Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00100
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/23/2012
Parcel: 2S114BA04200
Jurisdiction: Tigard
Site address: 9985 SW KENT CT
Project: NAGEL Subdivision: PICKS LANDING NO.2 Lot: 98
Project Description: Gas fireplace installation with fuel piping.
Contractor: FIRESIDE DISTRIBUTORS Owner: NAGEL, REESE C & EDITH A
18389 SW BOONES FERRY RD 9985 SW KENT CT
PORTLAND, OR 97224 TIGARD, OR 97224
PHONE: 503 - 641 -1919 PHONE:
FAX: 503 - 620 -5699
FEES
Description Date Amount
Specifics: Gas Fireplace 02/23/2012 $33.39
Flue Vent for Water Heater or Gas 02/23/2012 $23.32
Fireplace
Type of Use: SF Fuel Piping 02/23/2012 $14.15
Class of Work: ALT 12% State Surcharge - Mechanical 02/23/2012 $10.80
Total Number of Systems: Minimum Fee Adjustment - Mechanical 02/23/2012 $19.14
Audio & Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: 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 ma • • . • • - • • of the ru direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: — — — Jt — Permittee Signature:
'/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4176 by 7:00 a.m. for the next available inspection date.
Thls 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.
02/22/2012 14:04 5036707905 WIDDOWS PAGE 02/02
Mechanical Permit Application Poll (1111('1: 1:ti1': ONLY City of Tigard Received
0 13125 SW Hall Blvd., Tigard, OR 97223 ®� � '� Date r •.)- » M Permit No.: c -- . : - ' - ' 3. c .( 2 0 (. ,,,....0 i av
M Phone: 503.639.4171 Fax: 503.598.196 Plan Review
QQ �� y Other Permit:
T t C: A It I) Inspection Line: 503.639.4175 t Q9 `1 \ � t B _
Internet: www,tigard- or.gov ry �Q ,Date Ready /By: brit: S See Pena Information
. \ � �y�� lotified/Method: SappkmentalIofororatioo
i. 1!I I I ,II'I''�i') ApIII',u 711:;11.'4' I - I m;..:;," I ,�n ,,,,, mnP �� °I�_
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• .. Jn m, a'a:+ silo nmlm
❑ New construction Addition/alteration/re. .- - -,'. Mechanical permit fees are based on the value of the work
❑ Demolition ❑Other: \� performed Indicate the value (rounded to the nearest dollar) of all
Ilp:,ll i, i I'I' I I ' n I m ,�, =J, mechanica 1 . materials, equipment, labor, overhead, and profit.
lli r I'1 ! ll l�:� I 'rt unauul PF y. t' .I l 1 ,
I:se�•1 >' , I.,IiI Veil:, .,,,., •. 11.1.., : !t il?_ m' • ulen P N a n�n , '- ' fl x l u , ,f lll!Il :r ya! 'l I i 1: i l II I1 .' Value: $
n 1'J;',I 1 ` i�,. .. �; %• i I 1 11 hll IMt '/ 5I . P, C u n ull m ura l IC ruin IWllllul° all ll I I
liQ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building illllll sti �:<!'' " u�IWOtesr 'I�IU�Ia °, �' "h}A;,l',,; i l ,ilil -
l
F
❑ Multi-family
For special information use checklist. Master builder ❑ Other: I hecklisr.
Illi '= c IIIli1'1�� ''; �.� i IF' of II+ 1 ,a, �� a n n I nmu 1 Descriptior • I Qty. I Ea. I Total
I.hl ir, I a, rl'1 . , i,, , , I t e l d. 1 r P Dpul�17,ul,•• 'ill lopil l:;. +
I . t m ,. :::'.0*,;::., a tA1a I yi� I iUlt' I•, i. � I
' ` ij .,:,, n 1�1,,: • .:;gllf�,l1ll� HeadnPJcooling
Job site address: CNA lip - p r * , 0 f r t Air condite lning
l (requires site plan showing placement) 46.75
'-
City /State/ZIP: �-/ OR., 7aa Furnace 100,000 BTU (ducts/vents) 46.75
Suite/bldg./apt. no.: Project name: ! ` Ake
Furnace 10 ),000+ BTU ( ducts/vents) 54.91
Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic h• It water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heater. (fuel -type, not electric),
in -wall, induct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Tax map /parcel no.:
Other: 23.32
qq l I ° , . 11 :!r : •. Other fuel appliances
i ''!II'lii ��,- I!lihlCl�l !.� °i X �'� ��i�a "lk7 ;. i' f':1 .;� � � I' , ,,� , °q"{�� III!!;: n I If '. �� ' I :;i;: II -
• I, it 141 ;: ,'1 { I. i('','v lit y o o . ' • O I:�.. I 1� E _ I I, I
r.... "ul ,�: it I �� -r. � .Il .��f ,�; r 1h111 �,�'! . ,..:> : ,.� �I�i�?. "::, I � .� I �' i I��111 I I ii I (.t' "' � ll,.i stet haste..
,;,,, ,;, , , ,,,,, 4,1 �'� i.� i�Ill 14,w r I I � ( i' ��� Q W 23.32
/ S e Gas fireplac; / 33.39 33.3/
•_ I / _ , / /.. 4 Flue vent fo.. water heater or gas
°f' c CiAJL, e_o Vey fireplace / 23.32 .23 .3,..
LT '-► Log lighter I gas) 23.32
a Wood/pellet stove 33.39
Wood firepl•ICe/insert 23.32
ilil �N>,>}IJrillnll li P Inlpl:C3^7: , i;{ • , , , :'., _ 11ue/vent 23.32
�i :;: ',Jil• ill , , � u' a .. , It {' .;i!� it 0: :.p!U'iC I I I nms l n Chiron Aims/
' r dl)diGI�14�� ,,.....�:,;'�,,.'r`.,„ ( t: 1; �l�iii: 4: -. �I��!;�� I lil�fj�ii �'
. Other:
f� J e ie_L � . ,. I Th(� 23.32
Name:
��� V[l ( An 5�� qi� Environmental exhaust end ventllatloo
Address: 15 -SS- S _ _ " N � ' n ri- equpehtcUetherkitchen
r�'� �/ equipment 33.39
City / State/ZIP: Tti aroL I I Sin C� . q 7 4 Clothes drye° exhaust
P (�3 Lip 7 ( � y � . Fes: ( ) I room s,
33.39
g e-duct t xhaust (bath
lie
Phone: o tip: y 11i i
i i I {( y ?+ "" n,1 F n:. I toilet compliments, utility rooms) 23.32
: <Q'ri : l� P,R15. I mi r 1 3.: • .04. . !1`11 i(i; 0iii!:T,Iii' ' I . .1,1 , �ii! i 0' I 31 ' Yt> In I�tq( 'n ..: t1idcr8 wls :ace fens 23.32
a ;
• a--:�• : , . . 1 ,��
Business name: F Fire, S f d Di 1 /,-/t b « Fuel piping 23.32
�i' 4. i
Contact name: J� / ►
V� • , P `� /..t. $14.15 for first four; $4.03 for each additional
Address: /.lf3gej t i `� S .4 D i `Furnace etc.
City/State/ZIP: �[ / } /� ry` P Gas heat pump
� + 'c^-( bk. `7 ?
c ?Z WaWsuspended/unitheater
Phone: (9 7/) ,93s-._ 6 sai I Fax: : (2s) 2^ r * 9 Water heater
E -mail _ W5' otCJ , Fireplace
iiii ; Ii
Plili; i
�il; ±','' < :1 Ili .�':lii r iii!IIH'',!;'; w � 4J .. / I 4I V af. 111 / Range 1y. I S
t :I r. !h.lipiill l .I':1 .li!!i '•L I ) . 7 t 9 'Ili,., p3: •.og 1I , 1 I v+ I t
, 94t ji1j - .nlNpini; %•� ,�.,•: � '.II., I �'i ���: IPili.l! mi �il. �. $ h ' I
:..� .;• . � �• :_:�i;'fii���l•` fil rAll ;,.,.�.�,.j 1�1�t i�Q1111p�i�U; I. Barbecue
Business name: r / I. , >�
• .41 lam. i Clothes dryer (gas)
j � Other:
Address: 13348,9 �J py
L�yt�� P ftIlil(Ililllll +I {l�a1it n �*1 , , nun� -�� m uawn�n: I I
,,,���yyy. � �� jtG IYlvs' � +I�il) lilt) ` Ilfl� �'Ylb I 'll� II' ���IIIJ •1111111 Ai i�ll�ll
Cit / State/ZIP: ,/� n I ,,'•, .
�� , IC `1 7o�a Subtotal 76 .8/O
Phone: (q21) a giS- osc,./ j Fax: ( d -. �! J! D ,/i� Minimum permit fee ($90.00) g - ce)
CCBtic.: ,(�40 / Plan review (25 %of permit fee)
State surcharge (12% of permit fee) /084)
TOTAL PERMIT FEE _ /pp, Re)
Authorized signature: /11� /�{ This permit application expires if a permit is not obtained within 180
Print name: ��/ d;,ys after It has been accepted an complete.
r at. 4111 Date: - - • Fee method° ogy set by Tri-County Building Industry Service Board
1Muildina Wermlu\MP.C•PermitApp.doe 10101/09 440- 4617T(1 lrovCOM/WEa