Permit --ry CITY OF TIGARD MECHANICAL PERMIT
"• COMMUNITY DEVELOPMENT Permit #: MEC2010 00599
Date Issued: 11/18/2010
T'IGAARi 13125 SW Hall Blvd Ti OR 97223 503.718.2439
Parcel: 2S102CD02000
Jurisdiction: Tigard
Site address: 9680 SW OMARA ST
Project: Broadhurst Subdivision: Lot: 0
Project Description: Install wood insert.
Contractor: LUDEMANS INC Owner: FRANCIS, MARTY &
12675 SW BEAVERDAM RD FRANCIS, BRIDGETT
BEAVERTON, OR 97005 675 ENGLEWOOD DR
LAKE OSWEGO, OR 97034
PHONE: 503 - 646 -6409 • PHONE:
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 11/18/2010 $23.32
Type of Use: SF Chimney /Liner /Flue/Vent 11/18/2010 $33.39
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/18/2010 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/18/2010 $33.29
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to / O n / UNC by calling 503.232.1987 or 1.800.332.2344. „..
Issued By: �j J�� Permittee Signature: ®���! C�f �l
Xx CaII 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.
Mechanical Permit Appli Cat o t'1 ERIE 1 FOR 0ITICE US1'_ ON n
City of Tigard Received /. �tJ
r,� !/ 4t� Pe iNo ' / ?J /O 00 °� ,
f 13125 SW Hall Blvd., Tigard, OR 9723y 1 V 1 8 2 01
Plan Review ' Phone: 503.639.4171 Fax: 503,598.19.1 Other Permit
_ D ate/By.
• r'1 Ci A R 1) Inspection Line: 503439.4175 C OF TIGARD Date Ready/By: Id See Page 2 for
Internet: www.dgatd- o•.gov BUIL DING DIVISION Npef FitS, sapplemental Information
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Mechanical permit feels are based on the value of the work
❑ New construction ::4 Addition/al „on/replaccment
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other; mechanical materials, equipment, labor, overhead, and profit
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■.� 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building
❑ Multi - family 0 Master builder ❑ Other: Description Qty. Ea. Total
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Job site address: a p /
C o (} Ga / di, /77,or / Air conditionmg (requires site plan showing placement) . 46.75
-,f Furnace 100,000 BTU (ducts/vents) 46.75
Ci /State/ZIP
Suite/bldglapt : Project name: •. Furnace 100,000+ BTU ducts/vents 54.91
� I `490' i _ Heat pump 61 -06
Cross street/directions to job site: 1. Duct work 23.32
I Hydronie hot water system
23.32
Residential boiler (radiator or
' h dronic 23.32
Unit heaters (fuel -type, not electric),
in -wall, in suspended, etc. 46. 75
Subdivision: Lot no.: Plue/vent for any of above 23.32
Other 23.32
Tax map/parcel'no.: Other fuel appliances
471;474 ;_:.'a„ ^X, a °-- - -43 1 .. . , a.4.r.r +: i's;;.:,;- mz-s:v. ,~r :.rs..a2 11 k. t iff �-,Yf'- d Watcr heaDCr 23.32
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a .a?�rJdxer°ta _R ,. �NaG,ISw�s� ryn:emJ,�St* tea._
Cras .lace 33.39
A •• r /1 d iO O • Flue vent for water heater or gas
fi place r .
Lo• li: ter r 23 -32
Wood/pellet stave
Wood fi d lace/insert MI
/ FM
:� is r. L; m t,.:n *;, r-. �u,; . ; x :ny -! ca'yr • • r r fat Y 4 z 7 , 71' a ys , "14 >,v ° a . mN ;r .,t Chirnne /liner/flue/vent ism 23.32 r
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Name: d5 rt./ , . 4 rc.Q • d Environmental exhaust and ventilation
Address: q6 0 4.j. Range hood/other latches
r sst t equipment 33.39
,G r f - fe (� 0. a - Clothes d er exhaust 33.39
Ciiy/5taterL[P: � •F' �
Single-duct exhaust (bathrooms, ��
Phone: (g(3) `7 7/ F. : ( ) toilet compartments, utility rooms)
�PP�yynn�rY,.i��^ .' 5( .� W-7,,; ;1i ;); �` ''i�' ' :. 7;N',.5;.1 ` .r l �i%3.y0ry��^..d�52�+�� "' °;Y.. U w�c.-, w°:; ,'fi.:;: ^' ",' ""' ,t'�' ' �?tw:4�l , 1 7,,i 5 ; AtttcicrawlsP ce fans 23.32
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Other:
Business name: , v `
Contact nano: 9� $14.75 for first four; $4.03 for each additional
/ Furnace, etc- f
Address: /.:.. Co 7 -- 4 _ - • Cl ` . Gas heat pump
City/State/ZIP: g - e 07e. m. 7 , Walt/suspended/unit heater
J a , 6O D � 6' - .. a / ' Water heater
Phone:
Fax:: ( Fireplace
E -mail: p/7 ��sC�c°rrl�i /�'1 Ran 11=1.11.1 , E �' i, m ax,R' o m^ N rf . ' " ,.., w %"Sru.'Nt 'i57 q . J' a 3: i .. r f for � ��
Ya w ,�, r t v , � k `t" u+���„e � rY Barbecue
tr '�as'a'e4arY,fl,7,x'Cb:.
Business name: Clothes d er
• e'/77g 5 Other: M�
... l ,nr./.tlF 1 : Sb g arb" N.:" ; . H .,
Address: i7y -1.- katli t iNa : i i iltg .:a i 1 • �. _ �), ""%
Subtotal �6 4,,
City /State/ZIP:
Minimum permit fee ($90.00) WI=
Phone:( ) _ - F4: ( ) Plan review (25% of permit fee)
' r CCB lie.: . / I State surcharge (12 °4 of permit fee) /070 /
TOTAL PERMIT FEE DO. 4 IP ✓
` nig permit application explrca If a permit i opt obtained within 180
Authorized signature: .0, �r days after alias been geeepteM as complete.
Print name: C i7,. r�,G �/'�. Date: � � - �_ /Q • Fes methodology set by Tti- County Building Indasny Service Board
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