Permit •
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00256
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/17/2012
Parcel: 1 S125DB08600
Jurisdiction: Tigard
Site address: 9496 SW SHADY PL
Project: Worley Subdivision: RAZBERRY PATCH, THE Lot: 6
Project Description: Install Wood Insert
Contractor: LUDEMANS INC Owner: WORLEY, RONALD L & KATHERINE E
12675 SW BEAVERDAM RD 9496 SW SHADY PL
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 646 -6409 PHONE: 503 -452 -1890
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 05/17/2012 $23.32
Type of Use: SF Chimney /Liner /FlueNent 05/17/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/17/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 05/17/2012 $43.36
Stories:
Fuel
Fuel Types:
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: ) 144Aht i Cli t Permittee Signature: 04 cK ` l 2 &
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.
•
5 J
Mechanical Permit Ai t licatio.A F� VE 14)R OFFICE 1USE 0\1.N'
City of Tigard
I h !;` Rece ived ( " Permit N _ 35
13125 SW Hall Blvd., Tigard, OR 97223 P New a 1
Phone: 503.639.417I Fax: 503.598,19. t MAY 16 2012 may Other Permit:
T I C A R D inspection Line: 505.639.4175 pate Ready/By: 1 Jurir / - H See page z for
Internet www.tigard-or.gov Cl1'Y OF TIGARD Notified/Method: ji Supplemental Information
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■ CW Construction ie AdditionJalterat on/rcplacement Meeilanical permit fig• are bas on the value of the work
performed. indicate the value (rounded to the nearest dollar) of all
■ I I ernolitio Q Other mechanical materials, equipment, labor. overhead, and profit.
... r,.��, r ,,, E 1 .. y! Value: $
't : '' -�• "•. ti r r. d ti4c rc4d.W.'i r youi.£.,9i".iiFr.i � :t;'" �u � ^4/11 ... F „ 'TLy:: ^.,:�.^ z 4 , +Y`?'. .��.f�
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- and 2 - fam ily dwcl 0 Commercial /in• strial 0 Accessory building
For special information use checklist.
ul n family Master builder ❑Other t. - ._,
Description Qty. la. Total
er + w r . a w ! 1 -� .i... ., /' 1. v.�. .. ':"•�.L.. '. y f Ul -4..:,3'.74.4". y
§gaq ..F. V _ ? i - v + 1 c . ...; r r, ; f1 .: Hcating/coOIIn
;"" ' ^i• ' , v.v-X14..�L:ux:na� cn.xaw5.:us:anu..W.....t ..'.�1 .- , ; .,Inn:r., G..tG.) -.:„ .Y.,.
CI g� / e S Air conditioning f
to address: C � ` / (requires site plan showing placement) 46.75
City tate/ZIP: .77'-f o R I 917eZP Furnace 100000 BTU (dueCyveuls) 46,75
Furnace 100,000+ BTU (ducts/vents) 54.91
Sui . • Idg. /apt. no.: Project name: 0 /Z A. Heat pomp 61.06
C . street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
• hydronic) 23.32
_ Unit heaters (fuel -type, not electric), '
in - wall, in- duct,.sutpended, etc. 46.75
• $ubdivision: Lot rw. Flue/vent for any of above 23 -32 ,
Subtlivision: Lot rio.
23.32
• ap/pareel no.: Other fuel appliances_
R -, :1 41.4.
. ,`: 1� , l._ , r : ` j e - Y L : r I .-V water 23.32 -,
' ,1_.•� , .'- •.r,,,c� i.....u, :.s.,, 1y.: war-,�:i1•u..r Via,.&_.r�Lx,xrr .,-4 ,
_ . , Gas 21 •lace 33.39
.0 ' /1 00 �� 4 Flue vent for water heater or gas
I fir lace 23.32
Log lighter (gas) 23.32
Wood/pcllct stove 33.39
Wood frreplace/insert / . 23.32 21 3„ 2,
w
2 3.32 •- Chinmeyniner /nadvent if 23.32 a4
r Other;
M V Envirootal exhaust and ventilation • J
p Rangge hood/other cnta latches
/ i� _ e -• . , equipment 33.39
tate/ZlP: 4 ,R- I + Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
e- 45 ) .c7 ( ) toilet c ts, uhh rooms 23.32
,,�. z x ; Attic/crawl •ace fans 23,32
® Ocher: 23.32
tss name: ` - ii ill S Fuel tin
PP £
• et frame: $14.15 for first four; $4.03 for each additional �,
Furnace, etc.
• 1 Q • Gas heat pump
RE • 740 Wall/suspended/unit heater
_ 1� � � r a / � ' Water heater -
V -
,
' 456 ) 6
&• CO• G -/ Fireplace
E ii: on . G/C7c°/nQ.0 Range _ -
r ¢� , '' .7 L 77 C . :3". 5 r .i ,• � ., . -' f ',- ' l � ,t - • ' , :
,5^ai' ii: r'a ? _2 . s.� u.... ,•u a.A �i,.rt.._. ti~ .- �-a,_.,.r..,ILa_,.,2:a1. .`- '.): Barbecue • ' ,-,
Clothes dryer (gas)
- mine: saint, ..Z...G/c/l'I779i! - Other:
Subtotal ' V
6.67
tatclZlp: _ Minimum permit fee ($90.00) Cj0 dU
- • . e: ( ) \\ r Ea : ( ) Plan review (25% of permit fee)
i : tic.: / / - to State surcharge (12% of permit fee) /O_,,,f _
TOTAL PERMIT FEE /gv_ fc ,
i ` / This permit application expires if a permit is not obtained witbin 180
Au • rizad Signature �`�� tt /jG daJa after It has been accepted as complete•
L , • Foe methodology set by Tri County Building Industry Ser ice Boatd
Psi � name: t'�in i'� � 41- I �� Date: --5----/.6-'471.-
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646 09
; 12675 SW ON ROAD
BEAVERTON, OR 97005
1110011864683
FAX _ -
.. =: �_ _:: ^- � ..:. F 446.80$4
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FACSIMILE TRANSMIT
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To: C/7 a T �a .�
(303 „Tv- /960
ATTn ; 7 ,7ccAe" - S perm/ .S
From: Joni Hacker
CUSTOMER SERVICE Pages including this;,3
Ph: 503-646-6409
Fax: 503- 646 -8034
jonih@ludemans.com
Re: WeCr4an/C � C
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COO /LOO d 9VOE# SNVW3Ofl1J -INOC IE0899b9 CO S LC 171. ZLOZ /9L/90