional
Contact name: Furnace,etc.
Gas heat.
Address: ._ - — Wall/suspended/unit heater 111 - ill
City/State/ZIP. Water heater
Phone:( ) I Fax::( ) Fire i lace
Ran le
E-mail: Barbecue
-,4: ,,‘w.,::■'-..,r.,..,,.- :4,71..T,17,i,t.3;;;;w7,:z7v7F,',Iiik..,,,,.soir.4..4 ;;,-,.4 ,, Clothes dryer(gas)
Other.
Business name: / .../7 C0/ ...--/4,4-14-770
Address: Subtotal
Minimumiermit fee($90.00)
City/State/ZIP:
Plan review(25%of permit fee)
Phone:( ) I Fax:( ) State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE I
This permit aripnearios expires if a permit is not obtained rntbin 180
...t._..44.47.....)---- days after It has beta accepted as complete.
Authorized signs e5,-/ * Fee methodology set by-at-County Building Industry Service Board
Print name: Date:
113uildinsWerminNMECjerraiiApp_040113.doc 4404617T(1{i02/COM/WEB) i k i A —i cQ
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12761 SW DANBUSH CT, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00196
David Young
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12761 SW DANBUSH CT, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00196
David Young
Violation Summary:
Inspector Contractor