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Permit CITY TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00260 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/4/2007 PARCEL: 1 S134AC -03400 SITE ADDRESS: 11083 SW BLACK DIAMOND WAY ZONING: R -4.5 SUBDIVISION: HART'S LANDING LOT: 005 JURISDICTION: TIG PROJECT: ROBERTS Project Description: Install gas logs, gas line and fireplace. 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: 2 > 10000 cfm: GAS OUTLETS: Owner: • FEES ROBERTS, OFELIA P Description Date Amount 11083 SW BLACK DIAMOND WAY TIGARD, OR 97223 [MECH] Permit Fee 5/4/2007 $72.50 [TAX] 8% State Surcha 5/4/2007 $5.80 Total $78.30 Phone: Contractor: FIRESIDE DIST OF ORE INC 18389 SW BOONES FERRY RD PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS Contact #: PRI 503 -595 -3726 FAX 503- 620 -5699 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 B;: Permittee Signature: Se,e, 14pp o 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. • 05/04/2007 12:08 5036205699 FIRESIDE DISTRIBUTOR PAGE 02 — . ili r = � b > 7 P� 1 ' s ( r FOR nil 'IC'r �5r'i?l ' • eC� `eIYRiL"sll � Permit �iEap6 ''--• j 1. " R 0 _ . City of Tigard Datc/By: 13125 SW Hall Blvd., Tigard. OR 97231 AN 4 2007 Plan Review OthcrPermit: I 15 Phone: 503,639.417 Fax 503,598.1190i Date/By: i m Et Scc Page x for lnspe lion LInc: 503.639.417 , . Date Ready /By: Supplemental Information TIC:/�0.17 .8(J I Ur HHUA No tif i e d/M et hod: 1nCernct: yyww. t i g ard- orev 1:11[ ITT 'r# T. ,` 5C r = �tS1EIi>< &?r?; ;,y t :!, { I SM. !,: ; :: ' i i , . p .R , ;,, 3A, ; ; i!"x.,x r a t b, tv t T Fa .. +,. '�. `; ;,: _ , TY 1':'; .• ... t. ; �?F'.. • • = : •''' ' .cK ,. 5 • : �'+ ' it Nee* are based on the value of the work ;;:,; �. r;i ';:.�, , ';`;,' i� ... . •,....,: !,.. Mechanical perm ❑ New construction ❑ Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all 0 mechanical materials, equipment, labs; overhead, ant�rofit, Demolition Other: — Value: $ F � ` " ^,�t4 \yl.' ? �'R+• #�;X ' :14 1 ti.'Y ! ^? 'y `, �t � ,`'h`' -.. •• 1 , si, : :F • ]4 fi '; . x 1'rHP c:sl ? ..� 'iy r 1 , /i ,r <: �i'h% : �`n - s � ; A�T13'U�i?'. ; ,OF..,�� I. � �, � � ��s �,K'��`'�i ii` ; :.,i .. .: i' :'. ' <:.'.. . .: .' . /industriai ❑ Accessory building For special information use checklist. l- and 2- family dwelling El C ammereial — I I E Total ❑ Multi- family ❑ Master builder ❑ Other: Description i M � `;�, r �,d r:•'j(",.�, " 1 :IR i ii 'I1t * iC1..(g `,.� y k u i1` '• _Leiria coolin 77•74''''''''' STT 7 I ]V .i •tlNb.{A r #;- sAd,rt +1,. &i1,3;z s.�n y ii�'y -i :+ „ ", ���' pircondiuoning • ', 14 Job site address: I ) Deg 3_ • - / I ) - 6,12•64 . /, . . ( requir es sit Ian ehawi+l6 placement) t 4.00 Furnace 100,000 BTUjducts/vents) City /State — PAR Furnace 100,000+ BTU (ducts /years I7.�) name: Gas hcatpump 14.00 Suite/bldg./apt, no.: Project — Duct wor 14,00 k Cross street /directions to job site: � Hydroowic llot w1ZOt ±water system 14.00 Residential boiler (radiator or 14,00 • hydronic) Unit heaters (fuel -type, not electric),. 10.00 in -wall, in -duct, suspended, etc- _, Flue /vent for any of above 10.00 �^ L 10. Lot no.: _ _ Other: 1_ Subdivision: Other fuel a e plipnces Tax map /parcel ne.: t . •. ,,,, . 61Ti w:• . - i Water heater 10.00 ;' • ' - il�'''0'F e VQ.... �, isi`r t' t4' 24•; ; ;;i:a rFt:r.:�n�: q: ; ; i ` 10.00 :,ii.-f; s.` '''ii) ;:� +• `i.% • . , .� . •„ •I. , .�' — ••• s's y Gas fireplace • I 1 r, Flue vent for water heater or gas 10.00 l.� to fireplace Le li htor as 10.00 - Wood/ ellet stove 10,00 _Wood fireplace/insert _ t0.00 , , .x s "•'p �Fi 'M .-no Chimney /liner /flue/vent 10,04 1000 „,. ' 1 ,;,t:.; :: t.tn :''Vi• ∎. t ,14411e:1 yes k . t, :N.14 , `, '''':`'','‘:1''' ' t' �=�RO� !'��, ' , ' ry:;�r� "� • .. n,.. _ 4�' a: it �r Other: tal exhaust and ventilation T:nvlronmen N am e: .. � Range hoodlot ear kitchen 10 00 1 b 0 . , rn r. , l . . r• p - Address: / Clothes dryer exhaust 10.00 City /State/7.1P: Single -duct exhaust (bathrooms, S g0 5 toilet �m•trrtrrlcnts utili rooms Phone: (5 0) Fax: ( ) s '' Other ' toil / wisest 10.00 te era a fans • ,,, W° CO, I,' �'G'S;'�R _� 10,00 :. • 1 ... ai____j '` : Business name: piraf° P bt T ,��C V-! II;AD Fuel 't *In - _ 55.40 for first four; 51.00 for eachitional Contact name: hS 1 � t //�� 'Furnace etc, r Address: It3�'"1 s1 � . � - rLj /r4 Ctashcat3u_ -ri,� 9 2 2 Wall /sus .ended/unit heater �_ City/State/ZIP: '�� f I ` ono Water heater Phone: ( 5b3 ) 595- ,312-- _ Fax:: ter. t ) ap� Fireplace 111111 E - mail: 1 r}/1 G / " � I I I • � 44 -. Rang e ,:c. : : ,- -.• ' Barbecue t�t7iN7 . tA ' C l l ; : :. 1 L • is ' Clothes Business name: F'i t'QTdC � •. 4 . : . � •.er "'' " n Other: :C ' • ' �^ ,� �5'.z. +.') ,,,• • Address U . r }. , Subt l City/State/ZIP' Minimum pertnit fte ($7Z 1� ], © ' Phone: ( ) Fax: ( ) _ Plan review (25% of p fs it) State surcharge (8% of permit rot) 5,c3,7) t:CB t ic.: d q 7q - - TOTAL PERMIT FM 113.3$ - 'This permit application expires If a p Is notlfained within Igo • days after It tes been accepted as sombre. Authorized signature: ,�sW►i �;,►� � ll Date: - • Fe methodology set by Tri•Cotinly Building Indrsty Service Boar Print name: , �Z'lfw + A 1Aaulldlasuserrelt• C-PenmtApneee 04 /06/DA 441Y461 1T (I1/021COAtAV6a) J T CITY OF TIGA D . BUILDING DIVISION , -- - I PERMIT #: MEC2007- 00260 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/4/20t07 Phone: (503) 639 -4171 AO l� ' I I Inspection Requests (24 Hrs.): (503) 639 -4175 =�� INSPECTION WORKSHEET FOR DATE: 6/11/2007 TIME: 7:00AM PAGE: 56 SITE ADDRESS: 11083 SW BLACK DIAMOND WAY CLASS OF WORK: SUBDIVISION: HARTS LANDING LOT #: 005 TYPE OF USE: PROJECT NAME: ROBERTS DESCRIPTION: Install gas logs, gas line and fireplace. I OWNER: ROBERTS, OFELIA P, PHONE #: CONTRACTOR: FIRESIDE DIST OF ORE INC PHONE #: 503 -595 -3726 Inspection Request Scheduled For: Date: 6/11/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 049741 -01 503-595-3726 Y Corrections /Comments /Instructions: . PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: / 4 Date: —J/ — off Phone # : (503) 718 -� S----- r --r , CITY OF TIGARD , r. BUILDING DIVISION . -- - PERMIT #: MEC2007 -00260 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/4/200 - 1 Phone: (503) 639 -4171 /yea °�(� N�q Inspection Requests (24 Hrs.): (503) 639 -4175 ! F. INSPECTION WORKSHEET FOR DATE: 6!4/2007 TIME: 7:01AM PAGE: 103 SITE ADDRESS: 11083 SW BLACK DIAMOND WAY CLASS OF WORK: SUBDIVISION: HARTS LANDING LOT #: 005 TYPE OF USE: PROJECT NAME: ROBERTS DESCRIPTION: Install gas logs, gas line and fireplace. OWNER: ROBERTS, OFELIA P, PHONE #: CONTRACTOR: FIRESIDE DIST OF ORE INC PHONE #: 503-595-3725 Inspection Request Scheduled For: Date: 6!4!2007 Pour Time: Code # Inspection Description Confirm # Contact # Message // 699 Mechanical final 049445.01 503-595-3726 Y .(OU cps 4 -S - Corrections /Comments /Instructions: AA , Ll� .4 fr-",‘,...ii.- bt,- S'A r/-.J 6.4.--Alt/ 45,» — /'2 7 I' PASS n PARTIAL APPROVAL I I CANCEL n NO ACCESS IltL FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: - A D - C --` Phone #: (503) 718 - Z-rt -�;S