Permit r �o CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00226
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
TIGARD Parcel: 1 S 134DA04400
Jurisdiction: Tigard
Site address: 11265 SW 108TH AVE
Project: Gay Subdivision: DOREEN COURT Lot: 1
Project Description: Install gas fireplace insert and gas piping.
Contractor: LUDEMANS INC Owner: GAY, MICHAEL & JANET
12675 SW BEAVERDAM RD 11265 SW 108TH AVE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 646 -6409 PHONE: 313 -516 -0969
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 05/25/2011 $23.32
Type of Use: SF Chimney /Liner /FlueNent 05/25/2011 $33.39
Class of Work: ALT Type of Const: Fuel Piping 05/25/2011 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 05/25/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 05/25/2011 $19.14
Fuel
Fuel Types: Natural Gas
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: 5y,1 7,0,r
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.
Mechanical Permit Appli x 11 r:
F� t � FOR or- r:r(1.1 ()\ 1.1'
ilk J
City of Tigard r � a fi L;1 v..�� N, S Received ,
` g - °`s /1 1.,., Permit
III 13125 SW Half B1vd., Tigard, OR 9 � ,� /yEt�' r ere o ?aZ (p
Phone: 503.639.4171 Fax: 503.598. I LI 3 Lu I' > review
Dateliy:
Other r Permi
T i ( A R 1) lnsPeetioa Line: 503- 639.4175 Dam lteaayBY; Arta
t: www-tiSmd -or.gov [ 1I S S« P r
Internet � 1 ®= TIGARD NOtiScdiMetLod: Supplemental Information .
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❑ New construction 7 Addition/alter:tion/replacemcnt Mechanical perrrrit fees* are based on the value of the work
❑Demolition Performed- indicate the value (rounded to the nearest dollar) of an
Q Other: mechanical materials, e. ui. men
t g0rlz,"r' ,T 7z :In ,,a v , ', ` + : w ) I y ; 7:177,7:7,4";7; ... ^,*, , 'fir.: �a labor, overhead, and .r'pfiL
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Q Multi - family For special information use checklist.
Y ❑ Master build D Description Qty, Ea. Total
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Job site address: f ,. .. 7# I Air conditioning
O A -- site .tan shown- .laocmem:) 46.75
City /State/ZIP: 7' or , is • A 9 7c a Furnace 100,000 BTU (duetrivent3 in 46.75 NM
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg./apt, no - • Project name:
Heat .0 r. 61.06
Cross streeUdircctions to job site: Duct work
H • •nic hot water -tem Ell 23.32
.— Resr ]bolter (radiator or -�
h •tunic
Unit heaters (fuel -type, not electric), III
in -wall, in -duct, so- .ended, etc. 46.75
Subdivision: Lot no : Flue/vent for an of above 23.32
Other. _MI
Tax map/parcel no -: Other fuel a.. Hatters
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E J S •lace
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W .. • llct stove 33.39
Wood fir .lace/insert MI 23.32 M/
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ame: / g- (7 it. . )Environmental exhaust and ventilation
Address: Range hood/other kitchen
d- 4) 0 0 7 A • ui •meat III 33.39
City /State/ZIP; Q .„ _ O Clothes d • exhaust 111.11111221
Phone: (3;3) Single -duct exhaust (bathrooms, III
tiJ f� d 96 9 C ( ) toilet eo .artments, utili roortr:; 23.32
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Business
name Other: 2332 ■ ii -' s
Contact name: , $14.15 for first four, $4.03 for each additional
law
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Address: /c
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City /State/ZIP: _ 4g ., - 704 _i Eno
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Phone: 625 . - 6, 4 ” ago • - ( �J ,, 0 fl water heater _' Kuja
E-mail s CEIMIIMIIMMI
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Address: m ,, � , ,a C t „ rh., , ,47 �s� p;r :i
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City / State /ZIP: Subtotal , p,
Minimum permit fee ($90.00)
hone: ( ) F • : ( ) Plan review (25% of permit fee) !�
i CCB ltc -: y. / eo? State surcharge (12% of permit fee) � , 4► /
• // TOTAL PERMIT FEE . 10 - .` (/
Authorized signature: 0. ��, - T Permit stppllcadon expires if* permit is not obtained within rso
days after it tins been Accepted m complete.
Print nerve „ r ��� Date: 0_3_ g ' Fee methodology set by Tri•Co.mty Building Industry Service Board
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