Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
a Permit#: MEC2016-00605
COMMUNITY DEVELOPMENT a,
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 . .., ' Date Issued: 08/18/2016
T f GAR R,.0 AIwl
Parcel: 2S112BC10600
Jurisdiction: Tigard
Site address: 8256 SW MATTHEW PARK ST
Project: Fireplace/gasline Subdivision: MATTHEW PARK Lot: 5
Project Description: Install gas fireplace and gasline. 4/11/17:REPRINTED permit to include gas piping for range.
Contractor: FIRESIDE CONTRACTING SERVICES LLC Owner: BENSON, BARBARA J TRUST
18389 SW BOONES FERRY RD 8256 SW MATTHEW PARK ST
PORTLAND, OR 97224 TIGARD, OR 97224
PHONE: 503-684-8535 PHONE:
I FAX: 503-620-5699
FEES
Specifics: Description Date Amount
Gas Fireplace 08/18/2016 $33.39
Type of Use: SF Fuel Piping 08/18/2016 $14.15
Class of Work: NEW Type of Const: 12%State Surcharge-Mechanical 08/18/2016 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 08/18/2016 $42.46
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
"Illib
Issued By: ,her."7„..„6%.„ PermitteeSignature:
A ie
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application IFOR OFFICE USE()NEN'
City of Tigard
, " 13125 SW[tall Blyd,,Tigard,(11:41E.. EIVE1)
114 Received
DatelBy.
Plan Reisew " ,Permit No.: iitkiff.f.,,620/6._cfc)a
Other Pet nut Phone: 503.718,2439 Fax: 503.598.1960 Date/By.
.1.1G A it I) Inspection Line: 503.639.4175 .
By: tutu lit Ste Page 2 for
Internet: www.tigard-orgriv APR 1 I. Date keady/
2017 Nordied/Method: Sbpplemental Information
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''' CO-/t4AfilICLAI FEE. ,SCIILIIIILE1,,1./SWCHECKLIO,",-
;04:',, „ „.4',.;',..,- -,:',g',;:-,',„ ''''ci;.; - ',, i. v-, I - '•" 4.K. ..., 4,,),,,,,, i,.i. - . d,'-, .-, , 4., ,- ,, . .,,,, .„,e„.
1,1 Mechanical permit tees*are based on the value of the work
,....A fl li . s . -
0 New construction em...;,,,.4..i I , ,., 'I° •L performed,Indicate the value(rounded to the nearest dollar)of all
0 Demolition IN Other: mechanical materials,equipment,labor,overhead,artdprotit. ,_
Value:$
ttkir,tictiti;:, 01.: c0Nsf ftijci-itiiii,j ,,,;.i.,4,;;,:i,,,-,.,,i-,,:-,,,.,,
rA3,"4„...and 2-family dwelling 0 Commercial/industrial Ej Accessory building For special information use checklist
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. 'Total
_.,
Heating/cooling:
JOB SITE INFORMATION.AND LOCATION , .
- A 46.75
Job site address: .').' I4•,, kik(t'
.,'kartii ('-'1).II( "
2.C;>- ' VVI
9- Furnace 100,000 BTU(duets/vents) 46,75
_
..-------- Furnace 100,000+Bill tdams/cents) ' 54.91
City/State/7,1P: Air ‘71.,,,, 1 7 ,
4 A Al . 4
....,._ 61.06
. .
--- Heat um
Suite/bldg./apt.no.: Project name: ' ' '
": Duct work 23.32
*14101111111111111111111111
Cross street/directions to,job site: milyr__Ironic hot w
__ ater system 23.32
111110."- — Residential boiler(radiator or
hydronte) 23.32
tinit heaters(fuel-type,not iiictric),..
in-wall,in-duet,suspended,etc. : 46.75
i
Flue/vent for any of above 23,32 1
Other: 23.32
Subdivision: Lot no.:
— Other fuel appliances: i
fax map/parcel no.: Water heater 2332
itl'Esc"-ifinio—N-77-or.WORK (its, ,,, ,,, -:,, , , ,s-, ,, Gas fireplace/insert 33.39
,
- Flue vent for water heater or gas
1
...
krill I-4-m st i–• ‘„42(DO fireplace 23.32
, 1..9g lights!J23.32
as)
, 7 . i
......4 .... 1., ,4 ' ‘' e g f',....,....jr. ' - - - Wood/pellet stove tove 33.39
Wood fireplacetinsert 23.31
-
_
Chimney/liner/flue/vent : 23,32
- '
23.32 i
rd,P#OPEItre IIWNE.II-', '''" .S'.." TENANT , - ,-. . ':
:=:,..,$„--v : .,''. -,' -''':,',-..... -TENANT ''-',. .: ,' Environmental exhaust anti ventilation'
......
Name: 0airi2aerx.„-bfr 00 Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 3139
City/State/ZIP: Single-duct exhaust(bathrooms,
_ ,, -4 toilet compartritents,utility rooms) 23.32
Phone:( ) Fax:( ) Atticierawispace fans ._ 23.32
APP .„3 32
0:::, LIEANT ' .. :" '. 0 COTNTACf PERSON ' Other: 1
Fuel piping'.
Business na __ .,.._
me: . .°"-1 Y'rSil 514.15 for first four;54.03 for each additional
. _...
Contact riame: . .,'.,...1„,-.1.y\ Furnace,etc.
„_.... —
Address: kGas heat punt2,
c, .3)554 ' a ,r-tx ' ' . e
Wall/suspended/unit heater
City/State/ZIP: F". ,0I, ,, 44-1. ' Water heater
_ .„
Phone:(I:j:)3)toh4,1,--s/ _
—3.5 Fax: :( ) Fireplace
_
- . ,Range i ' «IS ILI.,ic
E-mail: A 4 p. , -1tre6tett ( "'s cePri Barbecue
CONTRACTOR . ": . „:.:,;. ,,,,, :: ::„ .... ,., : Clothes dryer( us)
Other:
Business name.
Address: SubtoL
City/State/ZIP: MMiirturn permit fee($90°ft)
Plan review(25%of perm' fee)
Phone:( ) Fax:( )
State surcharge(12%of per it fee)
— „,.... „......
CCB lie.; ' i : .3 TOTAL PERM FEE
This permit application expires if a permit i not obtained within I l i
days after it has been accepted s complete,
Authorized signature: .,,e" ..._Ah, Fce methodology so by Tri-County Buildin. Industry Service i .ard
[ Print name: Ell'i. ' ii1P 'ill i ..Wigiikliii Date:
1\Itailias5aermimmgc_PermaApa,„0401 I 5.dc,,, er 4.40-41,.f 71(I 1/02/COMAVF11)