Permit 1
' a
CITY OF TIGAR® MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00615
T [ G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 11/18/2009
..,. Parcel: 1 S 134CB 10200
Jurisdiction: Tigard
Site address: 12454 SW EDGEWATER CT
Subdivision: Lot: 0
Project: Varhum
Project Description: Install gas fireplace and gas line.
Owner: FEES
VARNUM, STEVEN S & MARTIN, ANNE -MARIE Description Date Amount
12454 SW EDGEWATER CT Wood Fireplace /Insert 11/18/2009 $23.32
TIGARD, OR 97223 Fuel Piping 11/18/2009 $14.15
PHONE: 503 - 277 -8074 12% State Surcharge - Mechanical 11/18/2009 $10.80
Minimum Fee Adjustment - Mechanical 11/18/2009 $52.53
Contractor:
FIRESIDE DISTRIBUTORS
18389 SW BOONES FERRY RD
PORTLAND, OR 97224
PHONE: 503 - 595 -3738
FAX: 503- 670 -7285
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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, • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Center. Th.se rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di ect questions to 0 • by ailing 503.246.6699 or 1.800.332.2344.
r
Iss d By: / Permittee Sig glift. /' =r / Pr:
Call 503.639.4175 by 7:00 a.m. for an inspection that busin s 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.
I .
11/17/2009 17:46 5036707905 WIDDOWS PAGE 01
Mechanical Permit Application Fo OFFICE USE ONLY
City of Tigard CEIVED Received p No.: • /�^—
'1 13125 SW Hall Blvd., Tigard, OR Date/8y: �� / �L/ �!
1111 C • Phone: 503.639.4171 Fax: 503.5
Plan Date Review Other Permit:
R e
T 1 G A R D Ins Li 503 1 7 2 00 `, 9 Date � Dat Read /B J uns: —
Internet: www.tigard- or.gov NOV t` y o S See Page for
Nottfied/lvtethd. Supplemental Information
i � TlGARD —
, ,l ; qi� . I lv�I'I,i�l lit'. i, l(I l l�Ihhl n. t ill l it 11 l 1. 'i! ., , y
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Mechanical permit fees* are based on the value of the work
❑ New construction ddition /alteration /replacement
performed.: ndicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical naterials, equipment, labor, overhead, and profit.
)
,11 n ,(I {1 , 0,1 1.1, ! #1; ' 0,0!0 111! 1' r i!! . 1 f 111�i1' i;ii�l,
OA'X'�+Is�l� OGI'S �':�i,u. ,.,.lil, , �....
u I i1 . , nu I, 1 i ,, „ 10 I $ I4 I n
illf�tilV�1 1 Value: . ,j I fI
and 2- family dwelling ❑Commercial /industrial ❑Accessory building ';i� � ' 1 � 1 "�
I(, 1 II-,, S� I,1 is .1111 {t Ll 1.'(' 11 1�'•IIJ 11
❑ Multi -famil For special information use checklist.
y ❑ Master builder ❑ Other:
y� { �s �,1 Description Qty. Ea. Total
i ii! ;1,t�+ . �� � .1,11111111 f11 0[11 I��if9`'' , F -.0410 }.'VK�da10 i `1i1iI1IIII i i 131111. � 4,i 1'1,!11;11 Heating/ma
,!1' 1111 4 ,lul! e, ,I i∎ . ling
Job site address: 2 Sy �d w Ar Air conditiol ling or heat pump
(requires site Man showing placement) 14.00
City/State /ZIP: `� ��� 1 1 K . , �� Furnace 100 000 BTU (ducts /vents) ' 14.00
� Furnace 100 000+ BTU (ducts /vents) 17.90
Suite /bldg. /apt.no.: Project name: \j ar � Urn
v Gas heat pur Ip 14.00 _
Cross street/directions to job site: Duct work 10.00
Hydronic ho water system 14.00
Residential t oiler (radiator or
hydronic) 14.00
Unit heaters fuel -type, not electric),
in -wall, in -di et, suspended, etc. 14.00
Subdivision: Lot no.; Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no
Other fuel a tpliances
, ,
, !1 , .1 ,'.. a . � , l , r ,, 1, , 1 ( 11 1 1.1 ! ' ' I,I I f' . II AI , :
�, , , , ": 1 IL1 1l , . ,t. , 1 ■iY✓ G�k� p 1( ; fJ� • ,! ,i i ,illil , I.iil,� Water heater 10.00
�Ii� 1 1,_ , ��, mss 645 .3 9.
( 1 - Gas fireplace /
f =��t �QC-42 L I t p J
�S � n� Fl ue vent for water heater or gas
fireplace 10.00
Log lighter (1 as) 10.00
Wood /pellet : cove 10.00
�{� Wood fireplace /insert 10.00
.,�i' . 1 1 , ,,,,.t.,'ii hii i}-!; �, ' .. 1'' 1� i , ■ 1l r •, 1111 ltl ! Ihlili ,Ii11i111
Chimney/liner/flue/vent 10.00
" 1
�4 J, j, ,,! I Other: 10.00
Name: - -te,Ve_ I�
V tf \ , \l.L►)'1 Environmen al exhaust and ventilation
Address: Z S VC.) Range hood /t ther kitchen
1�- l/`-Jrier C equipment 10.00
City /State /ZIP: \c A CI r' �^`' 7- 2-•3 Clothes dryer exhaust 10.00
Phone: (58) 7.. -jam 4 4 Fax: ( ) Single -duct a ::haust (bathrooms,
r toilet compar ments, utility rooms) 6.80
it ,! �� AP$f X0' -. , I 1.1 ! 11 1 ,! 1; 1 P li o rlr !) i,1III Attic /crawls ice fans
, 0 1 � �� �' .,�,'�I�,' P 10.00
Business name: t42es2 Other: 10.00
Contact name:
S"
1S *t' ��,t�l/ Fuel piping
- t 55.4!1 f
�E} I1t; e,,rra,r 1 for first four; $1.00 for each additional_
Address: Q Furnace, etc.
1(' Sta.) 4 O01 -- i ' 'rr Gas heat puma
City/State/ZIP: 9 '
y / t 1Y�'Q
4- .c + 7 -.
' Wall /suspend :d/unit heater
Phone: (30 ) L S `j -1 Fax:: gO ]) (01, O - 1 . 'LP Water heater
E -mail: Fireplace 1 i
V I.r�.cLtr�� \1. l«
,I �I "I 111$1 ! � lf l �� I n' � q pl U I', �'� l�� L`a� CG irY4 Range
.
, ,, Il
! (. V ! ill , I t 6OtV*6702 I r'!i _ III ' p .
�, a!n I , ,,�Irl !, 1 ' III ! (i Barbecue
Business name: Clothes dryer gas)
Other:
Address: i41•p , l • •! , :,
•^ ` •1 ,Illq, 1I1l1h: : ∎,d , k r ,IIIIIIIi1 i, � { iii i;
�v City /State /ZIP: 1• to . I �,..�I�;11,. I i;
9 Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($) i
O Q ' 4 Plan review(25 %ofpermitfee) •
CCB tic.: 7 7 /O' �O
,
S tate surcharge (12 °I° of permit fee)
TOTAL PER j��,'r
MIT FEE So
�� Authorized signature: . �� _ This permit application expires if a permit is not obtaine witd hin ISO
{ drys after it has been accepted as complete.
Print name: 1 r. L he 3 'z r r Date: t l -- VI - 0 i • Fee methodo ogy set by Tri- County Building industry Service oard
t;\ Building \Permits1MEC- PermitApp doc 0i /19/07 440 -4017T (11 /02 /C0M/WEB)