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Permit ,, CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2011 -00458 Date Issued: 10/18/2011 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S103BA00107 Jurisdiction: Tigard Site address: 11710 SW ANN ST Project: POTTHOFF Subdivision: LERON HEIGHTS Lot: 7 Project Description: Gas line for gas logs. Contractor: T & K MECHANICAL Owner: POTTHOFF, ROGER & MARY PO BOX 116 PO BOX 23968 FOREST GROVE, OR 97116 PORTLAND, OR 97281 PHONE: 503 - 844 -9173 PHONE. FAX: 503 - 846 -0195 FEES Specifics: Description Date Amount Other, Fuel Appliances 10/18/2011 $23 32 Type of Use: SF Fuel Piping 10/18/2011 $14 15 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/18/2011 $10 80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 10/18/2011 $52.53 Stories: Fuel Fuel Types Gas Pressure 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 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 1987 or 1.800 332.2344 Issued By: qua. 'e?mittee Signature: / / _ 1 Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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. 10/17/2011 15:53 5036269138 HOT SPOT FIREPLACE PAGE 02/02 Mechanical Permit A t Lica f .E 1 l ( t) 1. . 1'. ti i. i ) I i - ' City of Tigard 1 ( Y- l 1! .:11I PtamilNO.: lr1 C:! t �, 13125 SW Hall Blvd., Tigard. OR 9 OCT 7 20ii p' ' II Phone: 503-639.4171 Fat: 503.598.1960 OtherPumit 1 i c. , \ p i; ?;, lnspeegoa Lino: 503.639.4175 pate Ready/By: BM IEEEMEIN www.tigard-or.gov CITY OF TIGARD Nofifietymethod` t �fi� �s TYPE OF l �ttc lC) COMMERCIAL *SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work © New construction Addltlon/altention/replacerncft performed. Indicate the value (rounded to the nearest dollar) of all D Demolition [ Other: mechanical materials. e•ui'men labor ov -,' and ,refit. value: S CATEGORY OF CONSTRUCTION • m Erf IAi EQUIPMENT / SYSTEMS FEES* "i- and 2-family dwelling 0 Commercial/industrial 0 Accessory building - For special d{fonnntion use checkllsr. © Multi- family ❑ Master builder 0 Other_ Description Qty. Ea. Total JOE SITE INFORMATION AND LOCATION Head conditioning olin - --- Air cti Job site address: / T7 / D 3_, � • j ,! mice site 430 .. -, : .lacemeet 46.75 j � 7 3 Furnace 100,000 BTU (auarivestal 46.75 Mil City/StatrIZ1P: ckY. f V hltrnace 100.000+ BTU (dvcts/+cnm) 54.91 _ NM Suite/bldg. U Suite/bldg./apt. 1 Project name: _ __ Heat 'uot, 6L06 Cross street/directions to job site: Duct work II 2332 - - H , I nic hot waters : - I 23 -32 Residential boiler (radiator or � - -- r 1C -_ _- Unit heaters (fuel -type, not eleetti ), E in -wall in- duct.: r „ elc. 46.75 - Flue/ventfor of above ��ME Subdivision: .- - I Lot no.: Other: IMMO Tax map/parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23 -32 ` Gas fireplace 33.39 MI Q l l 11k tit `r ' Cl. M • Flue vent fbr water heater or as N M = 4 4 m ' _ .- . Lo• 1 ter _+ - 2132 Wood/pellet stove _ 33.39 In ------ "" Woad fireplace uasert 2332 ,-,, /liner /ftuc/vvnt MIIIIIMIMIIII r I : PROPERTY OWNER D TENANT Other: ./ M • ��'Jr] Name: ay- _ E nv l ro i • 1 tat exhau *and ven Range hood/ kitchen Address: i i rP A 1 equipment 3339 a / / Clothes • exhaust 3339 CRY/State/ZIP: /Z4P: r 3 Singleductexhaust (bathrooms, �� P @one: _1 / r �„ 2 - a D q Fax: ( ) toilet compartments, utility rooms) r. APPLICANT �. 0 CONTACT PERSON Aft G � fhna 23.32 MI Other 23.32 Business name: / o- i ' e p bC -°-- . Contact name: Q �� ` ei , A'Z. 514.15 for Brat tbasS4.03 for each additional ■ i�nace ea r Address: I l 5 41 (�Cc ‘A. t - �:, ... , m� 9 City /StatefZ1P: ,..� �✓. • A Q r 05 Wallhuspcadcd/unitheatcr __�_ IIIIMI IIIIII P h o n e : 6 , 3 ) . _ r I Fax:: I 3) (O - C11 3e watrrx heater w. E -mail: _ die .. . . CONTRACTOR Barbecue - Clothes . • Business name' . r P Other MI — - Address: ,_ 0. .t► a . l 6 MECHANICAL PERMIT FEES* �} Subtotal t City /StatrdZlP: iv 1 r `( �l ((Q - _ Minimum reran fee ($90 -00) 'i _0 Phone: ( 1 57— , / Fax: ( ) Plan review (25%of permit fee) CC/3 lie.: r� State surcharge (12% of permit fee) WORM Ol ���i.� I A / .-- TOTAL PERMIT FEE �, '(„ a T his p ermit apQt*etten eipisSt es permit is oat obtained within 180 Authorized signature: .A e e ` days after it Bas been accepted as cemplete. Print name: . • ,. . a . Q i VL z.... of Date: /� Im ' Fee rnatt>odotoSy by lti�oevb a8 ►a Y Service Board ...a....... ,..,.,Hr�►.rcr -vvmNn A 10101/09 44a- 4GIrr(I1/01/COM/wEn)