Permit CITY OF TIGARD MECHANICAL PERMIT
r1 0 . COMMUNITY DEVELOPMENT Permit #: MEC2009 -00244
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/29/2009
Parcel: 2S 111 BA04200
Jurisdiction: Tigard
Site address: r 14040_SVV 98T_H_AVE
Subdivision: MCDONALD ACRES Lot: 17
Project: McMillan
Project Description: Install gas fireplace, and gas line.
Owner: FEES
MCMILLAN, ROBERT L AND Description Date Amount
MARGARET R, 14040 SW 98T1 AVE Gas Fireplace 05/29/2009 $10.00
TIGARD, OR 97223 Fuel Piping 05/29/2009 $5.40
PHONE: 12% State Surcharge - Mechanical 05/29/2009 $8.70
Minimum Fee Adjustment - Mechanical 05/29/2009 $57.10
Contractor:
FIRESIDE DISTRIBUTORS
18389 SW BOONES FERRY RD
PORTLAND, OR 97224
PHONE: 503 - 595 -3726
FAX: 503 - 620 -5699
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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 ' cation ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or ' ect questions to OUN pIli 03.246.6699 or 1.800.332.2344.
ssued By: a/ r„/, lY..�/"(i Permittee Sign re:
Call 503.639.4175 by 7:00 a.m. for an inspection that busi 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.
05/26/2009 14:17 5036707905 WIDDOWS PAGE 02
% Mechanical Permit Application F012 OFFICE Ilse ONLY
Cl of Ti Received Permit No.:
City Tigard Date/By: MI ?iQ"R • Ooh
I I 11 1 111. 13125 SW Hall Blvd., Tigard, OR 97 CE TVED Plan Review
Phone: 503.639.4171 Fax: 503.598 Lll �� Date/By:
Other Permit:
1' I c. f D Inspection Line: 503.639.4175 Date Ready/By: tuts: la See Page 2 for
Internet: www.tigard - or.gov MAY 2 6 2009 Notified/Method: 11( I Supplemental Information
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Mechanical permit fees' are based on the value of the work
❑ New construction ❑ Addition/�ity►��ION performed. Ir dicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
,. ,•; .,•.� - , ,�' � Value: $
lillj : 1 I I •!lilt jli I �� :!'j'i 1 j rlli "' ..��.�,�..�;( ,ty,,y� •' t �;• ''� ''•� !' IlIl''��1 II {' i ijl { 1�I 1 � r :'1 ;! III 1 , • : I} !
!I ; !I il,! ! :11. �I:yt .11111111l�t 41#0 Y II.1Y!'RII�1"!1!Ii1 0§10,,110lifilii il!iilt',. �. •.1�.1I1�l1llfi,' 111 If{,IL,. , 1 1 :11711 mq �: t�mnn :. 4t um nl llnn , ICI , �nn; l mrm yl! m , '
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• ' i �' i: ml� w an 9li�i�t�titN !i�rilir�'ni(il�iit % • "}.t:
ol and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building , For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total
•{ dr 1 �,( ) !' I 0 I � i r -c 1 I �!, 1!I I!' 11
1�: ruilj; , Heating/cooling
:j IIEIi?• '{Ili l!! l 'I ,+� 1 1!0 .� i�� � r�,. 0itiOI:1 1.I1 II ' , .'I
IL •_ =,' l'llil!i1�I II�.16,. 1Ib:1 r' 7�' nisi' '. ••is `t ?r1P PIi� Ito �� Il;dlrt
Air conditioning or heat pump
lob site address: I LA 040 S ,y,J . Rr Av t (requires site man showing placement) 14.00
City /State/ZIP: \, of r , n R. Furnace 100, )00 BTU (ducts /vents) 14.00
Furnace 100, )00+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat punp 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hol water system ' 14.00
Residential b )filer (radiator or
hydronic) 14.00
Unit heaters fuel -type, not electric),
in -wall, in -di tct, suspended, etc. 14.00
Flue/vent fin any of above 6.80
Subdivision: I Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel a ppliances
n: !;1 l .'•Il :P ;l4' 1 I -,;pd l: i �'.• , d !'1 �! •'ril:il ., !:till xpl 11j 11; '' I Water heater 10.00
'h i ., I i ,',!;•;; " I Illl .j . � ,',= •' ! +ve ii t - i ' ! II !. ' 11, • I � I!I tI ! I. ,�• „�I
I I ' :. ^'��!;;th� ��'�!I!'��!r... ,1�TI :, ,'f�L +�'.ITI����nr.:� - li,�fliii.. ����i'L ,I;�J.�:t�+' • Gas fireplace I 10.00
etas 1l n o - Pi .p 0 i, U- D I A -i .)1/1Qp Flue vent fat water heater or gas
Qi la �n W L+h n n fireplace 10.00
t:Y C Log lighter (o_s) 1 0.00
- rte. p 1 1J Wood/pellet stove 10.00
/ Wood firepl; ice /insert 10.00
Ithii'I �. I; . i , I . In ptu , , a Chimney/liner/flue/vent -r /flue /vent 10.00
iiPlil ; ; ga + � m m p',tltt!ms :1 a i i! 1 i 7, ' "!:' `i l'' 1 1 1 P il 1 l y� li II I I ! I' , ''.1 11 u i , ,, �
'•.' +Ini„': :.,„ " i 4 ,•,.4 .14unW.'.... .•..,r!Iia,l • .) . I i Iitmltlliltt !Iin' -∎.' : Other: 10.00
Name: Cpl") n me .(Y1 \ I4 pn Environmei rtal exhaust and ventilation
Address: L1 u3 g o :;Lc , c$ + Av a Range hood, other kitchen
equipment 10.00
City /State2lP: if 9 j 1 OR q '1 a'h1.. Fax: ( ) toilet . Clothes dry( r exhaust 10.00
, o rooms) 6.80
compartments, Phone: pi/ t)
,.,, ,.., sl , 5 -, - I''u i ': , :';a'; - �!• I;' � '! �;.. 1 1i ; • i itg I ' + itidi 'I'' ' 1 Attic/crawls lace fans 10.00
'11; u -' .Yd:� I t ;:li. ! 1 ! ; ; N I li il ; Iii' ! ,;1iC .i,' I !II a .. ;; a ll'i,
-1 -1 � n Other. 10.00
t U i�
Business name: (�� c3 OtQ J I'M_ � O►I a /} n Fuel piping
r `� p P R
Contact name: jmq $5.40 for first four; $1.00 for each additiona
Address: 1Ss q SW BOOne J /� R R,J Furnace, etc
Gas heat pu'np
City/State/Mr 4 i ) xvi, O p p -7 D t f Wal /susperded/unit heater
Phone: r n 1 Fax.. (5bN 1D 5 Water heate"
3 �-� L Q Fireplace I
E -mail: Range
■ ,Ij!!; I` t :y'I l ilj i' I !;:- ?jIQi1. �I i t I {i, � {II•II, j111fI1 ( ll c :. { i , l • i' : :: �Il :f • F :'1 ' ljl�!111�'I'Pr :i ?;!i!iillu i'`; �jglj,l'Ijl' I Barbecue
'i !' ; '.1 a 1, 11 1 1 �' 1111th f 1 11 a• d ! I ! iik0C* $0 t '1 _ I ... I I'!' " 1 ; , iir ;( II
t � : h'li�.,'•I Itl:C. 1;11) :'tn � a• •I!III: e„i1111 iN! -u ^.�• :I ' 1i
Clothes dry':r (gas)
Business name: F1' 1rPSidi "-- -is} D OrP D/hn
Other:
Address: sn xnP AS Ot .bQ V e IgII{��!'!' iiiIiiii: I(mgtf v 1I I Eir Ili''' I ii 11 r° mill
City /State21P: Subtotal
Phone: ( ) Fax ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee}
s CCB lic.: /�/L State surcharge (12% of permit fee)
v"! TOTAL PERMIT FEE i d�
,
�{ This permit application expires if a permit is not obtai within 180
Authorized signature: r r/ 0 µ • d ays after it has been accepted as complete.
Print name: - A�tot i f 1 d Date: 5 . )D • Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 01/19/07 440.4617T(11 /02/COM/WEB)