Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00500
T EGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2011
Parcel: 2S 102C 002709
Jurisdiction: Tigard
Site address: 9715 SW OMARA ST
Project: SANCHEZ Subdivision: FREWING'S ORCHARD TRACTS Lot: 28
Project Description: Gas fireplace insert with gas piping.
Contractor: LUDEMANS INC Owner: SANCHEZ, J GUADLUPE
12675 SW BEAVERDAM RD ZAVALA, BLANCA E
BEAVERTON, OR 97005 9715 SW O'MARA ST
TIGARD, OR 97223
PHONE: 503 - 646 -6409 PHONE:
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 11/08/2011 $23.32
Type of Use: SF Chimney /Liner /FlueNent 11/08/2011 $33.39
Class of Work: ALT Type of Const: Fuel Piping 11/08/2011 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 11/08/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 11/08/2011 $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: •ermittee Signature:
/
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 Application ‘ Fi R OF FR E i S1 ti■l.i
City of Tigard 1 _ -
;
� !r 1
13125 SW Hall Blvd., Tigard, OR 97 \'� pla Review
Date/By: Phone: 543.634.4171 Fax: 503. : Other Permit:
In lion Line: 503.639.4175 � y S - /:
T'f t ; A R I) Q 4 B ate Ready/By: . See Page 2 for
Internet: www.tigard- or,gov ,0 cy\ %)� Notified/Mcrhod: Supplemental info*atadon
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❑ New construction _ Additl0n/alterati • sue Mechanical permit fees' are basect on the value of the work
�� performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition Cr Other: mechanical materials, equipment, Iabor, overhead, and profit.
.:1 r 1 h, T. r 7.e7e �a ;.:' Y M ::lY' e� .? tC. "YA1A.. •r":'C :.',F `1 y ! , f -..tFt Fri Value: $
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: 1- and 2- family dwelling 0 CominercialJindu• trial ❑ Accessory building
For special information use checklist,
❑ , Multi- family [] Master builder [j other: p Description 1 Qty. 1 Ea. T otal
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Air conditioning
Job site address;
7/5 � . 0 en__ j %quires Site plan showing placement) 46.75
City/State/Z1P: r/C a A 9 - 7„,?,, .,�,- Furnace 100,000 ETU (4ucts/vents) 46.75
- / Furnace 100,000+ BTU (ducts/vents) 54.91
Suite%bldglapt.no.: Project name: 4r7G , - Heat pump 61.06
Coss strectldinections to job site: Duct work 23.32 ENE
Rydronic hot water system 23.32
_ _ Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -waft, induct, su . ded, etc. 46.75
•
Subdivision: Lot no,: Flue/vent for an of above IIMI
Other; 23.32
Tax map/parcel no.: Other fuel appliances
h�l �':4 r F !a" Ott ra.r e ' . ^ M aEr Fr c � E ' ez 1 �`�: �a4, SD �"a; & E 4
Water heater 23.32
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' { nlA...RI� ' A rC: G �` f r` . �Mx
h i ..w ._,..
h.5 7't? // m / /2,5 &i•a q17 Q/ Flue vent for water beater or gas
fireplace 23.32
R ci //f t - Log lighter (gas) 23.32
Wood/pellet stove 33 -39
- Wood ft .lacelinscrt • NM 23 -32
)74 1 .74 , 51,,..l;',, r 1, r r s; d , �^r ,, "biter riv , ;;?,, '1� '{ 7, r ° a " +f'"" Iii" ""." Chi mney/iiner /flue /vent f 23.32 rZ . y
a', i ' , i i a b x �Y v fl � g a 7} N, 1 '.A r) ar
vuTe:Sra.,ra , ., ,c:.....a_5...,xn.<a ,,e :aa �t�,n.,.,,t , . a,,, ..sfzs:i . . rr. l_ µ. �., a,, ..4.r,ror>r.rr.IPC.0 ..Sir...s�:t„ Other: 2332
Name: . �� 0. .3 � • - Environmental exhaust and ventilation
Range hood /other kitchen ISE�
Ado ellir. 9 7./ g •Ui. mcnt
C5ty/StatefZIP: 77& r & D 97, Clothes dryer exhaust 33.39
< Single -duct exhaust (bathrooms,
Phone: X31 7/0 - 6 Fax: ,) toilet co • , • ts, utiti rooms 23,32 .11111 i o ,,; r ' r{ t i � � . " r r r J ,. . • k ! "r� e,, W b. . ° Y( "1 { � n ° i ll� r v eCr x'�a� n n r ,U i
�!M�.�,,. ` S ' r 23.32
}} IM
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Other:
,~ ii Fuel PiPin%
Contact name; ` $14.15 for first four; $4.03 for each additional
Furnace, etc.
Address: /a 6, 7 _ . . -mil - i c , Q Lr Gas heat pump
MI
- � -
CSty/State/Ztp: 4 0 - 700 all
W/su ded/unit heater
®(
Water heater
Phone:
3 - &,.. Lv / 4 ,. GL3f Fireplace /
E mail 4/7 cD / of c'le Q It I `I Range rrhr4
yh {ifY r r wSF7a a �a� f �rmc Ord! li1ej ��1wYE� tVli?t ~ S " .� opV, .,
,} h�� a J 11" {tr ]f X24 • 5 k L; r Ct i F ' O t+' i1 Y;,W rnlh t 7 r b C . P r �vl..t Y s * ",Ca Barbecue
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.�v;..esdr..nAt. t:FE .7- ..��,"n.w:_ L, �., b :.,, aw � .;
Clothes dryer (Ras)
)3usincss name: is , - 7q Other: 7y �
`- ; a r �� ty t..r y ,%..i"Ai's^ ,, ,,,;,7, ,,w, ,,,, 7: 1. i ,,, 77 ?"'Teal IR
Address: -� in
,`, P? : ni $ n e �5 � d a i,.u , z , x r , � 7 s ^ ` ._.. .'s .
City/State/ZIP: Subtotal cQ . 79
Minimum permit fee ($90,00) 11 Q -Q(�
Phone: ( ) P lan review (25% of permit fee)
CCB lie.: / ap? State surcharge (12% of permit fee) d. ,- 0
_ / - TOTAL PERMIT FEE / _4'C
`~ nit permit application expires if a permit Is not obtained witbia 180
AuthOr2ed signature: - �r-
days after It has been accepted as complete.
Print name: 7-5j7% - i.. bate: `/. y �� * Pee methodology set by Tn-County Building Indusoy Service Board
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