Permit •
•� _ :, : CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00635
,�: Date Issued: 11/30/2009
6T1GARD- 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
brommoitl Parcel: 2S102AB00202
Jurisdiction: Tigard
Site address: 9455 SW CENTER ST
Subdivision: Lot: 0
Project: Nutial
Project Description: Installation of gas insert and gas line
Owner: FEES
NUTIAL, KAREN E Description Date Amount
9455 SW CENTER ST
TIGARD, OR 97223 Gas Fireplace 11/30/2009 $33.39
12% State Surcharge - Mechanical 11/30/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 11/30/2009 $56.61
Contractor:
FIRESIDE DISTRIBUTORS
18389 SW BOONES FERRY RD
PORTLAND, OR 97224
PHONE: 503 - 684 -8535
FAX: 503 - 670 -7285
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: t,( Q,p l Ai d Permittee Signature: 1 71_, 4 C(C(LL ,L-�
Call 503.639.4175 by 7:00 a.m. for an inspection that business 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.
' 11/27/2009 08:33 5036707905 WIDDOWS PAGE 01
Mechanical Permit Applicator: r �, -�
' ' � � R OFFICE clsz, 'ONLY .:
City of Tigard 3 r � i A ' Received
Penult N•
? Date /By. — oD 103.5
'° 13125 SW Hall Blvd., Tigard, OR 97_ Plan Rev,c■
C ." Phone. 503639.4171 Fax: 503.598.1960 Off - ' 2n�'` Date By: Other Permit.
T I GARD Inspection Line: 503.639 Date Ready /By. luris Ei See Page 2 for
Internet: www.tigard or.gov - ,,?,. Notified /Method. Supplemental Information
`i,ii'PE - OE' tat. ' ; ., r . C011%tym ERL'iAlr FEE"; S Cfpii4.[1L r §g Oitt K> isI
❑ New construction ddition /alteration' replacement Meehan cal permit fees* are based on the value of the work
performs d. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechani;al materials, equipment, labor, overhead. and profit.
CATEGORY OF GONSTR,L'CTIQN' Value $
-and 2-family dwelling .'RESYD'ENT'IAI,,EgWP'MENT % ? ;PIES+
g ❑ Co ❑ Acc building /s,r. M "
For special
Multi-family tnformau
❑ on use checklist.
y ❑ Master builder ❑ Other:
De script on Oty. I Ea. I Total
• .�
- ,. � ,'� OB SCtE'714FCORMATION ANII . ;'. Heatin
Job site address: vl A Su._ St G S aes LCr Air cond tinning
v re wires : ite plan showing placement) 46.75
City /State /ZIP: t, cso,_to1 1 cj -p I ' 9 224r Furnace 100,000 BTU (ducts/vents) 46.75
v f' Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: LPro name: t- - 1
1v�`1�� l Heat pun (p _ — 61.06 —_
Cross street /directions to job site: Duct wot k 23.32
Hydronit hot water system 23.32 _ _ I
Resident al boiler (radiator or t
h dronic, 23.32
Unit heaters (fuel -type, not electric),
in -wall, i i -duct, suspended. etc. 46.75
Fluetven for any of above 23.32
Subdivision: Lot no.: Other 23.32
Tax map /parcel no.: Other fuel appliances __
1?ESC$IP 1OM1 Of WORI( Water heater 23.32
Gas fire lace i eC't 1 33.39
1 l
C Into 1Q't i d Q Q t � 1 os rt Flue vent for water heater or gas
Q- \� 9 ne �j
�I re lace 23.32
L Lo: li:ht.r (gas) 23.32
Wood /pe let stove 33.39
Wood fir ;place /insert 23.32
Chimney 'liner /flue /vent 23.32
PROPERTY OWNER . 0i'TENANT ' O ther: { 23.32
Name: 43 1,. a 1 c&_ Environmental exhaust and ventilation
Range he od /other kitchen
Address: q L i j G o f f , . . t e r S e r ui r met t 33.39
City /State /ZIP: °T ; ri cs k t 017 ) 4 q 1 ^ 2 24 Clothes c ryer exhaust 33.39
Phone: ( 7S 4� l� Singc ct exhaust (bathrooms, L13�-3 Fax ( ) toilet t con on y prooms) artments, utility rooms ) 23.32
' tticrcra fans
- , 4'P,PL1CANT) : 0 CONTACT rtilt50N, .;, . A , �Ispac 23.32
Other: 23.32 i
Business name: t - t- S t de D \sIr ( boo(, rs
Fuel siring
Contact name: V -lc I jt ne 5 14.15 for first four: 54.03 for each additional
` � '32541 S b ^ ^ r* S
Furnace, lc. -1 ,DiJV
c Gas heat wmp
City /State /ZIP: p f e--t L 1 fl � 1 , q '9 "2-24- Wall /susp ended /unit heater
—
Phone: (C bfEd . Fax: : (5 O '9 •0 - 9.2p5 Water he; der
Firer lace I
E-mail: VII I FN reS'1dedl &t,,cam Range I
CO) \TR:4CTOR ' Barbecue ,
Business name: S Q le fS f - c ' e Clothes d yet (gas) _
C Other • Address: — -
1VIECHAIVICAL Pi R1gIT I EEC
City /State /ZIP: Subtotal
_
Ci 0.0()
Phone: ( _) —1 Fax: ( —) _ Plan review (25% of permit fee)
CCB lic.: 4_0 q State surcharge (12% of permit fee) I Q ,
TOTAL PERMIT FEE 11 0 . a
_s' _ .� This pern it application expires if a permit is not obtained within 180
Authorized signature: - 17A
V` �. / • , , days after it has been accepted as complete.
L 'rint name: L - { - {�� • - e O i i Date: 4 j 1 °2 1 QC1 • Fee met rodology set by Tri- County Budding Industry Service Board
1. \auiIdingPc B ite \MEC - Permit AR, App doe 10/01/09 410.4617T (11/021COMM'Fn)