Permit CITY OF TIGARD j MECHANICAL PERMIT
11 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00560
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 ® Date Issued: 12/06/2011
Parcel: 2S104AB09200
Jurisdiction: Tigard
Site address: 12354 SW 131ST AVE
Project: HOPKINS Subdivision: MORNING HILL NO.6 Lot: 121
Project Description: Fireplace insert with (2) gas lines.
12/8/11, REPRINTED permit to include natural gas stove.
Contractor: LUDEMANS INC Owner: HOPKINS, MARC W & DENISE S
12675 SW BEAVERDAM RD 12354 SW 131ST AVE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 646 -6409 PHONE:
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 12/08/2011 $23.32
Type of Use: SF Chimney /Liner /FlueNent 12/08/2011 $33.39
Class of Work: ALT Type of Const: Fuel Piping 12/08/2011 $14.15
Occupancy Grp: Gas Fireplace 12/08/2011 $33.39
Stories: 12% State Surcharge - Mechanical 12/08/2011 $12.51
(manual)
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $116.76
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 'cation Cen K. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or di ct questions to OUNC by call • • 503.232.1987 or 1.800.332.2344.
•
Iss d By: / !/ Permittee Signatur :
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 A _ ._ . _ .
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City of _ t, .,4y� .
Tigard ,, Received
111 xar .y DateJBy�..
a
13125 SW Hall Blvd„ Tigard, OR 9 °" r, Flan Review
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Phone: 503.639.4171 Fax: 503.598�`1060 cj 'F ° Other Permit
Other
T f C :� R) Ins Line: 503,639 ,_. P
+ ;' . pato Ready/By: S Sec Page 2 for
Internet: www.tigard- or.gov ' 1 ' n h Noufied/Method' Supplemental informadon
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0 New construction Addition /alteratian/replaccmcnt Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other mechanical materials, equipment, tabor, overhead, and rofit.
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1- and 2- family dwelling ❑,Commercial/industrial 0 Accessory building
Master builder Multi family
[ ] [] For special information use checklist.
0 Other Description 1 Qty. 1 P. 1 Tote!
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S7`" / Air conditioning
Job site address
49 ..� „Se /t3 U e_ (requires site plan showing placement) 46.75
City / State /ZIP: /6 /. , a e 9 7,,a,,.__ Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (dt tsJ vents) 54.91
Suite/bldgiapt,no.: Proj ect name: ia. d,• / Heat pump 61 -d6
Cross street/directions to job site: Duct work 23.32
. -', Moil D r Hydronic hot water system 23.32
�.r • t/" d1,..., Residential boiler (radiator or
3 T , \ 0 .1 h dronic 23.32
�.� J s • �" Unit beaters (fuel -type, not electric),
t' 1 • .-f., r / o in -wall, induct, suspended, etc. 46.75
�1 " 1 t r Flue/vent for any of above 23.32
Subdivision: ■ 1/M 11 Lo .n ..:
J Other: 23.32 .
Tax map/parcel n".: . 8/ ' Other fuel appliances
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' , ,; r e ,, , T r !r kr...,. , r r.,, d 1; ^ I4C, , Water heater 23.32
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• - / Gas fireplace 33.39
,Q ' 'ir% �J : 6 /Y1 e'/ 2— ..' a Flue vent for water heater or gas
� fireplace 23.32
f_ =�/ 0 93/G0 e S b L.o• li:hter 1111111=111•11111
,,,,,,,,,,777,7,7.,'.'.,:.:,,,,':'''....';'.:7777:: stove
Wood fireplace/i l'1G / 23,32 32 3,j
;, 7 re y-7- T , t himney/liner ue/vent / 23 .3.'
.t r "...1,. i :_' ., ... ' ,2,' a ",.....K ,•......: ',, ...e_1. ,. : ._,,.., +iV4 Other: 23.32
Name: • ,i 7,-a- , . , Environmental exhaust and ventilation
Address: /3 --- t / Range hood/other kitchen
. r {' equipment 33,39
City/State/ZIP: / 0, c7X 9 y Clothes dryer exhaust 33.39
Single -duct exhaust (battrrooms,
Phone: (5 3 706,- 5 /5/f< toilet compartments, utility rooms) 23.32
n + r- : t c r' ' AtticJcrawlspace fans 23.32
a r . '.., .... _,....,.. !
Other: 23.32
Business name:
sr u If S Fuel ipiing
Contact name:. _0� j $14.15 for first four; $4.03 for each additional
Address: /' urnace, etc.
s:
o? Co 7 -- • _ •4e.r • is �i L i Gas heat .0 is
City /State/ZIP: g e ,C5'/' E 7 pO r Wall/sus. ended/unit heater
Phone: � �/ &. 67 /c ? Fax:: ( z� . y6- „ � 5 Valet heater 1/,.2.
1 .
/ Fireplace
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Clothes d er .:
�
Business name: Other IIIIIIIIIIII
Address: . ^ ,� - , 1 rry + r r tw A�L ,K, A+
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City/State/ZIP: Subtotal m
Minimum permit fee ($91100) '0 .r i
Phone: ( ) Fax: ( )
Plan review (25% of permit fx) IIIIIIIIIIIII
CCB tic.: / l0/ • State surcharge (12% of permit fee) CJ. dy)
.r TOTAL. PERMIT FEE pi 0
Authorized Signature: 'This permit application expires if a permit u not obtained within 180
days after it has been accepted its complete.
• , �j[ • Fee methodology set by Tn- County Building Industry Service Board
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Print name: „ / cz� , _ Date: 1i` `°- , /,/
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646•6409
12675 SW CANYON ROAD
BEAVERTON, OR 97005
l a I-800486-5683
1 F FOR. A,,,. SEASONS FAX 503.646.8034
FACSIMILE TRANSMITTAL
To:`_' Date: c . 1/
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From: Joni Hacker '
CUSTOMER ERVICP Pages including this: c
Ph: 503-64-6409
Fax: Fax: 503 -64 -8034
jonih@ludemarlis.com
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CITY OF TIGARD MECHANICAL PERMIT
"° COMMUNITY DEVELOPMENT Permit #: MEC2011 -00560
[CAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/20
Parcel: 2S104AB09200
Jurisdiction: Tigard
Site address: 12354 SW 131ST AVE
Project: HOPKINS Subdivision: MORNING HILL NO.6 Lot: 121
Project Description: Fireplace insert with (2) gas lines.
Contractor: LUDEMANS INC Owner: HOPKINS, MARC W & DENISE S
12675 SW BEAVERDAM RD 12354 SW 131ST AVE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 646 -6409 PHONE:
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 12/06/2011 $23.32
Type of Use: SF Chimney /Liner /FlueNent 12/06/2011 $33.39
Class of Work: ALT Type of Const: Fuel Piping 12/06/2011 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 12/06/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 12/06/2011 $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 1.800.332.23
/
Issued By: 0 Permittee Signature: / i
lei - / �
;/
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 ApplicatiQn fit, t cs OFFICE l C +: U S►: MIA City of Tigard C ) n Received
C, I .
, 13125 SW Hall Blvd., Tigard, OR 9 Mi. plan Review
6 Phone: 503.639.4171 Fax: 503.598. 60 4L ri° nateBy: pmt Permit:
T 1G A R I) Inspection Line' 503.639.4175 \)i-C1 � Dale Ready/By: /urn. H See Page 2 for
Internet www tigard-or gov y • O� . ` o � C O wl NoUfied�ethod Supplemental Information
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Mechanical , p, enult fees* are based on the value
of the work
0 New construction Addition/alteration/replacement performed: Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other mechanical materials, e9uipment, labor, overhead, and profit.
'; r wn {; °'+a.. a"f°!' 4R"'ear 7a%>^ rr r: ' '"a S �'; c ' S y m y J 'r t, it' 4 J •` a ,�t , ,.
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I- and 2- family dwelling ❑ 0 Accessory building
For special information use checklist.
0 Multi - family ❑ Master builder 0 Other: Description Qty. Pa. Total
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reb?i.wA . �rc�rr�Sx`s' s ..� z .i»..s,.,. , ._ter ' �J . Heatin cooliR n
� /7` / Air conditioning
Job site address
/c9 5 , / A 1,/ ocquites site plan showing piaccment) 46 -75
City /Statel2lP: 776 0 a 9 7) c7- Furnace 100,000 BTU @let /vents) 46.75
. Furnace 100,000+ BTU (duet /vents 54.91
Suite/bldg./apt. no.: Project name: Z a.+ / ' Hcat pump 61.06
Cross street/directions to job site: Duct work_ 23.32
ilydronic hot water system 23.32
Residential boiler (radiator or
• hydroni) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
• Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map/parcel no.: Other fuel a • .liances
M :.1" ' v4 w .. !r a tia'� . ,, 3 , ` a s vaf v r } k d + dr'a+', t7n, $1 r y W ater heater 23.32 In
A. ;,; :.taza „.l. .eii"4.:,;i:A 3,k,. cSoatic,a:::`ccr ea. ri „sr1a 2.<;. "cx,iy,y,LN S',. i".. Z.,1 4i rrrx+.�:.:i.:4 0,',;L+••
Gas 11 . lace 33.39
PS 11 /J s 72 6 / /95c-r 2- i• V Flue vent for water heater or gas
� �� S ° fire*lacc 23.32
Log lighter (gas) IIII 23.32
Wood/ • ellet stove 33.39
Wood fireplace/insert I7 G 23.32 gill;
� xc r . a : t rry `
+7 .. N % ,, n f7 ; - Arr : .:m..- i %• Chiron /liner /flue/vent 23.32
.; + < > : n C y r n Y^� a `.. P yn r, rt 4 ( ro 1
. „x.tS�: .n. .,6:?,, b,f., e:.3 ;h;"; :7:•wb.,,m. .•. ?..a wA, .,, t. e.,.,J..x...»v>�: ' v..," s i x a. Other: 23.32
Name: ." elyc c� 16), „. Environmental exhaust and ventilation
C d Range hood/otherldtchcn
Address: / } A .5 �' • e . . ui merit 33.39
MI
City/State/ZIP: Q y /I, 7,7.....* Clothes d er exhaust
Singtc{luct exhaust (bathrooms, -
Phone: (5/.3 '706- c//5/f Fax; ( ) toilet corn• _ • . ts, utili rooms
,; Lr4 a utta .. ,, J x : e w a x Tr_h'(i 7 , ix' , er i. I A th c/c rsw l .ace fans �
f is ry ,J tf, . v..:.v ..,_,,. ;..: h r it' ,J rr a 'r' n t> S 1, .. a hs � ' :5.- N. }a.,t, ..t .. ,:..,v 0!' -0 23.32
W 4: ., t.� x:.Aa .x ,. Other: .
Business name: a. " . .1 S Fuel .i.in:
Contact name: 411 04., 9 j $14.15 for first four $4.03 for each additional
Effille 1.11•11111
Address: te; Co 7 - • _ ,,,Ar e, • 0, 1. • Gas heat purrtp - IMMIME�
City /State/ZIP; 1 rn 'c / 7 4 Qi'' 4' 70 0 ' wawsustendediun Itheater III
�/ Water heater
Phone: 3 69.. 0 x:
Fa: ( ...24 ; , .. CO r
Fi -lace Cr Mill '
E-mail: on f ) J fQ Q Range
r z , n a : v rrr, , ,Y r >Y I. d" r l r .,,� pr 7 L a• � ..! ,:: 1, Barbecue MiMilli vt ;; rvr ". >t/�:� S x +l • a k , rR t 4 ti u P y� i Yr ° ti 40',, fey i C �� F r
Fb° <, d r.._ r tr...u. a. k M, av; Fh ,lr ., n.r $u.,aw . W k .. .. a au;
Clothes d er +<
Business name: L (..,�r. ep S Other: MIN
7
t ,, ,x r r ) , i 5r ,;5::.,: 1 p g rx r r, r � f x z
Address: -,..4,/7/ �• 6 4 . y i , : �1 , , ' a 1;:ii. ., i r 7.e.. i 4' '. . „r. -o .:..c r:17'+r..ry .:.. «- ������ v�
City/State/7;1P: Subtotal r�
Minimum permit fee ($90.00) ' r I
Phone: ( ) Fax: ( ) Plan review (25% of permit foe)
7 CG _ State surcharge (12% of permit fee) , •
CCB lie.: _
TOTAL. PERMS FEE O• n ; 0
[ 'Lis permit application o: if a permit u not obtained within 1
p uthonZed signature:
r days after it has been accepted as complete.
-
2 , " �i` -''Y, , !/�a�� � � Date: �� ' 7 - -/f � • Pee methodology sot by Tri County Building Industry Service Board
punt name: t i^^ i'i /`
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