Permit MECHANICAL PERMIT
CITY OF TIGARD
' COMMUNITY DEVELOPMENT Permit #: MEC2010 -00157
Date Issued: 04/09/2010
4IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102CB03900
Jurisdiction: Tigard
Site address: 9955 SW GARRETT ST
Subdivision: Lot: 0
Project: Allen
Project Description: Install natural gas stove with associated piping.
Owner: FEES
ALLEN, TIM Description Date Amount
9955 SW GARRETT ST
TIGARD, OR 97223 Gas Fireplace 04/09/2010 $33.39
Fuel Piping 04/09/2010 $14.15
PHONE: 503 - 620 -3344 12% State Surcharge - Mechanical 04/09/2010 $10.80
Minimum Fee Adjustment - Mechanical 04/09/2010 $42.46
Contractor:
LUDEMANS INC
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005
PHONE: 503 - 646 -6409
FAX: 503- 646 -8034
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ( au 9 ) Permittee Signature: �Q
_
Call 503.639.4175 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.
Mechanical Permit Application RECEIV' FOR OFFICE USE ONLY
City of Tigard 1aL Received �, Permit No.: , • C�
Ii
! Phone: 503.b39.417 } Fax: 503. j98.196 13125 SW Hall Blvd. Tigard, OR 9722 - l• oh, lv
0 AP O 2 O 1 Plan Review Otter Permit:
Date/Br
'r 1(. n !: i) In; tine: 503.639.4175 .aLe Reafly /1iy: Luis: 10 See page 2 for
Internet: www.tigard- or.gov CITY OF T r ,, . eaCa Supplemental Information
BUILDING DIVI `l ! 0 --
4 ss r " 1. raH1 r y rc, r t : u z
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❑ New construction kr Addirion /alreration/rcplaccment Mechanical permit fees* arc based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
tab e y 1 Y .; Value $
..5 rq " y ',"4:/,i Eel' lY Y R. ."" .., i ,,, „RaSru,, - nerrvn.,': ,�'iv :ny'._ . �m''''''7"4,7, ......x°^^ nau 2-family dwelling a3rt , � rS ES .'
Alf 1- and 2- fa
❑ Comm+ rCtfillmdustrtal ❑Accessory building
For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other;
Description 1 Qty. Fa. Total
f 1Yt" . J Sirs 1 r _ v a , " M""
r " a '' ° „r.., t��'vn4�Nr,��r.�Glt'oa �yt,n , tc.v , Heating/cooling
Air conditioning
Job site address: AP' r ` S 46 Q r (requires Nile p]nn anOwing placement) 46.75
City /State/ZlP: Furnace 100,000 BTU (ducts/vcnts) 46.75
• /C9Q n 0/ � q -7 c
Furnace 100,000+ /3T13 (duets/vents) 54,91
Suite/bldg. /apt. no.: Project name: gilt yJ Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
-
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronie) 23.32
Unit heaters (fuel -type. not electric).
in - wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: I Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
y , Y ,i'l , "�u t r ale` : 4 t Water heater 23.32
i t ...,eN 1 ,,, " ,...... rltirl+j � F - L�+�y� tu{� ti t ,
; __.., > >,.. u a eras fireplace i 33.39
l ,/- /) C 1c1 // ®/ e- - 7 4 01- 1 ‹ a'? si Flue vent for water heater or gas
fireplace , .
G977 4,,,• 0 - ' ' Log lighter (zas) 23.32
Wood /pellet stove /7 '. f 33.39 3339
Wood fireplace /insert 23.32
r Sr' f " tlS•r+°x tx fu >r ,yrycwr, x , x } x c r ur r t d'. �y Y ChlmncY/lincr /fiuc /vcn / 3.32 � 3,
, . V t �� t �,.�� y L 2
t " "uiM 3R!," '&'x ..- ,iii .4a Other: _ 23.32
Name: ! % 72//e-ii Environmental exhaust and ventilation
p _ � Range hood /other kitchen
Address: ! '" (�y4)1-r �, 1 / equipment 33.39
City /State/ZTP: ( .1, 7 a c - CialC 9 y,.,9.,3 Clothes dryer exhaust 33.39 1
single -duct exhaust (bathrooms.
Phone: (S o) -,, Fax: ( ) toilet compartments, utility rooms) 23.32
,r t x aw . , - "' , .n *
�+ a , t . Y ;,t, 9 Attic /crawl; acc fans 2332
i :' r,p Li V ,:. y , . 4,hi? r i k.J. '�f,7"4t tffrr�..,7.�'' :1.' �V rli . „. ! of " tt t , .r, r
F xi� ::a... 1. . « a :.... .,, r.:.. .15/ ......... .. .:: .... -_ .
Other: a 23.32
Business name: .L1 g Fuel . i . in
Contact name: VQ ,s Q `r H e r $14.15 for first four; $4.03 for each additional
Fur etc.
Address;
/ , 7� 3 J ,� ra ro.04 Rot eras heat pump - !
City /State/ZIP: 4 ed Lie .. h Om 97096 el
Wall/suspended/unit heater -
Phone: 578)404/6,. �v4f Fax:: (,g'b, G G' O p Water aec 1 .
E -mail: jam / rOV 4, , e /»4d $ Coivl p Ran e
rr 1 i f r .:. . .r r f o- , - F ]1°s " d rj Y , j Hj i :ii,, .. Barbecue
? r,Fr H .ra n �( [ xh t a N 1]` ff C " " r "i i : rF / . r4 !
tt`Y _. r,
,' . r tf, 1 ii r.::! W. r, ., r.. ... ... -.' lei ry
_ Clothes dryeggas) •
Business name:
Other:
j
n> r l
Addresss:C t w n ia,, 9 +r Y + E F i
Subtotal
City /State /ZIP: gy 61_ 6P(�
_.., - Minimum permit fee (590.00) .90 d)
ppp Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
,C-CB lie.: S I q ( ID D 3Z I I0 State surcharge (12% of permit fee) /0, 4PO , • �1� _ TOTAL PERMIT FEE f th . Al_
permit apptican expires If a permit is not obtained within i$o
Authorized signal T� /
-r.5. Gtl
days after It has been accepted as complete.
rd
Print name: M► /�t& Date: - t- /( • Fee methodology set by Tri- County Building Industry Service Boa
j if/ r
.., . e. n. „ -_ 440-46 t lr (t IOV(OnfnvEO)
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