Permit CITY OF TIGARD MECHANICAL PERMIT
to • COMMUNITY DEVELOPMENT Permit #: MEC2012 00298
TIG 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/06/2012
Parcel: 25111 BD00305
Jurisdiction: Tigard
Site address: 9840 SW INEZ ST
Project: Winterbottom Subdivision: PEMBROOK HEIGHTS Lot: 5
Project Description: Install (1) wood stove and chimney liner.
Contractor: LUDEMANS INC Owner: WINTERBOTTOM, LISA M LIVING TRUS
12675 SW BEAVERDAM RD BY WINTERBOTTOM, LISA TR &
BEAVERTON, OR 97005 SULLIVAN, JOHN R TR
9840 SW INEZ ST
TIGARD, OR 97224
PHONE: 503 - 646 -6409 PHONE: 503 - 431 -6919
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 06/06/2012 $23.32
Type of Use: SF Chimney /Liner /FlueNent 06/06/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 06/06/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 06/06/2012 $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: a i / Permittee Signature: eA f /92.04../ c 4-77
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 P rmit A licati FoR f)r E ( tit; 0\1,1'
City of ' and EU I 1 b Received / • g D le u / Y • Perrot NiiG c2 o/a - OD
13125 SW It Blvd., Tigard, OR 97
JUN O 4 2 2 Flan Review
Phone: 503. 39.4171 Far 503.S98.I9 t Date/By: Other Permit:
T 1 G:� I: D Inspection ne: 503.639.4175
Internet: . ,tigard CITY OF TIGARD N h a nod s see Page i fnr
: III DING DIVISION supptementar Information
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0 New construction • le Addition/altcralion/replacement Mechanical permit fees' are 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 •roiit_
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ng ❑ CommerctaVm•�ustrial El Accessory building
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❑ Muln •family ❑ Master builder ❑ Other information e
rr, rte • + c c ny .e -•r , .,a r Description Qty. Ea. For special uce isr
� °rte,. +43 r' .;�'" S ;.: F s z r V �' ��, .,� +� J> •' `��"
1: ..ti.23 : 4„e,,...:- [r „ rye..,. -44':g1Z;7: 47 r ?a� 'A. 2 .;L»_i Hearin: coati.
Z 7 Air conditioning
Job site address: 0'. Q c -7/71C ..; _site .), sho • . : •lacement 46.75
City /State/ZIP: /`, rcz1 O Pomace 100,000 BTU (duets/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
/� _ Suite/bidgJapt. no.: Project / , t / N 7 r I., ru Heat pump 61.06
Cross strea/d rections to ob site: Duct work 23.32
H dronic hot water . tem 23.32 MEI
Residential boiler (radiator or -
h dremic
Unit heaters (fuel -type, not electric ) .
in-wall, in -duct, su . dcd, etc. - 46.75 .
Subdivision: 1 Flue/vent for an of above 23.32
l L ot rio.:
Other: MO 23.32
Tax map /parcel no,: Other fuel app_ nces
•
:i } ti.. , :A' + r: "'r7c 33 , Water heater 23.32
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Gas fire • lace • 33.39
L `�1�1 s ./"ZiOi es _ Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
• W... . el let stove 33.39
-,...:..., Chrome /liner /flue/vent .' 23.32 _IOW
. ,. 4 .a._ _L _ - '.t Other. _ 23.32
Narne: Environmental exhaust and ventilation
Range hood/other kitchen - rell �
Address: 94 e~S G l n -S e ui •ment
City/State/ZIP: al C . O RI 9 Tao Clothes • ex . ust _ 33.39
Single -duct exhaust (bathrooms,
Phone (23) y3 9/ ' F ( ) toilet com•artments, utili rooms 23.32
67 r-.... - v.:1111.,..--,..:;•1,-., , a � �,, , .�,c,R L2n-,. 3 ,, ..3: . y '7 + ,..1._.,r ' ..„tr 4 ., Tfr `` ... , ,,: ?,: ie. AmGcrawlspace fans 23.32 Ell •
Business name:
Other: 23.32
PeRPW,111 Fuel .i.in:
• ' �� - 9G X _ $14.15 for first four• $4.03 for each additional
Address: rev? Co 7
Ci /StatelZlP: 7 00 r' Wallis. • ended/unit better Mil
Phone: (5Q /� P. ':: (..5&4 '0 3, Water heater ME _�
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Clothes dryer (gas) _
. 4 ( /P7ri 5 other ;
Address: .-..7/77 f .. -�, c' " a .{ + 7a
• -
City /StateJZIP: Subtotal JA
Phone: ( )
Minimum permit fee (590.00) 90. • • IMMINEMIllin Plan review (25 °� of permit fee)
/ I State surcharge (12% of permit fee) O. ,'0
TOTAL PERMIT FEE d 0. ,' •
(� //, / , This permit application expires if a permit is not obtained wifhia 1R0
Authorized signature: - :* 7 ./ 'r``- days after it has been accepted as complete.
{ � _
?tint ram b�� _ .�� I Date: • Fee methodology set by Tri -County Building Jndrstty Service Teo =rd
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6464409
12675 SW CANYON ROAD
BEAVERTON, OR 97005
HMO-8864883
• t F i .. �.: FAX 59 3646.8054
FACSIMILE TRANSMITTAL
To: C/ f 4T 7,z2 Date: 6- 9 / 0-
G 3Y 4 / 96to
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From: Joni Hacker
CUSTOMER SERVICE Pages including this: 3
Ph: 503- 646 -6409
Fax: 503- 646 -8034
jonih@ludemans.
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