Permit •
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00436
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/20/2009
;TIG. Parcel: 2S103DB06800
Jurisdiction: Tigard
Site address: 11180 SW EDEN CT
Subdivision: Lot: 0
Project: Bushnell
Project Description: Install gas insert and gas line
Owner: FEES
BUSHNELL, GEORGE Description Date Amount
11180 SW EDEN CT Gas Fireplace 08/20/2009 $10 00
TIGARD, OR 97223
Chimney /Liner /Flue/Vent 08/20/2009 $10.00
PHONE: 503 - 620 -7593 Fuel Piping 08/20/2009 $5.40
12% State Surcharge - Mechanical 08/20/2009 $8 70
Contractor: Minimum Fee Adjustment - Mechanical 08/20/2009 $47.10
LUDEMANS INC
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005
PHONE 503 - 646 -6409
FAX 503 - 646 -8034
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1 800.332.2344.
Issued By: / -C.(L Permittee Signature: dW /0L
Call 503.639.4175 by 7:00 a.m. for an inspection 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.
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City of Tigard vatarBy' d /
.. - -” 13125 SW Hall Blvd., Tigard, OR 97223 AUG 2 0 2009 Plait Revle( ()titer Permit.
C Phone: 503.639,4171 Fax 503 598.1960 Dote/13y1
CITY OF TIGARD Data Ready 'By, Juns: El Set Page?. for
inspection Dm: 503,639 l/ Supplemental LiCorrnuUan
BUILDING DIVISION
Internet: w' w,tigard -or gov IVISIO Ncttnedmhcthod, l �
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. Mechanical permit fees* are based on the value New construction 1 Addition /alteration /replacement performed, Indicate
El Demolition ❑ Other: @{� � yC ,pr l l •JVy mechanical materials. e ui merit, labor, overhead, and rdiit
f � �, I �� � i a . � L N vl lft 1lr' r 411 ' $ `F +I �I.14' °� � 'l'' �1
, r , l,„ ,t, .1 , v ),. +. ? f: t 1g ft ,40` 1 N� i'rr tr ?1 00
,,
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special informalion
[ f builder 17 Other: , . Qty. ow Total
Nlultt•famlly M��as
A j ro o t F, ! r r, , II r (■', ,, h`
Air conditioning or heat pump
«5 J J Q 7' 14.00
Joh site address ��l �Q � � 00 Furnace 100,000 BTU (ducts/vents 14.
City /Slate /7.1P; G.1 r 100,000 a 90
Project name: -. A / r
Suitc/61dg. /apt, no.' ) �S t
- - Duct work 00
Cross street/directions to jab site: — H dronic hot water 'stern
Residential boiler (radiator or
P
-- 11 dronic) 14.00 E
Unit heaters (fuel -type, not electric),
In -wall, in - duct, suspended, etc. MI 14,00
f Flue/vent for any_ of above 6.80 NM
Subdivision, 1 Lot no.: Other: 10 00
Tax map /parcel no.: Other fuel nppllances "'
; ,, , . t q +r,'' i , u �, � y � tli . : ,, 1! ', Water later „ „l.l i i,.�,l °;�;'� , , �i'.c( °L i �c' ''1 �1., ,, . „.. i ^ 7 :.:1' - ; i' r' i „V " ",irG t:l a fire lace S ' � i is
''" f Gas -.. r"/Y "1 ( ferrl Flue vent for water heater or gas
Fireplace 10 rt 0
-. -- 1Y7 Do' Ii titer as) 10 1
If Wood /pellet stove 1111111 10 00
Wood fireplace /Insert t '
a I - ° i , Chimnc /liner /flue/vent t /o. 00
` v 1e 1 'f 1 9 n I i,' . V °
I: , 1'1' x i 1I” :1 z ; ,( ' y)�;, ;l�, ,:le' : d,Rit :,;Ar N - ...,ti , t�
odic,. 10.00
Name: y Environmental exhaust and ventilation
_ Range hood/other kitchen
Address 4) P/7 .. - 10.00 MI
10.00 Clothes d er exhaust
Cit /Sta t el ZlP' _ [� 7,90 3
(ball
Phone:
(5 )6 ot'.3- . - 4 3 Fax ( ) .. 6.60
��, ! :: a,�i'��'bi ,l t b +r � �� �� 1 .��
� � � ! .f, : klon p. -. "m nci t �41yet t 10.00
Su siness name: _ ., g I» et
Contact name: � /• 4 p, , F t+, i A t $1.00 for each adrItional
.Address: OP' 7 £ e !1 e r . Q - Ir i --
City /State /ZIP ` tt a G - 0 9 70 Walllsus.endcd /unit heater
0 Water heater
PI1017C: )�� Fax: ; rP�a �7�/• � j' - �,l Ir4I1Z
• E - mail: Oa °� esuoN S . v i
. f t 7.. , 1 ',p' , r.. , ., I j ' �" 1. " ':7 ' „ ., ..'1''ll{iTh'' garbdCUC
° Clothes d er ;as) ��
Busuicss name — Other
Address_ - _ - JI;'�t it i�r' 1'1'1,' 1n m ' ' d tai o
C,Ity /State /ZIP Subtotal <35•
( ) - Minimum permit fee (572.50) `'
Phone; ( ) Fax: Plan review (25% of permit fee)
CCB lie,; .,.6 �+�/�
j/ State surcharge _ (12% of permit fee) .?
. TOTAL PERMIT FEE eT. e,9d -
ThIS p ermit application expire' If a permit is not obtained within 180
Authorized signature days after It has been itxxepted as complete.
r �^ Q� Fee methodology et by r'n- County LiuiI5Iu Industry Serv,re Board
- Printnamc' 001 QG �!� Date:
4 )-z
naApp dee 01/19/07 4C1.a0 /02 (COM/WEB)