Permit CITY OF TIGARD MECHANICAL PERMIT
IN
S COMMUNITY DEVELOPMENT Permit #: MEC2012 -00154
TIGARD 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2012
Parcel: 2S110BA03700
Jurisdiction: Tigard
Site address: 11645 SW CLOUD CT
Project: SKOKAN Subdivision: SHADOW HILLS Lot: 28
Project Description: Gas fireplace insert with fuel piping.
Contractor: COST PLUS HEATING & AIR Owner: SKOKAN, ROBERT & KATHLEEN
7132 N FESSENDEN ST 11645 SW CLOUD CT
PORTLAND, OR 97203 TIGARD, OR 97224
PHONE: 503 - 286 -2009 PHONE:
FAX: 503 - 286 -6552
FEES
Specifics: Description Date Amount
Gas Fireplace 03/23/2012 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 03/23/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 03/23/2012 $14.15
Stories: 12% State Surcharge - Mechanical 03/23/2012 $10.80
Minimum Fee Adjustment - Mechanical 03/23/2012 $19.14
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: c-- Permittee Signature: r _ ^
i
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.
03/23/2012 10:28 5032866552 COSTPLUSHTG &COZYFIRE PAGE 01
Mechanical Permit Application , �� , , ,�; , ,, , , ,I , , •, ,
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City f Tigard
13!25 SW Hall Blvd., Tigard, 0 R°°°'"°d
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Other Permit
Phone: 503.7182439 Fax 503. ';'..1 �-'• r, 940.:01.
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In on Lm: 503.639.4175 DeterBy
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Mechanical permit fees' are based on the value of the work
❑ New construction el Additionfalteratio6/replacement performed. Indicate the value (rounded to the neusest dollar) of all
❑ Demolition ❑ Other: mechanical materiels, coulinne labor, ova and profit
Value: E
CATEGORY OF /8YSIIDIsP9L '
® 1- and 2- family dwelling ❑ Commercial/indusbial ❑ Accessory building Farspecial falbtatation toeetatmat
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
MR 'i'1 IN AND LOCATION sin • Air conditioning
Hat11q/tooNttl:
lob site address: 11645 ew dead et (rimes site plan domain P'') 46.75
Furnace 100,000 BTU (dncte/veaas) 46.75
city /State/ZIP: tigerd or 97224 Furnace 100,0004 - U ,(duete/vaats) 54.91
Suitclbklg.lapt. no.: Project name: Han tip
bodoitea site ads showiest Oigeteon0 61.06
Cross street/directions to job site: Duct work 23.32
Hydrunic hot water system 23.32
Residential boiler (radiator or
hydrunic) 2132
Unit heaters (fuel -type, not electric).
in-wall, in-duct, intslarlided, etc 46.75
Subdivision: Flue vent Boo any of above 2332
Other: 23.32 -
Tax map/parcel no.: Other add appliance=
DESCRIPTION OP WORK Water heater 23.32 u ert e,
• Cres gas fire place Insert log Bghter,gas line to two Coepbttee Flue v r water heater or gas 1 33.39 �j� 1
fireplace 1 , 2332 2.3
Lot: lid (em) 23.32
Wood/pellet stove 33.39
Wood fvepleeelinselt 23.32 ,
® PROPERTY OWNUt i 0 TENANT Chimney/liner/flue/vent 23.32
• Other. 23.32
Name: robert/kathleen Skokao Envirmanental exhaust and veotibtlloa:
Address: 11645 sw cloud et R bood/ot6v kitchen
equipmc t 3339 ,
City/State/ZIP: tigard or 97224 Clothes dryer etdtaist 33.39
Single-duct exhaust (bathrooms,
Phone: (971 )255 2824 Fax: ( ) toilet compartments, utility moms) 23.32
B APPLICANT 0 corffAti' PERSON Attiderawlapaoe fans 23.32
Business name: Other. 23.32
Fad 910111:
Contact name: Steve sandernon 51415 for flat four, 54:03 for each additional
Address: Fes
• Gas heat pump
City/State/ZIP: w /unit heater
Phone: (503) 7819090 I Fax:: ( ) Water healer
Fireplace 2 1 N' "
E -mail: steveeoetplus@aoLeom Ream
CONTRACTOR Barbecue
Business name: costplua beating and air Clclhes dryer (Bas)
Other
Address: 7132 a fesetnden - SWADIANICAL PST MEP
City/State/Z1P: Subtotal
pot Na1d or 97263 .
Phone: (503) 286 2609 Fax: (503) 286 635E Minimum P fa ($90.00) IA Cl) I Pam review (253'0 of hermit fee)
CCB tic.: 47976 S ), /) 3 y State smcharga (12% of permit Ste) f d
TOTAL PERMIT FEE �(1L
Thi
app antoa emirs id a permit is not obtained widths 100
Authorized sign days after it bas born accepted as tempters