Permit q CITY OF TIGARD MECHANICAL PERMIT
1 • COMMUNITY DEVELOPMENT Permit #: MEC2010 -00694
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/30/2010
Parcel: 2S114AB05200
Jurisdiction: Tigard
Site address: 9405 SW MILLEN DR
Project: Witham Subdivision: KNEELAND ESTATES Lot: 39
Project Description: Wood fireplace insert.
Contractor: LUDEMANS INC Owner: WITHAM, ELLEN
12675 SW BEAVERDAM RD 9405 SW MILLEN DR
BEAVERTON, OR 97005 TIGARD, OR 97224
PHONE: 503 - 646 -6409 PHONE: 503 - 701 -8362
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 12/30/2010 $23.32
Type of Use: SF Chimney /Liner /FlueNent 12/30/2010 $33.39
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/30/2010 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/30/2010 $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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By` Permittee Signature: E!a
Call 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.
Meth aoical Permit A licatioi Ft.)it (1.1.1( : t S!•: ON 1,1
IN City of Tigard - Rceeircd
13125 SW Hall Blvd, Tigard, OR 97223 Plan Review
' ' Phone: 503. 639.4171 Fax 503.598. v "? \� �/gY
D other Permit
r I GA it 0 Inspection Line: 501639.4175 ' 6
j . � O NO Date Ready/By. Ink la see Page 2 or
Internet: www.ligandor gov A % L. Noiised/Metbod: i"i1J Supplemental lefoemat ou
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❑ New construction Addition/alt + io.
1 • Mechanical pczmit fees* arc based on the value of the work
performed. Indicate the value (rounded to the neatest dollar) of all
❑ Demolition Q Other: bi mechanical. materials, - • i • meet, labor, ovcrhea • and . • fit_
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For special information use checklist
❑ Multi ❑ Master builder ❑ other- Description 1 Qty l Ea. 1 Total
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Job site address: Jr Air conditioning
e Sreqire• site plan showing Pbcetnent) 46.75
City/Statc/ZIP. "` / -r 0 7 C Furnace 100,000 BTU (ducn/vems) 46.75
3 Furnace 100,000+ BTU (ducts/yenta) 54.91
Suite/bldgJapt no.: Project name: / . r °I Heat ., 61.06
Cross street/directions t0 job site: Duct work _ 23.32
r H ., • is hot water - , : 23.32
I Residential boiler (radiator or
• hydronic) 23.32 _
Unit heaters (fuel -type, not electric),
in -wall, in -duct. su..... ed etc. 46.75
--
Subdivision: I Lot no.: Flue/vent for an of above IIIIIII 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances _
u . r .< F : r 1t ) G s 3 S -" P I A :r ii %b �t f' Wa 23,32 • , ., �, . ., ti S o ..., n '... . � -` Y . r...k.:,: lV,V :,u,'.a ',t,,,,, :nµ szrYl..sv.4.* a,'. - ..,- •-- -._. v' ' t ; `-ei'
Gas firepla ■ 33 -39
L 4. y j � . e_ Flue vent for water heater or gas
fi .lace 23.32
007,71 MI
Wood pellet stove 3339
- -
Wood f • lace/insert 23.32
H r , e r t r*N m, r 0 ,- .'1','-t 174 , 3 r' e : a iri7 > , vy 4 ¢E71 Chinon /liner /flue/vent VII 23-3
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...,.,.,:lii `,. ,; i Other: 2332
- „ v Environmental exhaust and ventilation -
Range hood/otherldtchen
Address: 9 c75 f le =•ui• ment 33.39
C ity/Statc/ZIP: p_.. r I /< 9 f Clothes dryer exhaust 3339 li
Single-duct exhaust (bathrooms,
Phone: (503) 70/ ;'3 6, Fax ( ) toilet compartments. atilt rooms) 23.32
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,d wa f t � F s x; > 'fi , 2 1��^i Y // tr Attic/cia ' , e fans 23.32
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Other 23.32
Business name: • .Ii i 5 Fuel piping
Contact lie: 7"�' 9G � Furnace, $14.15 for first four S4.03 for each additional
IIIM
Address_ 1d fa 7 f -- - - S e-r . • • Gas heat pump �
City /State/ZIP: A _ - .. ,a, 2 ° y0 7 Wa1V- • ...ded/unit heater MINIM
Phone: .3 CD + Fax : (SQJ & °.a3' water heaver _�
E-mail : an a /efeie.rt74/ 0 -
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Business name: I e 5 Other
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Address: A b ir t r: w vt a a r f Hr 1 ��7i+j' .77
�ty�tat�ZlP Subtotal -
Minimum permit fee ($90.00) '" • 4
Phone: ( ) P4: ( ) Plan review (2S% of permit fee)
CCB lie.: , (4,? State surcharge (12% of permit fee) /C -. Q
TOTAL. PERMIT FEE . • 0. , d
Teis permit application expires ifs perartt la not obtained within 1S0
Authorized signature' •
_ F f� after It has been accepted as complete.
•
Print mine �n .r _.,e-,,,‹.. Date. -. Pee methodology set by TA -County Building 13161211 Setvice Board
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