Permit ` CITY OF TIGARD MECHANICAL PERMIT
'. , l DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00054
Al( 13125 SW Hall Blvd., Tigard, OR 97223 (5 639 -4171 DATE ISSUED: 2/10/04
PARCEL: 2S 104AA -11900
SITE ADDRESS: 12475 SW 129TH AVE
SUBDIVISION: BELLWOOD NO. 3 ZONING: R - 4.5
BLOCK: LOT: 138 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
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: 1
Remarks: Installation of gas fireplace, venting & gas piping.
Owner: FEES
SMITH, DORIS J TRUSTEE Description Date Amount
12475 SW 129TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 2/10/04 $72.50
[TAX] 8% State Surchar€ 2/10/04 $5.80
Total $78.30
Phone:
Contractor:
LUDEMAN'S AREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 51469 Final Inspection
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 Oregon
Utility Notif ation Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952- 1 -0100. Y•u may obtain copies of these rules or direct questions to OUNC by calling
(50 )246 -6699.
Issu d By: ,_; ; _ / _ - ,,. _' Permittee Signature: JO/ ,d'�! ,
Call (50 . 639 -4175 by 7:00 P.M. for inspections needed the next business day
F e b - 0 7 - 04 1 1 : 44A P _ 0 3
., •
•••••••.•...araavema ... ...... an.L” 4 -,...e.--------,„
Ity of Tigard NOISIAIO 41ne Re''ej*I'd Jig
Onleity: / _ .( :) .44 / 9 parmait 14o.: iltejezle,/_..0eo 6.1(.__
3125 SW Hall Blvd,. Tigard. OR 97 01:1V011 . _All Plan Review
her :
home: 503.639.4171 Fax: 503.5 . - Ot Anton
98.1960 • Dummy.
Ispeetion line: 503.639.4175 irOOZ -. '2.-. Date neady/By: hz El Sot 11Nre 2 tar
Bernet: 9nrivr.ciligard.nr_lls Notifted/Mnbod: f e l , Sappieweatal latorosnott
rvkiiial gra3D3a___ r— c ommERam, rm. samovLE - USE CHECiaigT
Mechanical permit fees' arc based on the value of the work
A New construdiOn Erridition/alteration/ruplaccment perfunned_ Indicate the value (rounded to the nearest dollar) of all
A Demolition 0 Other: medtanical mataials. "ailment, labor, overhead, and profit
,_.
"
CAT111GORY OF cams-ram-nom Value: S
-- - - orsiocriTiAL EQuirmENT/ SYSTEMS FEEs.
laieruld 2-family dwelling 0 Commerciallinduslrial 0 Accessory building , -
For special ififorpsaliais use checklai,
j Multi-family 171 Master builder 0 Other: Description I ory, I En.] Total
.,.. .._ -
join srrE INFORMATION AND LOCATION Ilaidattioodlag
Aif conditioning or heat pump ._
.- .
�b site address: / 5- 6,..) / a 9 7' ,gue (reqsims Me plait showing ploccermi) 14.00
:ity/StatrJZ1P: / / 6 Or ce eg 2 7 c .- Ftunacc 100,000 13111 Olhietsrvenn) 14.00
• -- FigIlaCC 100,0004' 4111 : (01.01dVIZith / I 7.90
1one/bldg./apt no.: 1 Project name: ,,, 71- Gattpheat 14 00
- „..._
:Foss streeddinxtions to job site: 13uct with 14.00
' ' llskonic hot water SYSteln 14.00 . .
_ Residential boiler (radiator or
hydonic) 14,00
--- ...- Unit heaters (fuel-type, not electric).
— -
in-wall, in-duet, suspended, etc. 10.00
" • — Flue/vent for any of above 10.00
inbdivision: I Lot no.:
Other: 10.00
_ —
fax malt/parcel no.: Other fad appliances
— .
Water heater 10.00
DIESCIRIPTION OF WORK
— Cm fireplace / 10.00 ir.ocv
C P 0 1,1, .5 7 ti 'e ,.. ...._. Flue vent for water lieMer or gas
fireplace / 10.00 AO- CIO,
_10.00
- - Log lighter (gE
Wood/pellet stove __ 10,00 -
-
Wood fireplace/insert 10.00 .
OWNER
drfitonarrit 1
Cl TENANT — Chimney/liner/flue/vent 10.00
Other 10.00
- ..
Name: Oari s cz.5 eyi /'7L 6 Environmental eshauM and veatilatioa
.......
" — ' " Range hoocUother kitchen
Acidrms: /c,9 5 ,/ 7„..., 5 ej _ / 9 ii /9 ve nrilrel _.. __. _ 10.00
-
City/StatefZIP! - c, 2 9 7 c? .. Clothes Myer exhaust 10.00
. Single-duet exhaust (bannooms.
Phone: (SIA) 5 _ ,Q6- 7/1 F ax: ( ) .„ toilet comportments, utility m i-
orns) , 6.X0
.....- -
gifrAPPLICANT 0 CONTACT PERSON AttickniwIspace fans 10.00
- Other: 10.60
Businms name: . 4..e., Ct alio /7 -$ Fuel piOug
Contact name: .- 2,,,,, op / , 52:/0 c A//e, :A —
eo SSA, tor first then SIAS for each additional
Furnace, en:.
Arkin:Ss 71 S ep
e Taro vea,„, / 2 ,Q
Gras hempen/I
City/StsterLIP
el* V_Co 1 = .fr) G , 2, 9 20 aS.'' WaWsuspended/unit heater
P (5 ) 6 VG & 4/ Fax; ; (5 eovrte, - ,ea.,3 ;/. Wtaar heater
Fireplace i
1,,-mail: Range
_._ _ __.-..._.
CONTRACTOR Barbecue
Clothes der ) ry (gm
Address: _ MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal ;70, ev ,,
Phone: ( ) Fax: ( ) Plan
_ __
........_. _ _ ...._. —.----- Minimum permit foe ($72.50) 7,. „Tel
I
--- . — .... ...-......._..._, ___ review (25% of permit fee)
CCB lie.: .574/0 9 — 0 Sam snrchamc (8% of pi:mit foe)
TOTAL PERMIT FEE ?ef! ..3 0
Authorized signanue: 4 C2!1,4,........ Tata permit appikaties expires If. penult Is wet ebtsieeel wisei■ iso
days steer k has beem accepted ss complete.
Print namo—,' I ? - ---, I • Pee usediodoluo set by rii-Cowely Building Industry Service Board
sen 7- 07
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received - 3: 4l 3 Da te Requested 3/3/ 0 "I AM PM BUP
Location /2 —Cri 75. /a9 Suite MEC 00 5
Contact Person U ,�� >Gl�t�t�C., Ph ( 563) b - � I PLM
Contractor n � Ph ( U.� �f� 2� SWR
BUILDING Tenant/! • ,vD7,(/Z ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
C
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
G as Line � I p r
a pe
Final
PART FAIL
CTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL