Permit Support Document (18) CITY OF TIGARD MECHANICAL PERMIT
° al.' COMMUNITY DEVELOPMENT Permit#: MEC2017-00749
Date Issued: 10/02/2017
T[GARD GAR13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 IParcel: 2S111AD05700
Jurisdiction: Tigard
Site address: 8710 SW PINEBROOK ST
Project: Vandiver Subdivision: PINEBROOK TERRACE Lot: 80
Project Description: Install gas insert with venting system. 10/18/17: REPRINTED permit to include gas piping for fireplace.
Contractor: EVERGREEN GAS INC. Owner: VANDIVER,WILLIAM BARON
PO BOX 388 GLASCOCK, ELIZABETH LEAVITT
WEST LINN, OR 97068 8710 SW PINEBROOK ST
TIGARD, OR 97224
PHONE: 503-407-9542 PHONE:
FAX: 503-344-6345
FEES
Specifics: Description Date Amount
Gas Fireplace 10/02/2017 $33.39
Type of Use: SF Chimney/Liner/FlueNent 10/02/2017 $23.32
Class of Work: ALT Type of Const: Fuel Piping 10/02/2017 $14.15
Occupancy Grp: Minimum Fee Adjustment-Mechanical 10/02/2017 $19.14
Stories: 12%State Surcharge-Mechanical 10/02/2017 $10.80
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
t
Issued By: _ _ Permittee Signature: I
Oir
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 Applicaii
E(3EiVED1,0R()l 1.1( L. i til: t)1't
ece:ved p Permit No: A. o
Ci of Tigard and i 7—
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111/41 - 13125 SW Hall Blvd.,Tigard,OR 97223 C C T 1 l 2017 Plan Review Other Permit: •
Phone: 503.718.2439' Fax: 503.$98.1960 Dsteifiy:
r 1 t r:D Inspection Line_ 503.639,4175 CIT/ Date Ready/13y: -Inds: ex See rase a.for
� � 776) (Information
Internet: www ttgard or govBUILDING Noufiodlt,'letbod /_�' Supplerr.enta
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it
❑New construction •l ddition/alteration/replacef lent P ortt;ied�lndicma lZe vial M
are based on the value of the work
value(muuded to the nearest dollar)of all
.i mechanical materials,eq ippent,labor,overhead,and profit.
EI ■ Other: Value:$
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iformation use checklist
■.Multi-family '0 Master builder ❑Other: ;Description f Qty. Ea. Total
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Job site address: ailjb. • M �/M A Air conditioning 46.75
City/State/ZIP: . IBA 4 o Ma Furnace 100.000 BTU(ducts/vents) 46.75
Suite/bldg./apt.no.:
SP name: Ap,tel.' I. Furnace 100,000+BTU(ducts/vents) 54.91
Cross strect/directions to job site: HeatFump _61,06
Ductwork 23.32
-^ Flydronio hot water system , 23..32
Residential'boiler:(radiator or ,
— h , ..Jc 73.32
Unit heaters(fuel-type,not electric),
Subdivision: I Lot no.: in•wal'1,in-duct,suspended,ete.
Tax man/parcel no,: Flue/vent for: of above
1111.1321,
J yr5•'- 1'7'7:-.7::',T"-:1'.',7.-17,7' 'T 1, ^^sr , w A 7 7-77-7-,-;-- + '' .Other: 23,32
��WP"� �r A. . Other fuel:appliancr`a:
f I * - �� Water heater 23,32
Gas f tegace/ipsert 33,39
IF rFlue vent for water heater or gas
A _ ■ fireplace 2132
Hrn.!S1�r"r- r u` t ;r 1+vr rNrr,a71ac +I. 7 : r;.it't ;_,_:,:),,-%.t-.",;?;;:;:,,;,`).,' ? , _. Log lighter(gass _ 23.32
�'Y"y/ ;ayJ.wrrtl;.ta.rht ..,,,z,;,,:,*,4,1,.: f.rtr : 1 S, , ,. r.• r 7 ... -
Wood/pellet stove 33.39
Name:
-- -� - Wood fireplace/insert .. 23.32
Address;
Chimney/liner/flue/vent 2332
•
City/State/ZIP: 23.32
Phone:( ) Fax ( ) Environmental exhaust and ventilation:
i ' g l3■ 7 rMt, rl F' ,777_71,1,:;,',,:,.„„ S r!r i t �■j,- y 1 1, 1
, ",,..74',,'; F Range hood/other kitchen
w3�1r.R. s4Lrl'yVh;wrl,,,Z. pr. ;;r,r ri
equipment 33.3.9
Business name: x allrallp
,/� �, Clothes dryer exhaust 33.39
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Contact narrte: ` r , a v"� Single-duct:exlraust(bathrooms.
• ' ,r ` toilet.compartments,.utility rooms) 23.32
Address: 40
�j� / w Attic%o awls.ace fans 23.32
1 rbil I S ! � s Other_:_ 23.32
,/, Fax::605 fit-1g•
[ ,, ,• Fuel t_ilpiin$; .
E-mail"O ,1--A k" v J IS . a ' x14.15 for ft<rot tour;s4,03 for each-additional
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1 prM4 :�Ny t s i.r q r: t f I 4 'w Fu�tlace,etc ! /: ,)
Business name: j ' , Gas heat.. m.,
l.a '1
Address: - Wall/suspended/unit heater -_
City/State/ZIP; Water heater
Phone:( ) Fax;( )
FJteOlaee
CCB lie: ""rte+ 03 ( Karate -
•� /� barbecue _
f �� Clothes dryer(Sas)
Authorized signature: _.
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