Permit CITY OF TIGARD MECHANICAL PERMIT
a.
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00573
TI G AAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/05/2012
Parcel: 1 S135DCO2200
Jurisdiction: Tigard
Site address: 12081 SW LINCOLN AVE
Project: Wood Subdivision: NORTH TIGARDVILLE ADDITION Lot: 63
Project Description: Wood stove and chimney syste.
Contractor: TOM BISHOP CONSTRUCTION Owner: WOOD, RALPH E
4578 SE 103RD AVE 12081 SW LINCOLN AVE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 644 -7868 PHONE: 503 - 320 -9024
FAX: 503 - 626 -9138
FEES •
Specifics: Description Date Amount
Wood /Pellet, Stove 11/05/2012 $33.39
Type of Use: SF Chimney /Liner /FlueNent 11/05/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/05/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/05/2012 $33.29
Stories:
Fuel
Fuel Types: Solid Fuel
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 • / S Permittee Signature: w e,
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.
.;ti
11/01/2012 15:48 5036269138 HOT SPOT FIREPLACE PAGE 01/02
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Mechanical Penult Applicati ► 3 ' rill< t r I l i . 1. r. • r c,, l ,
. EcEN I Received , ��o �a-oo 57
of ' and _ DeteJny: a/ 0/ /A
City of
IN ._...
1 3 1 2 5 3. 182439 F�503.5 8.1960 NOV 0 1 20 12 ' Plan Review Other Permit
- inspection Line: 503.639.4175 Date Ready/By: ': el " • raga Z for
I ! i . A It ! 46ed1IwleUwd: - �maid maid /oformalion
Internet; www.tigard TIGARD No
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'TYPE. OF WORK CO r : — vsEtaRx.ISr
CIAL FEE'.
Mechattial permit fees* are based on u - value of the work
0 New /� • ddition/alteratioa/replace1tent performed. Wiese the value (rounded , the nearest dollar) of all
o Demolitioo hv n ❑ emoondiotl mechanical atati:dalss equipme', labor overhead, and profit
[] D - Value: $
. CATEGORY OF CONSTMtUCTION REStmENTI EQUIPMENT / : I. FENS'
1(1- and 2- family dwelling Q Co mrlercialrutdustrial El AecessorY building For speatat Information cheddist
Q Multi-family ❑ Master builder ❑ Other
Description • • Ea. Total
SOB SITE INFORMATION AND LOCATION Air conditioning
• ` ii '^ (rcquara alto plan showing pla�letd) 46.75
Job site address: -
ac , (_ . vR C 11 .. i Furnace 100,000 BTU (daeawrs, lv 46.75
, } Furnace 100,000+• BTU (dllcnlveats) 54 - 91 Heat pump
= (regairea Bite plea showing placement) 61.06
Cross street/directions to job situ; Duct work I 2330
-
Hydroaic hot water system . 2332
. Residential boiler (radiator or
hydronic)
Unit heaters (fuel•4ype, not electric),
(n -wall, in -duru susppMed, etc. . 46.75
Flue/vent for any of above _ 23.32
Subdivision: Lot no.: O<fle< 2332 "
map/parcel Tax Other fad a, . • :
Water heater 1E11 23.32
DESCRIPTION + t Clash - ,lacrrinsertt IIMI MI
4-, Flue vent for water heater or gas 1
fireplace 2332
eplace
a.6 S e l.a liy,ter( :•; I 2332
Wood/pellet stove I1MI 3339 :EM
Wood .i , laoelmscrt MEI FM ���.
Cbimney/lma /ftueJvent 23.32 :L9tt�
T. P • • OWNER CI TENANT Other 23.32
Environmental exhaust and veafla on:
Range Name: �•. n r n C' hood/other kitchen
Address: / r • , .e ) L ii_celi 3339 " lie equipment _
s � et-7 Cl 3339
CiQr/Statel7�: l I! tfG V ✓ r / ' Single -fits (bathrooms,
Phone. ) ) C j 2 Fax: ( ) toilet compa rlments, utility rooms) 23.32
Q CO NTACT PERSON AttiCkraw -,.:. 91115 23.32
/: APPLICANT GI 23.32
Business names (1 04 S p t", rt p ViL Fdeltplar
Contact name: ' j [ a , , 1 4 G 6 Vl..� L ,. • 514.15 for first tow; 84.03 , r d th additional
"�li Furnace, etc.
Address: I �n�rS -1� (�`� �1,�0 Gas heatjump 11111
City/State/ZIP: • 40 , vr. A ,' `1 9 0 Wall/ dal/unit heater
•'' Water heater
Phone: (��i3 n?�o �v1- Fax : (g3 F ..lea Mill
E-mail. ,,,, ac,i - Vim_ • at' 4 YLfi 144_! - .e.o Rmr I _ ��
CONI . , Barbecue Ir Mil
Clothes , � a
Business name: / u 11 d r Other:
Address: ( t - ti /03..-c MECHA.NEFALPE • I FEES'.
1C ✓1 47 MI
City /5tate2lP �Y' "�� Subtotal ulimam ∎ - . fee ($90.00)
fi ) /_ / �/ l Fax: ( ) Plan review (25% , fpermit fee:) .
CCB lic.: (V Y S tate Surcharge (12% , f permit fee)
S�� i i TOTAL P;4' 1TIEE AO -
■ ibis permit appicttlon expires if a • . h not obtained within 150
Authorized sig»a . "_: /, � '
i • day* after it be* been . • • led as complete-
. mffire 6,A.. l . • Foe methodology s by Td •, ding Indv y Sarvioe Board
Print name:
T•lo..ae .. •. . Pon Aeo... • . 03/07113 44046171' (11071COMIWEB)
,