Permit CITY OF TIGARD MECHANICAL PERMIT
3 - COMMUNITY DEVELOPMENT Permit#: MEC2015-00221
T f CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/20/2015
Parcel: 2S 111 DD13500
Jurisdiction: Tigard
Site address: 8686 SW HAMLET ST
Project: Christensen Subdivision: MILLMONT PARK Lot: 12
Project Description: Inspection of previously installed woodstove
Contractor: OWNER Owner: CHRISTENSEN, DORIS L LIVING TRUS
8686 SW HANLET ST BY CHRISTENSEN, DORIS L TR
TIGARD, OR 97224 8686 SW HAMLET ST
TIGARD, OR 97224
PHONE: 503-670-0656 PHONE: 503-670-0656
FAX:
FEES
Specifics: Description Date Amount
Wood/Pellet Stove 04/20/2015 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 04/20/2015 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/20/2015 $56.61
Occupancy Grp:
Stories:
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 N. ' on •er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1090. You may obtain a copy of the rules
or dir- t questions to OU• by ailing 503.232.1987 or 1.800.332.2344. //
Iss ed By: / Permittee Signature: V
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.
Resenc1O4-17-15; 1O: 34AM; # 2/
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building,electrical,mechanical,and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7),need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement Is true and accurate.
b of ,s cAL.stFrtJs-e.,(3
Prin a of Permit Applicant
_iki;a2;,....
Signature of Permit Applicant e
Permit#: H T SO/° l S -ecg,9,(
S� lO �ti4�- r x':,''40
Address: at . 0-
Issued 1:0 -14-1:0 -14- Date: /00//`") \I/4.4
This Copy for Permit Offices
Resent04-17-16; 1O: 34AM; to 1/ 2
Mechanical Permit Application 1 OR OFFICE IISF O\I l
City of Tigard Received By. yi A�� I'cnnit No.:nee, �/dis
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review I Phone: 503,718.2439 Fax: 503.598.1960 Dan Review Other Permit
Date/By.
l I G R n Inspection Line: 503.639.4175 Date Ready/By: Juds
Internet: www.ti ardor. ov y S ple Pent l Information
$ $ Notified/Method Supplementallnformation
•
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
❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
„... : Value:$
Al-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special Information use checklist.
❑Multi-family ❑ Master builder ❑Other: Description I Qty. I Ea. I Total
Heating/cooling:
. Air conditioning 46.75
Job site address: � .,(8� ) vk Ares l ."-X S ( )
Furnace 100,000 BTtJ ducts/vents 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:
Duct work 23.32
Cross street/directions to job site: 4 ArA. S; Hydronic hot water system 23.32
Residential boiler(radiator or
SO c V4 0I\ ' - 'TVttl-J I-N<.A Da-1 -A►Y(1111. hydronic) 23.32
Unit heaters(fuel-type,not electric),
1 a-E?v 5.-c-- C.% 0,4 L ft„fivT a$ri\ -Tit-4._ Let,a 11SA-t_. in-wall,in-duct,suspended,etc. 46.75
T 3_a-0/451::: Flue/vent for any of above 23.32
Subdivision: Lot no.• Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23-32
Y: --`rr *E ,` i 1a Gas fireplace/insert . 33.39
Flue vent for water heater or gas
MAO SIMALA P{LtV LOvt1. t h 5)-cal (->}+ 001J;r43 t_ fireplace 23.32
Lo li hter( as 23.32
ood/pellet stove II, 33.39 ',S'S ..1/1.
Wood firep alnsert 23.32
Chimney/liner/flue/vent - 23.32
'. k1 t-K-7. - Gi I'1- 's h" ` ' t. . •� ,o Other: 23.32
x ° - x" - `- a :4: :e *1,#
-- t° Environmental exhaust and ventilation:
Name: \ L S C v.14.L!T�N S f J Range hood/other kitchen
equipment 33.39
Address: 8C, 42)6 ■LA.) 17,76,YrIt(l 1"
4;1 Clothes dryer exhaust 33.39
City/State/ZIP: `to 4- 0>2 _`'`, ""'l Single-duct exhaust(bathrooms,
4 toilet compartments,utility rooms) 23.32
Phone:(6011 y Fax:( )
A a(o .. .y 1 Attic/crawlspace fans 23.32
F< - , 'u` -' < 4.,-v 1 i s ` Ml 23.32 r l'itiitt1 .,..4 i;iZPvagh L ;i11 , ,14r.„- '
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name:• l>0111V* GV\r‘i\��st.� -' Furnace,etc. I
1
Gas heat pump Address: O, C271.7 v.> Aiki ` i 1,1"-
Wall/suspended/unit heater
City/State/ZIP: •"T l(v Pr 0.., 0 i L c,-1 , I Water heater
Phone:(ors Ia1.0 O t,s b I Fax::( ) Fireplace
Range
-E-mail: ,► � •t �� Barbecue
Clothes dryer(gas)
Business name: (n,(-)N) I2"- Other. y --
:-
: ; _r - . , . e p s a _Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) 9,0*ii)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) 'U( V)
CCB lic,: TOTAL PERMIT FEE (�f tt�� . r
This permit application expires if a permit is not obtaine wd ithin l '
days after it has been accepted as complete.
, ,
Authorized signature: p ��•�1i • Fee methodology set by Tri-County Building Industry Service Board
Print name: - ■ r I Date: L
I-\BulldinfAPennits\MFC PermitAno 040113 doe 4 s 1/021COM/WEBI
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
8686 SW HAMLET ST, TIGARD, OR, 97224
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00221
David Young
Existing installed wood stove appears to meet all manufacturer installation standards.
Installed in block and brick alcove with required 6" vent in a masonry chimney topped
with a spark arrester type chimney cap. No combustible materials are located within the
manufactures clearance to combustible setbacks.
Final inspection passed.
Violation Summary:
Inspector Contractor