Permit CITY F TIGARD MECHANICAL PERMIT
011 DEVELOPMENT SERVICES PERMIT #: MEC2000 -00432
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/01/2000
2S111CB-01100
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PARCEL: 25111
SITE ADDRESS: 14975 SW 103RD AVE
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
WOD 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of wood fireplace insert.
Owner: FEES
HUMMEL, DENNIS AND JUDY A Type By Date Amount Receipt
14975 SW 103RD AVE PRMT CTR 11/01/20( $72.50 2720000000
TIGARD, OR 97223 5PCT CTR 11/01/20C $5.80 2720000000
Total $78.30
Phone:
Contractor:
LUDEMAN'S FIREPLACE + PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 646 -6409 Final Inspection
Reg #: LIC 51469
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain 4-iis of these rules or direct questions to OUNC by calling (503)246 -9189.
Issue By: `77. zdl_ Permittee Signature: C4/
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
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I'
Mechanical Permit Afttion
R Date received: / Permit no.:
A 1 ' City of Tigard 4 �rr,, 21100 Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tig R297.2 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 E1aPMENT
Fax: (503) 598 -1960 c ounlitlI `( pEV Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
X 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction Addition/alteration/replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 1 9 - 15 5 w 10 3 'Rd Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ • .
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: N LL\LA_ vkA_.E 1 _ jurisdiction's fee schedule for residential permit fee.
�iky county: YE 6 Ai -C� _ ` z,Li. b t 1 .
Description and location of work on premises: 1 ki SPA U _ AND COMMERICALIINDUSTRIAL EQUIPMENTSCIJEDULE
1.t7 0 O F'P l 0S1 -T— Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res.only Res.only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes 0 No - Air handling unit CFM
Is existing space insulated? 0 Yes 0 No - Alt conditioni (site plan required)
g P Alteration of existing HVAC system 1
MECHANICAL CONTRACTOR Boiler /compressors
Business name: LAD Ad\A FLQ; U�CE� PA.71 p State boiler permit no .. _ , _
HP Tons BTU/H _ . .
Address: IU -15 ) Qotn).a c rv: '�p Fire/smoke dampers/duct smoke detectors _ •
City: saa..v 1? ( 4-0V1 I S tate:Q(L I ZIP: C)(X5 Heat pump (site plan required)
Phone:6o3 64 b (040 q I Fax: 5o310y Install/replace fumace/burner BTU /H
CCB no.: �( - 2 3 Z Including ductwork/vent liner U Yes 0 No
Install/replace/relocate heaters-suspended,
City/metro lic. no.: wall, or floor mounted
Name (please print): a Lik a Vent for a • pliance other than furnace
CONTACT PERSON Refrigeration: -
Absorption units BTU/H
Name: " (_(,( - p , EA„ t) Chillers HP
ilk �� F Com r ressors HP
Address: .
Environmental exhaust and ven ilation:
City: State: ZIP: . • Appliance vent -
Phone: Fax: E- mail: • Dryer exhaust
1N , EL , Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: > - max 4 )1,...)\S tkJ ikA. (_L Exhaust fan with single duct (bath fans)
Mailing address: [.{ 91 5 j c ' r A e_ Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: --I 6 State: n � I ZIP: � N Type: LPG NG Oil
Phone:r ,? o if Fax:- - • - -1: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: _ _ _ Number of outlets •
Other listed appliance or equipment:
Address: , _ _ _ __• Decorativefrreplace
City- State: ZIP: Insert -type V ���1� ( 10 .00 ) 0.Q.>
Phone: _ fait E rani;_ Woodstove/pellet stov
Applicant's s' Date: Other.
A
PP .:�i�1a� .�, _ � �-_ / __ a ♦ Ocher. re Name (p • 2 V. r 1 l.- (3 . ' . . . •
' Not all jurisdictions accept _.•t cards, please call jurisdiction for more • -- - - Petn fee .- - $ �0= • .. O ° .
Notice: This permit application fee $
0 Visa 0 MasterCard M inimum 1
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
E within 180 days after it has been State surcharge (8 %) .... $
Name of r as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount , 440-4617 (6A0/COM)