Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010-00271
Date Issued: 06/16/2010
D TI AR1? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S133DA05800
Jurisdiction: Tigard
Site address: 12930 SW GLACIER LILY CIR
Subdivision: Lot: 0
Project: Gates
Project Description: Fireplace insert installation with venting.
Owner: FEES
GATES, RONALD C & LISA J Description Date Amount
12930 SW GLACIER LILY CIR
TIGARD, OR 97223 Wood Fireplace /Insert 06/16/2010 $23.32
Chimney /Liner /FlueNent 06/16/2010 $33.39
PHONE: 12% State Surcharge - Mechanical 06/16/2010 $10.80
Minimum Fee Adjustment - Mechanical 06/16/2010 $33.29
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: 4 - Permittee Signature:
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 Appiicatioti,) i
'1 r , ' ', - Receiv
City of Tigard . - Date/By. ( p ‚' 'o error t xo.
13125 SW Hall Blvd., Tigard, OR 97223 �� - �CJ ' - 1j�1�
RCview
Phone: 5O3•b3S.4171 Fax 503.598.1960 JUN 1 5 2010 Da y Other Permit: _
TIGARD Inspection Line: SO3.639.4175 Date Ready/By; has: 12I 5ce Page 2 for -
Internet www.tigard- or.gov '' --
. ft • , - NotificdMlethod. II Supplemental Information
•
I"5 P; .: Ohs ' Ir tIC
7 '
0 New construction p erformed. l Ind ate the value (rounded nded to the nearest dollar) of an
❑ X'Addition /alteratio /replacement
El p
Demolition L . J Oihcr; mechanical materials, equipment, labor, overhead, and profit.
�fAN'�" ,i.t Ai1; values
dweifin � ' ,.
X 1- and 2-family R ❑ Commercial/industrial Accessory building �- -+•••• - • ' . ° ..»..., -
❑ Multi - family 11 Master builder ❑ Other For special information use che.cklisr.
Description Qy`[ Ea .Total
3.0i STIE'I F 4 C� .AN» A 1t ••, tilratinWcooling — Job site address:
•
/� 1 Air conditioning or heat pump
(recLireS sit plan showing placement) 14.00
City /State/ZIP: / - _ Furnace 100,000 BTU (ducts /vcnu) 14.00
1 Furnace 100,000+ BTU (ducurverts) _ 17.90
Suite/bldg. /apt. no.: Project name: CI,. 0 74. C S Gas heat pun. 14.00
Cross street/directions to job site: . Duct work f 0.00
Hydronic hot water system 14.00
Residential boiler (radiator or _.
hydronic) 14.00
— Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
— •— Flue/vent for any of above .80
Subdivision: Lot no.: e -
• Other: _ _ 10.00
Tax map /parcel no.: ' Other fuel appliances
1'k]i ^A atcr heater
W 10.00
Gas fireplace 1 0.00
__m A ft /7 G .•.= S ei - Flue vent for water heater or gas +
tire . lace 10.00
Lon lighter (gas) _ _ 10.00
• Wood /pellet stove 10.00
_ Wood fireplace/insert /) e / 10.00 / Oa
.? Y' _:__ ",�: . . Y i' E+1 : ' ( .. Chimney/liner/flue/vent 10 • /0 O
/ 10 00 .. _ 00
Namc:/ an 4 . /r.. L - 7 ,,, J? 7‘e--S _Environmental exhaust And ventilation
• Range hood /other kitchen
Address - �- V QG a equipment 10.00
City / State/ZIP: / /6Qrd r 9+��� Clothes dryer exhaust 10.(x)
rr ^' Single•ducl exhaust (bathrooms,
Phone:40j) .5- 90 6-6,4 -5/ Fax ( ) toilet compartments, utility rooms) 6.80
ASP•�`is1CC P1T j Cf tq.Wi if ; Attic /crawls fans 10.00
Other: 10.00
Business name: L 44 cje/r'1 A ►'.7 .s . Fuel i.in
Contact name: O /' /4 C. j'ee R - $5.40 for first four; $1.00 for each additional
Address: _ ._ 4 . 5 a c & 6 e u e c � R„/ Furnace, etc. -
J G�� —� J 6...� s/
r City / State/ZIP: C3 ea t/er}� h _ 0A ' 700.E wan/suspended/unit . Gas heal pump
heater
Phone: 454$) 4' .. ep VO 9 Fax:: (5 la3il water heater
. Fire•lace . Ell
E -m ail: 1 dA/ /�Sem4A s • c24: Range
-fe a .,, ,,, i v rn•s
L'C'11 ,i'+L : ' x Barbecue
Business name: i —
Clothes dryer (gas)
Other:
Address: .
7V1 1 I- r1140 )II# REES*
City /State /ZIP: Subtotal I
Ph. e:( ( ) Fez. ( ) Minimum permit fee (S72,50) u 'jV , uu
Plar, review (25% of permit fcc)
, •
Illy lie.: 796 5, State surcharge (12% of permit fcc) Ei al 10 , to
TOTAL PERMIT FEE _ Q 111(1, e0
Authorized 5ignaturc: This permit appricati.)n expires if a permit is not obtained within 180
dnvx niter it has been accepted as compote -
Print name: a' / �geXe A Date .,q AC Fcc methodology set by Tri-County Building Industry Service Soonl, / 73
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