Permit •
y p C ITY OF TIGARD
MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2010 -00013
TIGRD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/13/2010
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Parcel: 2S104AA05400
Jurisdiction: Tigard
Site address: 12225 SW 127TH AVE
Subdivision: BELLWOOD NO. 2 Lot: 75
Project: Robinson
Project Description: Install gas insert and gasline.
Owner: FEES
ROBINSON, CRAIG W /DENISE E Description Date Amount
12225 SW 127TH AVE
TIGARD, OR 97223 Gas Fireplace 01/13/2010 $33.39
Chimney /Liner /FlueNent 01/13/2010 $33.39
PHONE: 503 - 590 -8084 Fuel Piping 01/13/2010 $14.15
12% State Surcharge - Mechanical 01/13/2010 $10.80
Contractor: Minimum Fee Adjustment - Mechanical 01/13/2010 $9.07
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 $100.80
Required Items and Reports (Conditions)
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to'follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth, in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questio.: . e NC by cal g 503246.6699 dr'1.800.332.2344.
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Issued By: A , Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card •shall,be kept in,a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Ra /$y v PematNo.: �
t: ' T ` Ci of a v d . JAN 12 2010 DatelBy 1 i !o :.�
" plaaRe'view OtherFcnmt: liir,w,,,, -° q 131 SW Hall Blvd, Tigard, OR 97223 = r" phone: 503.639 4171, Fax: 503.596:196 CITY OF TIGARD ()al l5Y
a Read J RI See Page 2 for
w , - ral' 4 Ins tiara Line: 503.639,4175 Supplemental Information
I E , "A V " � I et: urww trued- or.>ov BUILDING DIVIS III , , otifea/Metnod:
m, S ° t pp�,v -.. rr� EEC
a ) ; s ° :r r W Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
�{ Addition/alteration/replacement labor; overhead. and rort.
D D ew lit1Ofl construction 0 O mechanical materials, equipment, •
(] Demolition ❑ Other: Valve: S ,y •
✓ p er �"" ,7 ( �x. 1 4 p, a S . r ' �'' �n� a e • j -` , M "�'
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A ccessory building F or special information checklist.
1. and 2- family dwelling ❑ Commercial/industrial Q Qry. � Total
❑ Master builder 0 Other: Description
1 ❑ Viuln fairuly �, �y n f ,. .
'j`' Y f� #"t -'"`,.[�1' '^ b' %t, A9 lCr^ 9� 1. r.�,, : 3.
:~xry ... ,.," Air Conditioning 86.75
l �i? � te.mses site plan stwwin •tacement � ��
Job site address: ` • f Furnace-1.00,000131'u (aucc�v
CJ` Furn 1 0 0 , 000• BTU (ducts-/vents) 54.91
• City/State/ZIP: / Ora✓ 61.OG
Project name: �'`-J Heat -. •
Suit�lbldg.fapt. no.; . 1 Cy i h 0
Duct work alligiall
Cross street/directions
to site; _� 1d drone hot water system
'Residential boiler (radiator or h dionic) IIIM1111
• - Unit heaters (fuel -type, not electric),
in-wall in-duct, an s of above
a ex- ��
Fluer'vent for anvof about
Lot tlo.: Other:_
S ubdivnion:
Tax map/parcel no
Other fuel a • t'lances �
er
7 f pJe` y, 33.39 ne.
l/ � S' P a � Flue vent for water heater or gas
--/— ✓) q fireplace
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•' .43 /h G Lo: li' bier (. s
+ Wood/• lint stove • p
Wood ,Fir •iacclinsert
pe.er 6 .. • f 1 �` '4 71 r m �;' � 4• a µ • , A" , ' ' QtiSCr:
�.: r:'1 ' r ' ) • N '�1 t . j3 • G . C Qwv:vt, u.9„
Na : , Environmental exhaust and y'entltation
Name` ' 1 en d / /1 S ,or t) Range hood/other kitchen
Ti5's •w e•vi•mcnt
Address: / / `� �`� Clothes d er exhaust 3
City /State /ZIP; i a Af al I Single -duct exhaust (bathrooms,
toilet co •arttrients uhii rooms �� d.
Phony (aO9d �`C7�•
Fuel •1•in, 4. 13*incss name: Lee , e l t 1 $14.15 for first four; 54.03 for each additlanAl
�� • Contact name: w f ; , ... ..
4 z ° ra(409 g t G as heat urn• —
1 Address; P y �y _ r- Walt/sus. ndcdlunit heater 1111.111111111.11 Ciry /Start /ZIP; ( e. „,„ me ., n 4 :,,,e � ! O�.~J Water heater ���
�l `'�� Fax::' (•y° ` - gi eplace .
'I Phone: tr. ) f • aC� � (�,���
E J OIt C ®�? S 4/� „ ! 1 Barbecue
w �. � 1yhw' Bp `�'' , <,,,, „; "Try;;!a
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Other;
Business name: � l , a•3*., . y ; ` � r x r � � : -1 , • • ! . MEI
W. ,. w tz r jk?!d X
Address: C Subtotal Q
/ Minimum permit fee (590.00) • O . 00S .
IN City/State/Z1P: OM
r6
Fax ( )
Phone: ( ) State surcharge (12% of permit fix)
r 144'. TOTA PERMIT FEE /aO , a a
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CCB lit.: _ a rruit is trot obtained within ISO
(his permit application e if Pe ¢ptuptetF
days a fte r it has been Aecopted
Authorized sig�tatt�t ® 0 Fee methodelogy let by Tri- Comity 13oiidiug induq5y Service Board
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Print name: ' #. . ..f'
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