Permit 4
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00069
TIGARD DATE ISSUED: 2/19/2009
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S114AB - 02800
SITE ADDRESS: 09260 SW MILLEN DR ZONING: R - 4.5
SUBDIVISION: KNEELAND ESTATES LOT: 015 JURISDICTION: TIG
PROJECT: CLARK
Project Description: Replace existing woodstove with gas fireplace, install gas piping.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
VINCE & AMBER CLARK Description Date Amount
9260 SW MILLEN DR
TIGARD, OR 97224 [MECH] Permit Fee 2/19/200: $72.50
[TAX] 12% State Surchai 2/19/200 $8.70
Phone: 503- 348 -3237
Total $81.20
Contractor:
FIRESIDE DISTRIBUTORS
18389 SW BOON ES FERRY RD
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 595 -3720
FAX 503- 620 -5699
Reg #: LIC 40979
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specially Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center.
Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503.246.6699 or 1.800.332.2344.
Issue By: / Permittee SignatU e: ! L
� r
Call 503.639.4175 by 7:00 a.m. for inspections th •usiness day.
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.
PAGE 01
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WIDDOWS
02/19/2009 17:48 5036707905
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. , . ,
CEIVE
Tigard _ Received
D ate/By . ,A / 4 ? o? ii , Permit No.: I tag ee9,62)thy -
13125 SW Half Bivd. Tigard, OR 97223
Plan Review
' ' • Ill .: ,... Phone: 503 639417! Fax 503.59S.19 E. B 1 9 2009 Date/By: Other Permit:
i Inspection Line: 503.639.4175
Date Ready/By:
gi See Page 2 for
( Internet: www.tigard
CITY OF TIGARD Notified/Method:
:Ira , Supplemental Information
- ' .n:A :iv§i004, 40.80t:fii';,'',§01k0,0t:':i.g::ipat!*"01004V
Mechanic tl pennit fees* are based on the value of the work
0 New construction iTa Add ition/alterati on/replacement
.performer . Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other:
mechanicil materials, equipment, labor, overhead, and profit.
V
..i„iiY„ii'll':, , 1 ..:":;.:::':' al - ue s ... ..1.,,,:?7,..,.. 2.
, , ,...
:;;:
Ille 1 - a n d 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-family 0 Master builder 0 Other:
, Description. 1 Qty. 1 Ea. Total
';•101iJi.4-: ! ii0010;00 14. :8 NOH.-'00 1 i,(*.';':,.' , ;: ' ''.' ,. '."': :. ' '. Heating/et '
Air conditi( ming or heat pump
Job site address: 61 & rail ‘ , ves . ) b ,._ .
(requires site plan showing placement) 14.00
City/State/ZIP: -- ,cfi 1 c)( 1 9 -7 1 - 22i- Furttace 10 ),000 BTU (ducts/vents) 14.00
Furnace 1G1,000± BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: . Project name:
, Gas heat prop 14.00
Cross street/directions to job site:
Duct work
10.00
Hydronic h( 4 water system 14.00
Residential )oiler (radiator or
hydronic)
14.00
Unit heaters (fuel-type, not electric),
in-wall, in-d act, suspended, etc. 14.00
Flue/vent fo - any of above 6.80
Subdivision:
Lot no.:
Other;
10.00
Tax map/parcel no.:
Other fuel 2 pplia aces
i * § eliii i i 4 i* . .iii*OW::;': , : - ' , .:;,' , '',i , :', , ''';'?''::'! , "'i'PI'' ' Water heater 10.00
. ... . ' Gas fireplace
1 10.00
11 I e.: — ( 19 — 1 4 kik 9 S. Flue vent for water heater or gas
fireplace 10.00
IIIIMEIAXk C)44. ■ s., c-s.
(._)
Log lighter (I as) . 10.00
• 41 - - 01 116 lik • AD a_ k . Wood/pellet. tove 10.00
i Wood firepla :c/insert 10.00
10.00
‘ot , ( j y ,4:-; 'Akkioc O C t h h imney/line '/flue/vent er 10.00
Name: \ I \ r ‘ c e 4 b e x C r ...
Environmen, al exhaust and ventilat 1
Range hood/e :her kitchen
Address: if3t 2 s u1/4) t k - n b ,
equipment 10.00
City/State/ZIP: Ti QQ A -6 1 0 11, ek - - .9. - 2.41._ Clothes dryer nihaust 10.00
Single-duct e), !must (bathrooms,
Phone ( b?) 3 3239- Fax: ( )
toilet comport( (lents, utility rooms) 6.80
0-„:'101Pii, CA.Nt'::-,J,':..:i1;H„1::il',';'...:i-ii.i'('''': .( AftickrawisPa , ?. 0 fans 10.00
' Other:
Business name: .f..‘ te s . k d 1") stc 1)k3 t k--s
Fuel piping 10.00
Contact name: 3 ek:/--- Bes,r,ett $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: • '3 It •
Oaxme fi
Gas heat pump
City/State/ZIP: 1 , 61 WalUsuspende(1/unit heater
t
Phone: f3 5 • 92C) Fax: : ((3) ko2t, • stoq9 Water heater
Fireplace
E-mail: - ,.. V. 96 m ''tre - d- oal.S . Range
6 6 / 44- tatitik''' : !'' ', '''' '..:,','"' '.,':,,-.'"!'...' '''''-',..''..•:•.,,. : .' .•'' Barbecue
lger (t 1.9
Bus _ Clothesc
__
Vi iness name: sa as ___eb
_ ____ Other:
di
•
i:, .'. .:•::"(, .'• • :.- A lEetIANICALTE'RIVITFESt'r7';.,,,e''!0',W"
-------- ----- ..... ...._
-- ---
•
Subtotal
-- [ r
Minimum pertnit fee ($72.50) 192 ,
'hone: ( )
__________ ___._ Plan review (25% of permit fee)
D lie.: .•10 -qcl
St she surcharge (12% of permit fee)
•
TOTAL PERMIT FEE I„,• ( , 20
wthorized sigoatua -- ,SK -- :._ -- 'Ibis 1e'rinit app :atiWiTexpires if a_ permit is not obtained within ISO
Ai
days after it has been accepted as complete.
.
rint name: it - le – roe& 6 n - 1 Date: 211BI 0 9 i . Fee metbodolog I set by Ti-County Building Industry Servic e Board
lui IdingWormits 1 MEC-PermitApp doe 01/19/07
440-4617T (11/02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC -00069
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2119/7009
Phone: (503) 639 -4171 ' � �
Inspection Requests (24 Hrs.): (503) 639 -4175 U , �__
INSPECTION WORKSHEET FOR DATE: 2/23/2009 TIME: 7 :OOAM PAGE: 16
SITE ADDRESS: 09260 SW MILLEN DR CLASS OF WORK:
SUBDIVISION: KNEELAND ESTATES LOT, #:. 01E1 TYPE OF USE:
PROJECT NAME: CLARK : `
DESCRIPTION: Replace exiting woodstove witnlas fireplace, install gas piping.
OWNER: CLARK, V'INCE & AMBER PHONE #: 103.340 -3237
CONTRACTOR: FIRESIDE Dl RtB UTORS PHONE #: 5O3 -fi95 -3720
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Inspection Request Scheduled For: Date: :/2312009 � �� Pour Time:
`
Code # Inspection Description $4°C; Confirm # / Contact # Me- •.g
Posti he� me hvania.::l 000730 -01 603-969-1223
, C
C brinions /Comments /Instruction 6;4 /
.7
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PASS ❑ PARTIAL APPROVAL j 1 . CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDIT ONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718 -�1��