Permit . ,f
1 .
4 CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005-00180
AA '' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/20/2005
PARCEL: 2S114BA-01500
SITE ADDRESS: 16200 SW GRIMSON CT ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.2 LOT: 124 JURISDICTION: TIG
Project Description: Gas line to fireplace.
CLASS OF WORK: OTR 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
CLINE, JOAN D Description Date Amount
16200 SW GRIMSON CT
TIGARD, OR 97223 [MECH] Permit Fee 4/20/200: $72.50
[TAX] 8% State Surcha 4/20/200 $5.80
Total $78.30
•
Phone: 503- 639 -5299
Contractor:
MODERN PLUMBING CO
D + D ACQUISITIONS INC
11120 SW INDUSTRIAL WAY REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Phone: 503 -691 -6166
Reg #: LIC 00087906
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: -D, Permittee Signature: c°RQ, c,f � p
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business
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.
@4/19/2 @ @5 14:23 5 @36916771 MODERN PLUMBING PAGE @2
Mecbanicai Permit i, Do 1 = I I
City of Tigard Received
' Dsaegy: t; - Or -9 U� Permit No.: 6,c,e4 as) , a
13125 SW Ball Blvd„ Tigard, OR 97223 [� l (� 200 Plan R eview Phone: 503.639,4171 Fax: 503.598.1960 AI � , ; ,,,:� rti ,, I Daaloy: Other Peh:
Inspactibn Law: 503.639.4175
Internet: www.ci.tigard,or.us Gca .( OF TIG A �„�. '� I' Dete ReadyBy; Inrip Sec Page 2t4r
BUILDING plVl Notified/Method: -3.- I r Supplemental Igrnrmtmen
T'YPE•OF •WORK - COMMERCIAL •F,EE'_ SCIfEDULE - .TJSJ CHZCKrIST
D New construction , Addition /atterntjonfreplacemejl,t Mechanical permit fees'" are based on the value of the work
peflanned. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
.. . . . CATEGOR t OF CONSTRUCTION
.
Value: $
g1- and 2- family dwelling D Conuttcrcial/industrial ❑ Accessory building :. RFSIDEN117AL 1 QUTP!MENT /SYSTEMS I+EF,6*
❑ Multi family 0 Master builder 0 Other: For special information= checklist.
Description I Qty I Fn. 1 Total
. JOB ,SITE 'INFORMATION L
AND OCATION• Heating/cooling �-
Job site address; 0 Air conditioning or heat pump
�W Gr�'1f�Sf�11 C� ( roquirCe site plan shnwin� 1d.f10
City /State/ZJP: c r � Furnace 100,000 BTU (dects/vcnt 14.00
Suite/bldg./apt. no. Project name: Furnace 100,0004- BTU ehms/vente 17.90
G I t r 1 � ' Gas heat pump 14.00
Cross street/directions to job site: Duct work _ 14.00
• Hydmnic hot water system 14.00
°--- ReeidentiliI boiler (radiator or -'
hydronic) 14.00
Unit heaters (fuel -type, not electric),
itt-wall _ in duet, enapended, on 10.00
Subdivision; Lot no.: Fiue/vettt for my of above 10.00
. Other: 10.00
Tax map /parcel no,: Other foci ppnances
. DESCRWr1ON OF WORK Water heater 10.00
Gas fire .lace (0.00
-
' tt Q - "\ -- 0 T P 1 r e. Q C Pule vent for water heater of gas
fit pince 10.00
Lo l' ter 10,00
Wood/pellet stove 10,00
Wood fireplace/Insert 10.00
. . . 0 pROPFRTV • OWNrR • I • 0 T '.N-r Chimncy/lincr/tluc/vc nt 10,00
\ Other: 10.00
Name: 3 Q s) , �` \Y-Q_ Environmental exhaust and ventilation
Addreax- Range hood /other kitchen
equipment 10.UO
City /State/ZIP: Clothes dryer exhaust 10,00
/� Single -duct exhaust (bathrooms,
V3 1�.v
Phone: (
) .g -- S-299 Fax: ( ) toi let compartments, utility rooms) 6
.. 0 APPLICANT % 0 . CONTACT PERSON AttiGcrawlspace tans 10,00
R
Other: { 10.00
ucioess name:
. Fuel piping _
Contact name; _ S5,40 for first four; $1..00 for each additional
Addreas: A Furnace, etc. - ._ -.._ .
Gas hest pump - — _
City /Stato/ZIP: Wali/suspcndcd/unit heater
Phone: ( ) I Fax:: ( ) a ar h eater �._ __
Fir place 5 ' t 0
E -mail:
Range
CUNT [lALJ'Ox Barbecue
► Clothes dryer (gas)
Business name:
• e rr) \ to A 1.r Other:
• Address: I ;gyp 5 LA D t ir1Lic-ts - k - ri . ( k . MECRANTCAla PERMIT FEES
City /State/ZIP: 1 t, a't C ty'7pb Subtotal _
!'.!zone: (5 v3) Coq (- t o I to L 1 (50�) ( q 1,_(� y1 J Minimum
permit fee CO2.50) 7 �. 5 Q
Fax:
.Plan review (2s %ofpermit fee)
CCB lie.:
. 7 ct () S tate surcharge (8% of permit fee) .5- SO
TOTAL PERMIT FEE 7 g . 3 U
Authorized signature; / This permit application expires if permit :A net obtained within ,li 150
days after It has been accepted as complete.
Print name.' n ra h k . c, rt , c_ D t ! I C _ h • Frr. mrthneiningy net Fry Trr f'nunfy Rn�il ling rnebtatry Srrvire Rm
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