Permit CITY TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00786
°'' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11 /28/2005
PARCEL: 2S 103B D -01800
SITE ADDRESS: 11905 SW CARMEN ST ZONING: R -4.5
SUBDIVISION: LOT: 013 JURISDICTION: TIG
Project Description: Install gas fireplace insert & piping.
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:
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
GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
DIANE WEINSEK Description Date Amount
11905 SW CARMEN ST
TIGARD, OR 97223 [MECH] Permit Fee 11128120C $72.50
[TAX] 8% State Surcha 11/28/20C $5.80
Total $78.30
Phone: 503- 329 -6030
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Phone: 503- 692 -5563
Reg #: LIC 126881
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: � __,,e1)—A.,..2.'±,,,,..'" Permittee Signature: _s_o.e., C->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.
Nov 28 05 11:29a Scott Shamburg 503 691 - 8855 p.l
1•�ca saauawaa G11fliL �lIUU ED -
City Tigard 1 U �t i' E��J Received FOtt CFFICt use ONLY
Ci of Ti ar ■ _ t'
13125 SW Hag Blvd., Tigard, OR 97223 Ds : - .*i / remit Na, J, lr .
'
� L - VV I
Phone. 503.639.4171 Fax: 503.598.1960. Qp Plan Review
05 503.639,4175 t' t'_ " 2QL�� ! �-- Read l ftic °t1e rRy:
y rd y :
Other Pemat:
Internet www.w.tigardor.us a , �) ica rage 1 fur
+i r Nodfiedimeutett / r bll „
' T\/ !\1 - 1 - 1 ,- _ , .A Mr S�P�cmaatar'atorraatlob
' TV1E OF .WORR- ..1 :... ly,..et!}rO 11.>
Q New construction ditiodalteratiotdreplacement Mechanical permit fees' ate based an the value of the work
performer Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other
mechanical 'materials, equipment labor, overhead, and profit.
•
.:..-CA
; : - CATEGORY OF,.CON#RUt'1E'1(?hF '-:•.' • ..::�-77:, Vttitrc. S
- and 2- family dwelling Q Commereialhndostrial 0 Accessory building :..RESID. fTr i BQWp - / emjO SSR., ..
Multi Li Master builder Q Other
special intimation use cketallst.
;loll' SITE' INPORhtATION AND AND ii..00ATIOIV:: ' f Qty. Fa. Total
Job site address: /r9 / f� •r �' G Aircoaditionine or heat pump
+ ' izequira cite plan shou,ingplaermnt) 14.00
City/State/ZIP: —
%�f>o / 1 0.„....., ,, 2 i'3 Fuentes 100.000 BTU (duets/ems} 14.00
Suite/bldg./apt no.: � j � Pernace 100,0004- BTUatinvivcnts) 17.90.
CrosB street/directions to job site Gas hear pump 14.00
Duct ' stor k 14.00
Bydrnnic hot water system 14.00
Residential boner (radiator or
—
hydtnic) 14.00
unit heaters ( fucl_type , not eca ic),
` in - wall , in -duct, suspended, et etc. 10.00
Subdivision: _ ! Lot no.:
— Ftuc/vent for any of above 10.00
Tax map/parcel no.: !!! tither. 10.00
Other feet appliances
• • - , _.DEScfl PTlON OF':WORT{.= .
. / : � - • `... i _ . Weta hwtcr 10.00
Gas /x,47,,✓/ q!'. //l.-S:? af— !1 l/fs —� Flue vent for aatt:beaie or gas
/ 10.00 /0.c
V C / tiwptece 10.00
rp lighter (gas) 10.00
Wood/pact stove t 0.00
. Wood Breplace/intett '
• .:.:' ';L : - IrRolivi y t!1!rER' : :: '';.,.. ir.: cl.tariArif ' .
...:." hinmeylin cr /nue/ven / 10.00 /v. C °"
C
Name: ,.) Other 10.00
%f!„/ C! G#/L''l /I, Envlroameoal exhaust and ventilation
Addr �f ��s (t 2 zry Range hood/other kitchen
City /State/ZIP: 1 0/2--- , 0 Clothes dryer exhaust us 10.00
Phone: (57 3 ` G � � J _ � Fat: ( ) Single -duet exhaust (bathrooms.
' - .' : p APis•LYCANT - -- :: ` i ,.7 PERSON ... c wlsp:tce fOn utility `
toilet eomzaemci b tili rooms 6.80
' - _ ' ¢ ON'I'A CT rPERS' - • Anie/ to s 10.00
Business 'tams: Other: 10.00
lust piping
Contact name:
55.40 for Grit four; SLAM for each additional '
Address: _ ) umace, etc.
City/St tte2lP: Ga9heacpamp
WalUausifrided/rmit heater
Phone: ( ) I Fax:: ( ) Water hour
E-mail: ----I Fireplace / .// //
....,:': •' ": ::: : CON1 RACTOR' .' -. : '.
• nee
.. - Barbecue
BUS/Trc9S name: ` ... 54 g 11 G/L 4 `}�� L4J�` Clothes dryer (pas)
Address: fib / '�C / Other
i � ! / i
�� ��pp "" �,�,' i: : _ -- NffiCAANICAL pgRlt'QT,F$ES� '' •' .
City /State/ZIP: GGG 2G[.u- 0.,._.. ,9 7laloa
_ Subtotal . :•i , 00
Phone: (3) _ Foot: (G % — �� J C lefunmum permit fee (572.50) • 7 Z,Sv
Pl
CO3 1ie.: 1 /�,S9/ an review (25 afnttit fee)
State surcharge (beef, ofoeoemtit ke) _5 • TOTAL ITRM1T FEE 9f, 449
I Authorized sip /��� This permit application expires if a per»' is sot Abased within 180
•
Print name: / y� �� — �� V days alter it has been accepted as complete
.55 erg //
Date: `tAgg // — 1 • Fee methodology set by Td-County Building b,dupry Servtat smird .
CITY OF TIGARD � L-L 2-c, +0s_ 6 - 2e(0
BUILDING DIVISION
Ali ifi - PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /
I Phone: (503) 639 -4171 u,% �n ih
Inspection Requests (24 Hrs.): (503) 639 -4175 -�yi��11.,
I
INSPECTION WORKSHEET FOR DATE: ‘ 2,/ TIME: PAGE:
SITE ADDRESS: k 6 C S C- A- 1 'l Q-.'\--/ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: \(�,� PHONE #: .? 2-1-- .S 5
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time
Code # Inspection Description Confirm # Contact # Message ��(
U ( LAS -PI-( k--4-.C—e._ 0
Corrections/Comments/Instructions:
�- WV 'tom L-( > S 0 ( PI
C A L-:: - 2,5 • / - vv 4
1 --A: L-14,- q 1 /
..-
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1 PASS I I PARTIAL APPROVAL _ CANCEL n NO ACCESS
fl FA 'L ❑ CALL FOR INSPECTION U ADDITIONAL FEES ASSESSED .
Inspector: Date: Vc7O Phone #: (503) 718-