Permit . .
CITY TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00802
'l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/6/2005
PARCEL: 2S110DC -90102
SITE ADDRESS: 15655 SW 114TH CT 10 ZONING: R -25
SUBDIVISION: FOUNTAINS AT SUMMERFIELD CONDO LOT: 010 JURISDICTION: TIG
Project Description: Gas fireplace insert.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 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:
Owner: FEES
KATHLEEN VANLOOZEN Description Date Amount
15655 SW 114TH #10 [MECH] Permit Fee 12/6/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchaq 12/6/200E $5.80
Phone: 503- 368 -2980 Total $78.30
Contractor:
LUDEMAN'S FIREPLACE & PATIO •
12675 SW BEAVERDAM RD REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97005 - 2129
Phone: 503 646 - 6409
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 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344. / •
Issued By: z Permittee Signature: /- 4. c.C66-7 - t
Call 503 - 639 -4175 by 7:00 a.m. for inspections 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.
DEC. 5. 2005 2 :40PM
r .873 P.2 /3
Dat`�y: 1
Mechanical Permit A. 1 licatioli
City I t t >t(>1.: tit t It ', SF. (1' L
of lei artl
V Received fv o S
131 SW Hall lvd., Tigard, OR t I '' 41111 r ti P No.V , - Ddb p Phone: 503.639.4171 Fax: 503. '8.1960 Als
w I ' I Datdl3y: Other Permit;
Inspection Line: 503.639,4175 R ead Ig
Internet: www.ci.tigard,or.u9 DEC 0 5 200 'AA 1 J ^ y y ®5ce Paae Z for
Notdiad/Meth9d: / Snppiemantallnformatian
I
�- a
I07 � =J` CO&I11f AME X 7E lr" C1IEDUL - USE CHE
A 'Audi' . ,, - rrat ,-
: • t eca ma�perm rt ` a on the valt�t of the work
C New construction i
performed, Indicate the value (rounded to the neatest dollar) of all
❑ Demolition Iw Other: mechanical materials, e i m ent, lab or, overlie refit
CAT' GORY OF CONSTRUCTION Value: S ,p'tooQ 0
dwelling I� Commercial/industrial ' RESIDENTIAL EQU1PMF�VT! SYSTEMS FEES*
- and 2-family S 0 Access. ry building
&Iuhl- family III Master builder ❑ Other: For special txforrtlplinn use cltecldiat.
Description 1 Qty, j Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Hotta enolil
Job site address: 45-6,...5 , ICJ J /,t1/ 7 f -361. /0 Air conditioning or hear pump
(requires sac plan showing placement) 14.00
City /State/ZIP: !no rc y 47 R 9 7 P -' _ Furnace 100.000 BTU (ducts/vents) 14.00
no.: Furnace 100,000+ BTU (ductafventa) 17.90
Suite/bldg./apt.
I Project name: v� h �do 4 ten,! Gas cleat pump 14.00
Cross street/directions to job site: I Duct work 14,00
I Hydranie hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended. etc. 10.00
Subdivision: I Lot no.: I Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: I Other fuel appliances
D CRII'I'ION OF WORK Water heater _ - 10,00
Gas fireplace 10.00
a. 9 7 4. --pn e r I Flue vent for water heater or gas
C pc... 9c fireplace 10.00
- Log 10ter (Ras) 10.00
Wood/pellet stove 10.00 -
•
Wood fireplace/insert A G f 10,60 /O. oer
Chime /line tluc/veM 41° PROPERTY 0 , R I ❑ TI:N . , I / 10.00 f d,
J A - etcher 10.00
Name: ) f A � e t° , ?/4 r) ./era e _Environmental exhaust and ventilation
Range hood /other kitchen
Address: .41.7.6.,.__ ' /J/ Td G f ' /41 equipment 10.00
City/State/ZIP: 770 0 / art 9 7c; - i Clothes dryer exhaust 10.00
Phone: (.617.9 _ Single -duct exhaust (bathrooms,
9, 4 Far. ( ) � toiler compartments, utility rooms) _ 6.80 _
7. APPLICANT 0 CONTACT i•ERSON - Anlekrawlspacc - 10.00
Business name: 4 ,4. 4 ,„(7 C ®,,, s I Other: 10.00
,
Fuel pipiait
Contact name: c::::0 ,,, s .� / J c Ale /C 55.40 for first four, $1.00 for each additiona
Address: „a 4 7 e*gr/e'i n 1 R ( l r Pomace, etc. G as heat pug)
_
City /StateiZ vet - 4 C"
r / 9 7Oa i Wall/suspended/unit heater
Phone: ($4 Co re" ( Cy Fax :: (60 ed 5/6 1 3 �/ Water heater
l F J Fireplace
E- mail: I ge
CONTRACTOR I Barbecue
Business name: X 414 I Clothes dryer (gas)
Address: - Other:
MECHANICAL PERMIT FE S*
City /State/ZIP: Subtotal ,743 •
Phone: ( ) Fax: ( ) Dfnimum permit fee ($72.50)
_ Plan review (25% of permit fee)
.5i 9'C.t
CCB lic -: ?- � p.
� - State surcharge (8% of permitfke) 5 0 -
r TOTAL PERMIT FEE 7s� 30 I
Authorized signature: Thla petmie application expires if a permir Li not obtained within 180
days alter R has been accepted os complete.
Print name: I Date:
C A /Z.. 1 _ -Q� • Fee mcthadalogy set bylliCounry $tildieeg Industry Service Board
F
CITY OF TIGARD r . ,,
BUILDING DIVISION PERMIT #: MEC2005-00802
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/6/2005
Phone: (503) 639 -4171 //��i��u�lviIilij
I Inspection Requests (24 Hrs.): (503) 639 -4175 . ' ":_..
INSPECTION WORKSHEET FOR DATE: 12/7/2005 TIME: 7 : 00AM PAGE: 69
1
SITE ADDRESS: 15655 SW 114TH CT 10 CLASS OF WORK:
SUBDIVISION: FOUNTAINS AT SUMMERFIELD CONDi. LOT #• 010 TYPE OF USE:
PROJECT NAME: VANLOOZEN
DESCRIPTION: Gas fireplace insert.
OWNER: VANLOOZEN, KATHLEEN PHONE #: 503- 368.2980
CONTRACTOR: LUDEMAN'S FIREPLACE & PATIO PHONE #: 503 - 646 -6409
Inspection Request Scheduled For: Date: 12/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 023076 -01 503 - 646.6409 Y lllMt4- ( p
Corrections /Comments /Instructions:
C d/Lq.. ri,/4 .
K PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,-424,, Date: / Phone #: (503) 718-
278- -�
CITY OF TIGARD ' J ,. 141411r
BUILDING DIVISION A PERMIT #: MEG2005 00550
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/6/2006
Phone: (503) 639 -4171 Atli ll
Inspection Requests (24 Hrs.): (503) 639 -4175 d'
INSPECTION WORKSHEET FOR DATE: 12/9/2005 TIME: 7:04AM PAGE: 31
SITE ADDRESS: 13400 SW 121ST AVE � CLASS OF WORK:
SUBDIVISION: LOT #: / TYPE OF USE:
PROJECT NAME: PET ITT
DESCRIPTION: Furnace replacement.
OWNER: PETITT, THOMAS J, PHONE #: 503-590-0673
CONTRACTOR: PERFORMANCE MECHANICAL PHONE #: 503 - 762 -2474
Inspection Request Scheduled For: Date: 12/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 023207 -01 503 -350 -3325 Y ':V
Corrections /Comments /Instruc ions: 4S..rnwW\
M 4vcd� 204 S-6, /4 - so
. .
---) ,
1 I / I I. _ /
Fr OF / /i ' /,.
�[ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ID NO ACCESS
/ FAIL I l CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
n 9 / i — J Insp ecto : (� Date: l v� Ph one . #: (503) 718 - 7
V _
i
r
CITY OF TIGARD - .
BUILDING . DIVISION PERMIT #: MEC2005 -00550
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/612005
Phone: (503) 639 -4171 �'�nMy�j
Inspection Requests (24 Hrs.): (503) 639 -4175 .....� '__..
INSPECTION WORKSHEET FOR DATE: 12/6/2005 TIME: 7 :02AM PAGE: 72
SITE ADDRESS: 13400 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PETITT
DESCRIPTION: Furnace replacement.
OWNER: PETITT, THOMAS J, PHONE #: 603- 530 -0673
CONTRACTOR: PERFORMANCE MECHANICAL PHONE #: 503.762-2474
Inspection Request Scheduled For: Date: 12/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 022978-03 603- 350 -3325 N
Corrections /Comments /Instructions:
63
•
❑ PASS n PARTIAL APPROVAL n CANCEL NO ACCESS
I - I FAIL CALL FOR INSPECTION _ ADDITIONAL FEES ASSESSED
Inspector: Date:/..--`9 -- 45 Phone #: (503) 718-