Permit CITY OF TIGARD MECHANICAL PERMIT
111111 , COMMUNITY DEVELOPMENT Permit #: MEC2012 -00214
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/01/2012
Parcel: 1 S 133 DA08200
Jurisdiction: Tigard
Site address: 12653 SW SNOW BRUSH CT
Project: Cristurean Subdivision: AMART SUMMER LAKE NO.2 Lot: 142
Project Description: Installation of gas fireplace insert and gas piping.
Contractor: FIRESIDE DISTRIBUTORS Owner: CRISTUREAN, FLORIN & IOANA M
18389 SW BOONES FERRY RD 12653 SW SNOW BRUSH CT
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503 - 641 -1919 PHONE: 503 - 866 -7030
FAX: 503 - 620 -5699
FEES
Specifics: Description Date Amount
Gas Fireplace 05/01/2012 $33.39
Type of Use: SF Fuel Piping 05/01/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/01/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 05/01/2012 $42.46
Stories
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 • I'cation - -nter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090. ou may obtain a copy of the rules
or a ect questions to • NC b • . ing 503.232.1987 or 1.800.332.2344.
i or
Is - ued By: • /i / �� 1 i Permittee Signature:
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.
_Mechanical Permit Application . F OR O FFICE USE ONLY
. X
City R eeetved / �a of Tigard k in Permit No Y�f �d /�/
Date /By. r^r 7
" 13125 SW Hall Blvd.. figarrl. OR 97223 Plan Review
'� , Phone: 503.718 2439 Fax: 503.598.1960 Date/13y Other Permit -
4TIGARD. Inspection Line: 303.639 4173 Date Ready /By: Juris. H See Page 2 for
_ _ Internet. w AN' vv.t igard - or.gov Notified /Method: Supplemental Information
TYPE OF WORK ` - COMMERCIAL FEE* SCHEDUL USE. CHECKLIST'
Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
El Demolition III Other:
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL ;EQUIPMENT /SYSTEMS FEES*
,grI - and 2 d«elling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- lantily ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling:
_ Air conditioning
Joh site address: 1 2,053 'w 940w eas■ c (requites site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
CIIV /State /LII': Ez� 0 l. 019--2._ 2.... - Furnace 100.000+ BTU (ducts /vents) 54.91
Suite /hidg./apt. no.: Project name: Ti> TL (; - tit.► Heat pump
r - (re site plan showing placement) 61.06
Cross street /directions tojoh site: Duct work 23 32
L_
430\ 0 q n Hydronic hot water system 23.32
' S ���� "`- ��`"v% "" Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall. in -duct, suspended, etc. 46.75
1 • I" 11" l� L Lot no.: Flue /vent for any of above 23.32
Suhdisisicm:
Other: 23.32
fax map /parcel no.: Other fuel appliances:
DESCRIPTION OF. WORK:; < , .•; ;':: Water heater 2332
Gas fireplace /insert 1 33 39 33 'yl
NSW Li N 4 C -- T ..?(.-' I N G I"'F Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner/flue/vent 23.32
NI PROPERTY OWNER " - ❑ "'TENAIY "C )
,�/�,� ( Other: 23.32
Name: 10#0\1\1k CQ-k ✓IJ Environmental exhaust and ventilation:
,Address: (1 Gs SvJ 9,...10L0 b 9-, Range hood /other kitchen
equipment 33.39
�fil(' J 0g_, O' - l2 3
City/State/LIP: Clothes dryer exhaust 33.39
�(J
Single -duct exhaust (bathrooms
Rhone: (9l g0 Fax: ( ) toilet compartments, utility rooms) 23.32
pg APPLICANT ' ,4/CONTACT. PERSON. ' _ - Attic /crawlspace fans 23.32
Ok� A-SVU �� �,. _ . Other 23.32
Business name: ��'M
Fuel piping:
Contact name: I0A- i\--- C, _I 913 V--'A-ti i 5 14.15 for first four; 54.1)3 for each additional
Address: IA/05-3 L` i `°` Z G' ,( 6 - �'• Furnace, etc.
� Q Gas heat pump
City /State /LII': "f Q9, Q1 Wall /suspended/unit heater
Phone: (503) gW 40 ?)` Fax: : ( ) Water heater r-
s P`� /1 Fireplace 1 A
I' -mail: �CQ� � 1 \ --/A140
I y r,00 . Coil
Range
CONTRACTOR Barbecue
k ? (S_ ,_ { � ( c 5 -. --p; 6 Clothes dryer (gas)
Business name: 711.��' 1.� � f� 1�
' �� g` L� /� Other:
Address:
I( °� ✓ ►:JoOg� `i�'������ - ,,�
MECH ANICAL PERMIT FEES
City /Slate /ZIP: 1'Q (LT l_4 - t 1 0 "I1- j Subtotal 4 54
Y' Minimum permit fee ($90 00) �Q • 11x0
Phone: (5O� � .Q O' 1i 1 - S s. 35 Fax: ( )
Plan review (25% of permit fee)
('Cif lie.: {./ C . -7? State surcharge (12% of permit tee) A.Q. (0
11 TOTAL PERMIT FEE 00. .s
Authorized Signature: This permit application expires if a permit is not obtained within 180
✓ ✓✓ clays after it has been accepted as complete.
Print name: (Q41:1- Cp_tfe-5rufLe-At4 Date: 04/3 DAD(Z * Fee methodology set by Tri- County Building Industry Service Board
I Buildine APennus \MEC- PermiiApp.doe 03/07/12 440 -4617T (I I /02 /COM /WEB)
-