Permit CITY OF TIGARD
MECHANICAL PERMIT
a DEVELOPMENT SERVICES PERMIT #: MEC2005 -00057
�� 11 -- I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/9/2005
PARCEL: 2S 104CA -03500
SITE ADDRESS: 13672 SW LAUREN LN
SUBDIVISION: HILLSHIRE ZONING: R -7
BLOCK: LOT: 035 JURISDICTION: TIG
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:
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
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas fireplace insert & gas line.
Owner: FEES
HANSEN, JACK Description Date Amount
13672 SW LAUREN LN [MECH] Permit Fee 2/9/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 2/9/2005 $5.80
Phone: 503 - 524 - 6580 Total $78.30
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005-2129 REQUIRED INSPECTIONS
Phone: 503 646 - 6409
Reg #: LIC 51469
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-. — -- — —
Issued By: j Permittee Signature: t, 1ff
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
FEE. 8.2005 7 :11PM NO.278 P.2 /3
Mechanical Permit r4.1 l D i i).(t t)) i tt i. t ti l'. +111,1
' Received
City,: of Tigard Date/0Y. _ " / / ,-- -VC Permit No. .1 G ill d s M /
13125 SW Fall Blvd -, Tigard, OR 97223 9 einn Plea Review
Phone: 501639.4171 Fax: 503,598:196 D U ,✓,�,�rtir n � ' Date/By: Other Pamir.:
Inspection Line: 503.639.4175, -t - h : l i
�. Date Ready/By: la See Piet 3 for
Internee www.ci.tigard.or.us Notified/Method: Supplemental Information
CITY OF T IGtiiu)
BU{ J U
COMMERCIAL. FEE' SCHEDULE — USE CHECKLIST
❑ New construction Ad ditionialteration/replacement Mechanical permit fees arc based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials,, equipment, labor, overhead, and prafit
CATEGORY OF CONSTRUCTION Value: $
Jand 2- farnily dwelling El Commercial /industrial ❑ Accessory building _ RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
Q -
Multi - family ❑ Master builder ❑ Other: _ For special lrtformafion use checklist.
— — Description L Qt 1 Ea. j Total
JOIH SITE INFORMATION AND LOCATION Heitinp/cooliog _
/ Air conditioning or heat pump
Job site edr Tess: 13 lB zR. �Ge/ z4twrrr d CA✓ (requires site phut showing placement) 14.00 _
City /StatelZ[P: • /6,0t� a g 9'c2.,1 Furnace 10oOp0 BTU (duats/vents) 14,00
Furnace 100.000+ BTU (duchy /vents) 17.90
Suite/bldg. /apt. no.: Project name: s ecdis P n (ha heat pump 14.00 _
Cross sheet/directions to job site: Duct work 14.00
Hydronio hot water system _ 14.00
Residential boiler (radiator or
hvdronicl 14.00
Unit heaters (fuel -type. sot electric),
in -wall, in -duct suspended, etc- 10.00
Flue/vent for arty of above _
Subdivisio : Lot no.: -
Other. _ 10.00
— Tax map /p" -1 no.: Other fuel appliances •
DESCRIPTION OF WORK Water heater - 10.00 -
- Gas fireplace 10.00
!? A / 6' .. /, S' er 1 a r Ci n Flue vent for water heater or gas
• fireplace 10.40
/fr7 4 Log lighter (gag) 10.00
1 Wood/pellet stove 10.00
Wood fireplace/insert / 10.00 /O-Cd
Chimney/liner/flue/vent 10 :00 Agee'
PROPERTY 'OWNER Cl TENANT Other: 10.00
Name: AIN t^_ X Qiys 4..4, Environmental Exhaust and ventilation
Range hood /other kitchen
,address: 0 / G 7 ., . `50J- 1..„7ar P h." equipment _ _ _ 10.00
City /State/ 4IP: 77 a pe a� Q g. 9 7 a d 3 Clothes dryr exhaust 10.00
Single -duct exhaust (baduooms,
Phone: ( - 5'a 7 r� - ear siec Fax: ( ) toilet compartments, utility rooms) 6,80
V APPLICANT } ❑ CONTACT PERSON Atticicrawlspacc fans 10.00
• Other. 10.00
Business . c: --.'e .M 4 4 - . Fuel piping
Contact n= e: 1:::Q le QQ ' Al. R 1 55.40 for first four; 51.00 for each additional
Add i�ss: e are )yt �rX
Furnace, etc. .
Gas heat pump
City/Statearl el 14 r .r 7i4 , p( 9 700'6' WaWsuspended/unitheater _
Phon ( 1 ) o 92 - �' 9V 9 Fax:: (5 ) G s/�y c:PCL3 s/ Water heater ,
E-mail: Fireplace - / ,5.4'SiC
- Range
CONTRACTOR Barbecue
Business name: ' -':, in Clothes dtyerSgas) _ I
Other.
Address: MECIIANICAL PERMIT FEES"
City/State/ZIP: Subtotal c ps- 5/0
Phone: ( ) Fax: ( Minimum permit fee ($72.50)
_ ) _Plan rcyicN. (259!0 of permit fee) J
CCB lie.: ,..5 9(9 ? ` 0 6 r 3 ,3 � — - Stale surcharge (8% of permit fee) A
TOTAL PERMiT FEE '7 ..3CD
Authorized 9igtianlrC: T his permit a ppamtinn e ipirm if a permit is pot obtained within 150
days after it has been accepted as complete.
Print name: cn / ' 5`j/v ( ?)• 1 - 0 ---
C le`tt 1 (late: O '1 ! p c2 I 1 Fee methodology set by Tri.County Building Industry service Board
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 , -J
INSPECTION DIVISION Business Line: (503) 639 -4171 - MST
BUP
Received Date Requested .- — 1 ( AM PM BUP
Location --) , Lam_ _.1.% �1lI Suite MEC (9005-W
Contact Person ? .L,/ Ph ( ) ' 416 — ( eqU q PLM
Contractor. Ph SWR
BUILDING Tenant/Owner O,'_ _ _A .... tA! �� 5 _ — 6 s - e ELC
Footing ELC
Foundation Access:
Ftg Drain - ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing •
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING,, : r v:a`;-
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL Fe `
Post & Beam
Smoke Dampers
n
• A PART FAIL
LECTRICAL .
Service
Rough -In .
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE - ._ , . : El Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA 1 — d S
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL