Permit r CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00673
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/16/2007
PARCEL: 2 S 103 B B -04000
SITE ADDRESS: 12103 SW 125TH AVE ZONING: R -4.5
SUBDIVISION: BROOKWAY LOT: 040 JURISDICTION: TIG
PROJECT: GILLETT
Project Description: Gas fireplace insert.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM 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:
OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
THOMAS GILLETT Description Date Amount
12103 SW 125TH
TIGARD, OR 97223 [MECH] Permit Fee 11/16/20C $72.50
[TAX] 8% State Surcha 11/16/20C $5.80
Total $78.30
Phone: 503-524-1105
Contractor:
FIRESIDE DISTRIBUTORS
18389 SW BOONES FERRY RD
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -595 -3738
FAX 503- 670 -7285
Reg #: LIC 40979
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty 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.
Issued By: � % / 1 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for inspections 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.
Mechanical Permit Application U F OR OFFICE USE ONLY.
City of Tigard ]. Received
- `J g Plan Review j(9 I '' ?......B
Plan L n - fl & e z -7_3
II 13125 SW Hall Blvd., Tigard, OR 97223 NOV 1 6 iljli/ Plan Review v�"y` / Y/
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
TI G ARD Inspection Line: 503.639.4175 CITY 01- A t(aAHD Date Ready /By: MI See Page 2 for
Internet: www.tigard - or.gov BUILDINGDIVISlO Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction g Addition /alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
Multi-family Master builder For special information use checklist.
❑ y ❑ ❑Ot her: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
— Air conditioning or heat pump
Job site address:
� 'pN� (requires site plan showing placement) 14.00
City /State /ZIP: \' a r A !� 91 ac9 -- Furnace 100,000 BTU (ducts /vents) 14.00
�/ Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name:
. Gas heat pump 14.00
Cross street/directions to job site: Duct work . 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
r.
1 Gas fireplace 10.00
t ,S 1 .- CtS -t f(,C Q, 'W �/ � I? Flue vet f water heater or gas
^ (L T fireplace 10.00
e- ∎ - Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
PROPERTY OWNER' ❑TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: y S 611 ,-6-- Environmental exhaust and ventilation
Address: 10-1 J3 S /) � o Range hood /other kitchen
equipment 10.00
City /State /ZIP: —C. k.(Q. OK --)a- a, j Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone:? ) t-j .1OS Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR , Barbecue
- F
` Clothes dryer (gas)
Business name: \ - (5‘( e/ ` ) A tir> .t,� 1 Other
Address: I $3'S q 1.-c) 4 9t4a_ MECHANICAL PERMIT FEES*
City/State /ZIP: x 9 — 7 . -- Subtotal
Minimum permit fee ($72.50)
Phone: ( ) . 95 —3735 35 Fax: ( ) Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE .
by set b
' / / / This permit application expires if a permit is not obtained within 180
Authorized si natu • ' , days after it has been accepted as complete.
Print name: f - t'►;� ,..e �
1 Date: \ � (� * F ee methodology Service Board
r by Tri -Count Y Building Industry
I.\Building'Permiits1ME C- PermitApp.doc 01/19/07 . • - 440 -46t 7T (11 /02 /COM/WEB)
a
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation:. . .Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
1:\ Building \Permits\MEC - PermitApp.doc 01/19/07 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: h1FC2O07 -Q0873
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 ]6/2007
Phone: (503) 639 -4171 vi�l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/21/2007 TIME: 7 :00AM PAGE: 73
SITE ADDRESS: 1 2103 SW 125TH AVE CLASS OF WORK:
SUBDIVISION: t3ROQKWAY LOT #: 040 TYPE OF USE:
PROJECT NAME: GILLETT
DESCRIPTION: Gas fireplace insert.
OWNER: GILLETT, THOMAS PHONE #: 503-524 -1105
CONTRACTOR: FIRESIDE DISTRIBUTORS PHONE #: 503 -5% -3738
•
Inspection Request Scheduled For: Date: 11/2112007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
615 Mechanical rough -in 060037 -01 503 -524 -1105 Y
Corrections /Comments /Instructions:
•
_PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: //- o? Phone #: (503) 718- Z
CITY ,OF,JIGARD -
BUILDING DIVISION PERMIT #: M EC2007 -00373
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/1 &2007
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ��� "__..
INSPECTION WORKSHEET FOR DATE: 11/71/2007 TIME: 7.0(1AM PAGE: 74
SITE ADDRESS: 12103 SW 125TH AVE. CLASS OF WORK:
SUBDIVISION: ;RO()KWAY LOT #: (AO TYPE OF USE:
PROJECT NAME: GILLETT
DESCRIPTION: Gas fireplace insert.
OWNER: GIL LETT, THOMAS PHONE #: 503 - 524 - 1105
CONTRACTOR: FIRESIDE DISTRIBUTORS PHONE #: 503500)
Inspection Request Scheduled For: Date: 11/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 060036-01 503-524 -1106 Y
Corrections /Comments /Instructions:
ASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION U ADDITIONAL FEES ASSESSED
Inspector: .A Date: ft- 7 Phone #: (503) 718- t,-'