Permit 9 CITY OF TIGARD MECHANICAL PERMIT
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la ,.: COMMUNITY DEVELOPMENT
t Permit:' #: MEC2009 00593
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued. 11/05/2009
T iGARL� Parcel: 2S111A606600
Jurisdiction: Tigard .
Site address: 9285 SW INEZ ST
Subdivision: Lot: 0
Project: 'Fieldhouse
Project Description: Install gas stove and gas line.
Owner: FEES
FIELDHOUSE, THOMAS W /JANE M Description Date Amount
9285 SW INEZ ST Other, Fuel Appliances 11/05/2009 $23.32
TIGARD, OR 97224 Fuel Piping 11/05/2009 $14.15
PHONE: 12% State Surcharge - Mechanical. 11/05/2009 $10.80
Minimum Fee Adjustment - Mechanical 11/05/2009 $52.53
Contractor:
LUDEMANS INC
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005
PHONE: 503 - 646 -6409
FAX: 503 - 646 -8034
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
FuelTypes: Natural Gas
Gas Pressue:,
•
Total $100.80
Required Items Reports (Conditions)
This permit is issued subject to the regulations' 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246'6699 or 1.800.332.2344.
t ti
Issued By L�ari , L \ e J Permittee Signature: % JUL A�� ,
Call503.639.4175 by 7:00 a.m. for an inspection 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.
4
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NOV 5.2009 11:38AM
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ai(;�`;, City of Tigard 6 200 DateB d a a ( ►tt �)� f('i un I .;fl i "iM1,�:i +it,p't „w •
emit ^No
V 13125 SW Hall fllvd„ Tigard, OR 97223 NO 'v Y ........ , ! 4:�.. �� • •
Phone: 003,639..598, Plan Review
4171 Fax: 503.59S.1960 ` Dare/5y Other Permit)
T ttiiARU I Inspection Line: 503,639.4175 ail' OF T Date Ready/13y
I GARD
'',',4 ,f Internet: Luww.tigerd- or.gov . BUILDING DIVISION N
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®see Page Z,fnr.
� a III Supplemental Information.
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❑ New construction 11 Addition /alteration/replacement Mechanical perriiit fees are based on the value of the work '
❑
1
DefttoliCiorl performed. Indicate the value (rounded to the nearest dollar) 'of' all
0 Other: mechanical materials, e•ui.ment, labor, overhead, and .roil!.
.i ' � f A � U iRR�I ` "�"% s. a L '` a. a ti;Y " r c I¢' A
k0' , r' ' l'1, if tyP , a 1 r� ,:tl1 �.^' ° Value,5
, w �. _�� u arras y , yty n
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1 - and2 fbtru1 dwelling , �h ill . H 1 rte " � c,; ` �1 r
Y g ❑ Conuncrcial %industrial 0 budding h' n sv 4
Fors special r or a use chec/d lit.
❑ MuPtt- family ❑ Master builder 0 Other: P nT rn I
Description' I Qqf Ea. Total
' ' r Y'', '',I1ir A c 7 l. 1 a !! N I 'Cl QM1l' na Q I,1' � i ,nil! Reating,/eooiing
Job site addreys: 9x7 g' S 4./ , I , .- % Air conditioning it si pl or heat pump
/ (requires siu; plan•showutc - ]accmanr 14,00
City /State/ZIP: / /� • d ' 97a Furnace 100,000 BTU(ducalveniaj 14-00
Suite/bldg./apt. no.: P ro ect name: / -- Furnace 100,000a BTU (ducts /vents) 17.90
1 /h��/S G sshe 14.00 •
Cross strcet/dircctions to job site: Duct work 10.00
ydronic,hor water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, innd`uct, suspended, etc. 14.00
Subdivision: Lot no.; Fluch eni for an of above 6.80
Other: MI 10,00
Tax map /parcel no
;':1:; ‘ I , t ^ r' • , , r� py T p� a , r _Other fuel applinnees
.•'h �, r :' I ;: , ;:1;� lYraan�W Q'L "A '>Y v "1,q ,./, ' � tinkti'; Water heater 10.00
, – / Gasalreplace 10.00
`�' 124.12 �./ P2 C.. 4' C 4 h 0 !` rs 0 Flue vent for water heater or gas
3 Q� �r� fireplace _ .10.00
Log ;lighter (gas) 10,00 _
Wood/ ellei stove
Wood fireplacdinsert 10.00
: ;, j
I'n 1 4: I I I i � k l �`' ,, "" k ' sfl C}i lnvieyner uevent
.1 �i t 0 h u �' zen x'�t� tb •
I a "' � � � I k ° /li/fll 1 0.00 /O d4
Other. 10.00
Name: C)9rJ - / d
, y..
�S� Enviro nmental exhaust and ventilation
addr - Range hood/other kitchen -"
.� US _ fj c. 7= ut merit 1.
City/State/ZIP: p 10.00
-7.--/,9e?,.. 4 ' 7,,;5/ Clothes dryer exhaust 10.00
Phone: Q� ,...5-9., r Singleduct exhaust (bathrooms,
4 n'``u lh , •' , I t`lr t la � ry _ , r ,Fax ( ) u 1 toilet compartments, utility roonia) _ 6.80
a ; {j , i,! +, Q Q, e ft I ) hl nor C 9 Attie/craw 1 .Y m'r �i It%Ss' `' )space fans l 10.00
_ 'cm tp 1u - -
Business name: ' outer: 10.00 ■ �' /t7 4 Fuel piping
Contac- name: `��• .1 ! –
C x$5.40 for first four; 51.00 for each additional
Address: _ Furnace, etc,
City /State/ZIP: 4 , A e 0O, Gas hear t u Wall /SUSpende detl (unit heater
Phone: 4563) 6 I . y/� ' 6 Fax (S ) � �o• �Qj Water heater
E-mail: �opt . Fireplace _
4• P �vY,3I Ran e ,4-3796 :'' °'• g r in j, � x li�l,', nn , vg���up 1 .�' .
hw'll �� ,i ',i1!I °d IP, .:I,� �� 1• 1!
'• 1 eat�i�ln • ' „1 I_,,, ",, I'I. any di,4/Lk �I. lrk1_I &d" �atbecUC
Business nAme: 0.thes dryer (ga
Address; Other: �_
city/State/ZIP'
— _ " ' 1 ' 311F r lr t O NI t - r' ,1 la ,:, ,',,,) ", ,1 ,
Subtotal aS ' d
Phone: ( ) ! pax, ( ) Minimum permit fee ($72.50)
CCB lie.: .7 6,. ! I �_ Plan review (25% of permit fee)
TOTAL of permit fee)' 70
State surcharge 2
'� AL PERMIT 'EE . 0
Authorized signatur ThIp.peradtaplrllcatlon expires If permit is nor obtained within 180
' o days after It has been accepted as com lete.
Print name: , �Q/�0' , • �' a tr
or
� G Date: �� _ G� 1?ee mothodoiegy get by Trl•COUn[y Buildi Industry Service Board
I I -P, nitApp doe 0 1/19/07 440 -4d 7T 11 I /02/COMN✓r?a).
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