Permit Support Document (22) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT ' '
Permit#: MEC2017 01016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/22/2017
Parcel: 2S102BC00105
Jurisdiction: Tigard
Site address: 10260 SW BROOKSIDE CT
Project: Mack Subdivision: WALNUT ACRES Lot: 4
Project Description: Install medium gas insert. 12/28/2017: REPRINT permit to add gas line for fireplace.
Contractor: TOM BISHOP CONSTRUCTION Owner: MACK, DAVID J&LORI A
4578 SE 103RD AVE 10260 SW BROOKSIDE CT
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503-644-7868 PHONE:
FAX: 503-626-9138
FEES
Specifics: Description Date Amount
Gas Fireplace 12/22/2017
Type of Use: SF Flue Vent for Water Heater or Gas 12/22/2017 $33.39
$23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 12/22/2017 $14.15
Stories: Minimum Fee Adjustment-Mechanical 12/22/2017 $19.14
12%State Surcharge-Mechanical 12/22/2017 $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.
Issued By: OP
"76/1-C,_ Permittee Signature: 2JJg'f'� ,97-7e'
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 ApplicatW115 ' -— /., :
r RA'Cimed ' F1R O (ESt ONLVi
City of Tigard
--..
Date,8„. /2 Z:F (.7 ii, AN Mama Nn.
„, 4 1.3125 SW flail 131‘31_,"I.igard.OR 97223
DEC 28 2017 Plan((cya
71 n,. 1 - "!-Y...........,
111- ph m,„ .c.0-;'7 I S 2439 Fay ;93 S901900
Other Permit
14atc11,-.
-----------
r i cti.A R 0 Inspection Line: 503 639.4175
licit. 121 See Page 2 for
dCrry OF ,i.1(.7sicAp9 Date Ready 11,
Inten-let: WA.A.1 igar -or.gos
'''-' Noutiedasiethist,
Supplemental Inforntation
BUILDYNG DhlSKS1N;
i'VPF, OF WORK- - ' ' 1 i, IMNIMERCIM.,;FEE, SCIIERELE--:LAP.C11.14.710,IST _,,i
_....._,..„......„........
Mechanical permit fees*are based on the value III dle‘Noik
CI Nexv conslruction Add 11 t on/(literal ion/replace:man performed. Indicate the value(rounded to the nearest dollar)of all
Ei.1)enittlition 0 Other: mechanical materials.etijui anent.labor,overhead.and profit.
Vitlite:0
-, -'6 R 44Cno _..,.
2-' , - '
-and balm lv dwelling L 1( immereialt I n d LI St r jai 0 ACCeSSOry budding itns peciai infant/a/Ma toe checklist
Eli Klulti-hnily CI Mastei-builder [1:-j(nher: Description Olv. In. 'total
-3777 - - t ' t
'tv'eJli c
UK"INI,ORNIATION AND' ,LHeat ,'
OCAT1ON - - ' 'art (m• '
4222-----2L-22---:-------- ` ' ' ----------2!!---2- ' - - ---- 1 Air conditioninn 1 1 46.72 i
am
' Job site address: 102.(00 Skis.) R?rtStX31‘-it, sVe- C"i777 I yurnitcc 100,0I0 131 t.ideep.,,eititit It 46.75 1
_
; CitylState/ZIP:-Ti 6,1 yo/ -q.,-Lz. -1,----r2z, '"2„. 1 y.Furnace w0,000- 1.313,1 ithieltiv,elasi !... ......... 54.91lien)pump
i ' 0!06
Sttild/faldg,i'apt.no,: 1 Project mune:/71.tott,le_ ,___
Duct A.011
23 32 i
C.'ross streetidirect ions to job site:
I ivvtronle hoityikaer syslete 23_32_
Indrome) ,
i
23.31
Una heaters(Mel-type,not electric).
iii-vviill.in-duet smipended.De. 46,73
;
line sent any oltatove 23.32
13_37
; Subdivision: Ivam.:i
. ..... -... ..... , __ - _--i (On:tile:it;fueltappliartees:
lax map:parcel no,:
Water heater ; - i, ;-; f I_, - , oi,,,,,cRip-iiaN OF WORK 1_( as tt."21?.a.t:tttltin1c11 -3139 k3.73"31
---------t---' ---- - ----- ------------------- -------- ; ----- - 1 1-Itte vent 16r 'A aigr healer or!ii3 t
, .; t) 'Zat32-21t 0/'- JIil!ttlItilIt...„ -.1.„:,2":„.„,-_„ . ..I
Lott jOtteripi ' 73.32
oodteI9tstoe 33.39 1-
-1,
1 Wood firTI?ccitosert 2432
Ininuevinerifitielvent "i„. t. 1-2-
..,
L. i,....23 32. _ 2;
0 IttNANT '
j---3-kk-----k------------------- -- -k - - -- - -. ---- J.
- it 1191011
' /11ellnd
tai exhaust aventilation:
lin
Ke- ()
' -,--Iecc ii1 kande botaMilltei kitchen i
I 33.39
_
rikt,cidIrs;(p 2..c00 5.1.-&) _,Briotiv .',/e(-7,,-7----- Clothe!,direr exhaust 1 33,39
-._
( ity;0tate/1111:-77 ojr 3,/ OA 91722 Sirmle-duelmexhaust i bathrooms. ;
. 1
__t Ltoilei copartmeins.litiltitv rooms)m1 , 23.32 1
I
Phone:16113 ) 0' el' -941/0 CI 1 Itax:( )
I Attie/Cfal%!space fans 1 23,32 1
11 7tttt .> .0 COTA( E PE11D)N 1 (nhel................„_„... ;-123":;_1„._,.
PiPmg. 1
Rosiness name:1,...)0 7i-5,-.4,--/,--11 re 1 ( ,3 13 80„
-i p_a ,,c..., _-____....... ,. . . ......._______t S14,IS for Inst hati-j'0.03 for each itdditional
I
Contact name:mi :1,, ,,,,u, .m8„ : Furnace, is •
1 t\vidress:M; ii/ ,2 ':_'1,.' .c,S.L.4.). La , \ „6,is heaj pump_
"- '`,'"• _rc.,-,_ ....... ' Wallesumcmledinnit heater
(itsStteilll: ti3co,„Lite,ett--.(0,(3‘;;;;;
i 1
Water heater ;
I. ..
I
..Phone:(503)(*02,69 V -2_ I Fax: :1503)CO2,(29 gi'2.`a I-Replace
It-lut'il:/-14)-1 /- i-retrbry\ [iarbCC k Et.'
004>dEVLI q.NiS)
-...i..... 1,-
[
litIsiness name:37-0-k.1„1 . ,,,,,,.. ,,,,,,,, _,,,,(,,,,,,,„,,4„,„,,,,,c,,,,,,,. _ __„__,
v, ,,r.„,..._„,, ,„..„..„_.....,,,,,_ mEc.,,,,,,,,,,,,PERMIT PES* '
Address:
;
Subtotal
1 tatyiStamtilP:
hliniirlifill permit tee(090 00)
phonc:&:?..„) (4 (70( .
I Fax:I
l .3
'mite sureharne 4 12s-ti ilt permit iem ib ,,---
,..--1
.. ,,,
CCU'lie: 1 ,,e,564,17/ _ _,.., , _____ , ...,„, „,,,,,,_ 1, 1._,.,,,_,_.,,,__,,,,._,,,, ,,, _ I'OpAp PEDN.1111'FE1".
't his permit application expires if a permit is not obtained bithin PM
„..“-----'22-2. a---a) ae„:12-..p..: -a"'„„-- " ,..----
days alter it ii5A been accepted as complete.
Authorized sigumure: it ,--: --/ -'-..2 .__ .---.„,
t; in
fee eileidolop mby t "It iManim Ma Ming batman.-Seri,icc Boat
I Print tame.-7 ,/,(0J-- '7442LIA Date: t2_12..e)1P-1
I 15-Ids-po,,,,,,Nip( 1 ,,pt Apr,4,,,I 11 do
c1 -77(I I,C,'.Ci A.VA lit
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10260 SW BROOKSIDE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Mechanical MEC2017-01016
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Gas line approved with test 20 psi for 15 minutes
Violation Summary:
Inspector Contractor