Permit " CITY OF TIGARD MECHANICAL PERMIT
1 • COMMUNITY DEVELOPMENT Permit #: MEC2011 -00556
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/02/2011
Parcel: 2S 104C D04700
Jurisdiction: Tigard
Site address: 13867 SW BENCHVIEW TER
Project: ARMELI Subdivision: HILLSHIRE ESTATES Lot: 47
Project Description: Gas fireplace with venting and gas piping.
Contractor: FIRESIDE DISTRIBUTORS Owner: ARMELI, THOMAS F & TERRI F
18389 SW BOONES FERRY RD 13867 SW BENCHVIEW TER
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503 - 684 -8535 PHONE:
FAX: 503 - 670 -7285
FEES
Specifics: Description Date Amount
Gas Fireplace 12/02/2011 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 12/02/2011 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12% State Surcharge - Mechanical 12/02/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 12/02/2011 $33.29
Fuel
Fuel Types: Natural Gas
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.
Issued By: ermittee Signature: •
Call 503.639.41 "! :10 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.
•
Mechanical Permit Application RECEIVE =r
FOR OFFIcF USE ONLY
City of Tigard Received
iiii
"I S W , OR 9722 3 D E 2 Date/By: �� Permit No.: L,� 40/ _ `
` Phone: 503.634.4171 Fax: 503.598.1:160 Plan Review /
t tc A tta Inspection Line: 503.639.4175 CITY OF TIGAR Date /By: Other Permit: STS) / r0) 1 q_
Date Ready /By: luris:
Internet: www.tigard or.gov
BUILDING DIVISI Io,itied /Method: I See Page 2 for •Supplemental Information
.
• �:i, ';li'flfll`�;.7�`,, ii )ll , . i: �, �,_,� , u' �;bl�,it;• :ia� n ,r y,,
,,, .,, ... u• : ;U!. ,,,. i�,�4i';`l i;ilL�. t. '' , �I ��!' .•l5. fi:� li,i, 4I,!: +�.;
�,ib ., ':glNilui t ?ul Fylill., •y�.p4 ,lii! � ,,�J ��, + . ,r ,, ".�.,�
„
, .. ,. I Lfll<<�.,: ,,.. �; !SI!. >4'�•i,, , ',ii: ' ,:' ?!I�;' +1ill,'�fb'„ l('.I;;:. i r ! � u,r,.;;
. _• u. <,,,,,,,, ,,,, ,� .,:. I. -, .�:.! ..,,,�'. , , _ �.., . ..,,., , � , eS base „t ,m'; t: ` ....,n:', • f :r�rl m , � � I � ' �� „'
Addition /alten , .tion /replacement '' f � '' "h ' • ❑ New construction
Mechanical permit fees* don the value of the work
❑ Demolition ❑ Other: equipment, Indicate the value (rounded to the nearest dollar) of all
', iii:; ;;'i °i l';a'i I;I ; ; p; L ,, „•; mechanical materials, qupment, overhead, an
, i,i :i:i ,,,. • I ii;.. 'j;ij l � ? � �,r Ir +'I': ' ,I:, labor, and profit.
:ilii•1, (i,iili, r:lr ......... ?'i`7 +1fl} r ���t • :i:; 'i;i %i! I: P
n,. I �Olb,•i ,�a7T;tl : i1' :iii I !i. r B i;!i Value: $
.,�,1 - and . , y . .. , . • ,;r:: }
2 Tamil dwelling ❑ Comm ;Ih,9m, p:: m;, m',`.'y , . II,,,,. un,r,r,
❑ al /in al " Dtt �
Commercial/industrial dUStCI ❑ Accessory building i''I��I''if+`' , I m, � '.�`�!i t 'h tr,f ,..F � 7 1''T' ! x" �. ���;1� ., il •�`.
Multi - family ❑ Master builder ❑Other: For special information use checklist.
n!i. , .` Il,i,.,, `1 Description
,. ... .' jinll,',t.i l', iilj tiitfll;iilf; r, i �l�!il 'R`l0$ " li j,,,r i l:irf', i+pJ '. , t! t . .
�j�n1��}y�,, ,•i Is; .,It;.yilil; � Qty. Ea. Total
. -. , 6 Ln !., :r:,,u , .� , : - :.��r tin! fl ?A�t!RI�! (uirlji Heating/cooling
Job site address: 3g y � ` / (requires site plan
� Air conditioning
Job City/State/ZIP: site addre s `"� � � � Be t nil VJ e l I e r r g showingplacement) 46.75
t ,., C( 1 7,2,07. Furnace 100,000 BTU (ducts /vents) 46.75
Suite/bldg. /apt. no.: f Project name: Furnace 100,000+ BTU (ducts /vents) 54.91
Cross street/directions to job site: i>m �� Heat pump 61.06
Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall in -duct suspended, etc 46.75
Subdivision: ! Lot no.: Flue /vent for any of above 23.32
Tax map /parcel no.: Other: 23.32
1;•.,': { .,ii „u!i.':q "i'IFfriillSCl °!,i; " ul: f "n, . Other fuel appliances
,,,._ t . ! cixr i JIiIA. „,, ;�• =a, ,„:: fft 1 i, �'l.;rl i,. ';;,,, (i +3,,; -., I, I ' i,i : f II t ' ! � I ;t ' '"::.[. Water heater
r;:r.. „ n r. � 23.32
Irish-4 B.Lc n/1 r_ Qf 0 a Gas fireplace nt or 33.39 q "1� �-J , Flue vent for water heater or gas
i� _
fireplace `/ 23.32
�CJ pi V f ire lace ��
Log lighter (gas) 23.32
•
Wood /pellet stove 33.39
Wood fireplace /insert
„ ,,,,„;j i ;;... 1 ilk •aa Ap ti: 'ili'r - 1 , :ilifj ;!, ;1;;IH' y � , a:n t . ,,.,,I 23.32
1:1fM. ,. fl 'Ii;1417117. :1! ;ij':, , ,.:;s;;,, {���,,1 ., �u hl':., « li,l! °'f`'' . Ot Chimney/liner/flue/vent
23.32
Ia J,^ m,Nit , i,f:r(fli' i
i
�y� yv� �f ''' Ot 23.32 ,
Name: • --0 ` ' i /( ■ 1 V"i I
Environmental exhaust and ventilation
Address: ��(i _ -1 C. �\ Range hood /other kitchen
City /State/Z1P: v nn 'T '' tilt ^^'' ���� equipment 33.39
) _el, . t Oa, 4 Clothes dryer exhaust 33.39
Phone: ( ) �j- '7 Fax: ( ) Single -duct exhaust (bathrooms,
4 a.: : ;1 ^;t1 �+f .! toilet compartments,
aiilieii''i
, ih ;, ; I(tl ' _,, q ,, : ,'ii .':r I;,;;: '" i;rl ;, l ,...., 0 ,,. ,I, ;Ili '� ", : �„ �t. i . partments, utility rooms) 2332
is 1 .�, ,.1 LI'l!.,�1;i.1 ,j i� 1 „ t , i .,liu! „IIt1.j ill', , . ,I : . I ' L ' i , r , l „'; I
i ,;, I , rlpill:: :I!!" ��i,°„ �� "�'�l ",,��("�'����'�'1����'I;..� . : Atticicrawlspace fans
' - z, .. �':'.;:. 'i ll< , id, +le!:u ihl. -. ,,, , u ;rliii.. 23.32
Business name: rrp sj j D1 ��� Other: 23.32
Contact name: Fuel piping
$14.15 for first four; $4.03 for each additional
Address: r$Q �'��
1 Furnace, etc.
City /State /ZIP: Gas heat pump
t�elri r10A- i 612- ' '1 7, 2 Wall /suspended/unit heater
Phone: (Q 7/ o& ° OS-', J Fax:: ( Water heater
E -mail: A {/� /J (//yy Fireplace I
' l yi : '
�,,L Vi ! Yi , I I II!! , _' .'l ■ • / C , I�.,.nr� * „ y ;.�. Ran ��',
,!,L: 1 , ,:.i! iii; ,,,+i :, s 5i I. •.li'�' f 1"i l. I . a ,,, :: !', t ' t ( ,P', 'I j''; , I
I I ., � - 'fit * 1 1' :,i•I ,< , �:I ",In „ I'�I,rr�. ' I f .,� I Barbecue
Business name: r s t + e f S , ` l p Clothes dryer (gas)
Address: 1 VT ry . °tom � ' ^, r , � � , y� Other:
tit._) t�'a - -- it= �• 2 , ,�C-: `;q
/� 4'.�� p I ' jd(iS; "til( I11; u � , it ;:,:,n��q t : �' -, Ii'',r aa ;�pr:y. , i
City/State/ZIP: L ] /] r / :!Ilii,t..,:d51 !t,: ,' I'!I!j;' tY , . !I L.∎ ,T; I ?,,,, , „',1, *}. 6 I! I ii 1i; -i1 1,:
(� (� la 7 � � T i,h;;'.litil „i;:iraliirl
Phone: ( + Subtotal - ',�
q?i) a s es - „ , Fax: 1 J_ - 1 , , q /a Minimum permit fee rmit fe 0) g4_
CCB lic.: rC,fU� -�} cr/ `7 Plan review (25% of permit fee)
// (' State surcharge (12% of permit fee) /z)..50
, - / f .-4 TOTAL PERMIT FEE / , �(,
Authorized signature; This permit application e xpires if a permit is not obtained within 180
Print name: days after it has been accepted as complete,
-.E .4 . ,e t74 U/' Date: /!,7 /, I * Fee methodology set by Tri- County Building Industry Service Board
l: \ Building \PermitelMEC- PermitApp.doc 10/01/09
440.4617T (I I /02 /COM/WF•9)
ZO /Z0 39tid SMOGGIM 90BLIL9EO9 0Z :9t TTOZ /TO /Zt