Permit C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2006 -00105
DEVELOPMENT SERVICES DATE ISSUED: 2/16/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 BD -02100
SITE ADDRESS: 09755 SW PEMBROOK ST ZONING: R -3.5
SUBDIVISION: CLOUD CAP LOT: 003 JURISDICTION: TIG
Project Description: Installation of gas fireplace & piping.
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:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
ANETTE SAARINEN Description Date Amount
9755 SW PEMBROOK ST •
TIGARD, OR 97224 [MECH] Permit Fee 2/16/200€ $72.50
[TAX] 8% State Surcha 2/16/200€ $5.80
Total $78.30
Phone: 503- 639 -3921
Contractor:
G P & W SYSTEMS INC
732 MARBLE RD
WASHOUGAL, WA 98671 -9601 REQUIRED ITEMS AND REPORTS
Contact #: PRI 360- 835 -3516
FAX 360- 835 -5716
Reg #: LIC 108176
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: Permittee Signature: SIAl ,.Q. � D
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
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.
Feb 15 06 02:19p GP &W Systems, Inc. 360 -835 -5716 p.1
'Ir. V
Mechanical Permit A t - , ! \I FOR OFF lCE USE ONLY
City of Tigard 1� 10 6 D t Tr4' / 6 -06 - V -- t . : � L,� �� — 00) D �
13125 SW Hall Blvd., Tigard, OR 97223 r n Plan Review
503.639.4171 Fax: :503-598.1960 CD , . . Date/By: Other Permit
3 tion Lime: 503.639.4175 1. JJ
»spec � � G --a A I DataReady/By: !unit SI See Page 2for
Internet www.ci.tigatdor.us ON of - Plotified/Method )1 r I Supplemental Information
,‘p1NG
o N
TYPE V WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction • 2 rAdditionlalteaation/replace meat Mechanical Permit fees* are based on the value of the work all
❑ Demolition ❑ Other. m at
mechanical materials, equipment, overhead, and profit of
CATEGORY OF CONSTRUCTION Value S
IX - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
(D Multi-family ❑ Master builder ❑ Other For special information we checklist.
Desorption I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Hearin /coaling _
Air conditioning or heat pump
Job site address: q 7 S.5 sit.) eq2 Yri b Ycx.k_. ST (ru nitcs site plan showing f t) 14.00
City/State/ZIP: '73, y CA q ` 4 Furnace 100,000 BTU (ducts/Vents) 14.00
Furnace 100,000+ BTU (ducts/vnts) , 17.90
Suite/bldgJapt. no.: I Project name: Gas beat pump 14.00
- Cross street/directions to job site:- - . -
Hydronic hot water system 14.00
, Residential boiler (radiator or
hvdronic) 14.00
Unit beaters (fuel - type. not electric),
in in -duet, suspended, etc. 10.00
Subdivision I Lot no.: ; Flue/vent for any of above . 10.00
Other: 10.00
Tax map/parcel no.: Other fuel appliances
' DESCRIPTION OF WORK Water heater • 10.00
Gas focal= I 10.00
e. .te2 n d � S 2 ) e `l O 0 Flue vent for water heater or gas
(' fireplace / 10.00
Log lighter (gas) - 10.00
-
Wood/pellet stove 10.00
Wood fireplace/ assert 10.00
•
'PROPERTY OWNER I 0 TENANT Chimney/liner/tlndvenL 10.00
Other: , 10.00
Name: aneie, S Q rC fi4nn Environmental exhaust and ventilation
Address: ! 7S 5 .1 Pave . b �
Range hood/otherlatchen
` equipment LOAD
City/State/ZIP: G X ,LI Clothes dryer exhaust _ i0.00
7 Single -duct exhaust (bathrooms,
Phones ( ) 2 I Fax: ( ) toilet compartments, utility moms) , _ 6.80
APPLICANT ❑ • CONTACT PERSON Attic/crawLspaoe fans 10.00
Business name: ( p 4 it) sL(sT' ms .I. Other
Fuel piping
Contact name: G(/Nit,/e $5.40 for first four; 81.00 for each additional
Address: ?3 Z in Agtg iced Furnace, etc.
Gas heat vamp
City/State /ZIP: w mi to 4- fep7/ / Wall/suspended/unit heater _
Phone: (e0 car. ?Sap I Fate : ( ) $ac.0 /4. Water
E-mail: Range /
/` N. n CONTRACTOR Barbecue .
Business name: 6 rdr _S X
y S4e 15 , �/L C_ _ O e dryer (Rts) ,
Address: 7 73 - jekt_e goad MECHANICAL PERMIT FEES*
City/SratetZlP: L o fJ ( 4613644_ L*.+4_ In?f Subtotal
Minimum permit fee (57250) 7z. $p
Phone: (a1 8.35. RS I Fax: 6 i - 57ik. Plan review (25% ofpertuit fee)
GCB lic.: f d 4 iisedrer 39,x" State surcharge (8% of permit fee)
TOTAL PERMIT FEE 5 . NO
Authorized sign ' �i� .ntl•�. Tai permit application days atter G empires
been accepted as complete. l jc •
I Print name: Ltj; ' FJ .ice �1 • a i i, Date: AW�� • Fee methodology set by Tel-County Building Industry Service Board
•
CITY OF TIGARD f2er
BUILDING DIVISION PERMIT #: ac66 - d O / D S
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 ICI
Inspection Requests (24 Hrs.): (503) 639 -4175 °:_..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 9 75 fii2.47t6-1451-0--- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
&/0 699 3‘ - 7 - 7— 63 - Z 8"
Corrections /Comments /Instructions:
is
Ott3 i 6/2.- I ' I. 4.41
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p P ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR I SPECTION ❑ ADDITIONAL F S ASSESSED
2-P\--7-
Inspector: / Date: Phone #: (503) 718-