Permit w
..•
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00652
nil I I DATE ISSUED: 10/12/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S133DB -03300
SITE ADDRESS: 11571 SW SHEFFIELD CIR ZONING: R -12
SUBDIVISION: BRITTANr SQUARE NO. 2 LOT: 057 JURISDICTION: TIG
Project Description: Install pellet insert.
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:
> 10000 cfm:
•
GAS OUTLETS:
Owner: FEES
MITCH & JA SWANSON Description Date Amount
11571 SW SHEFFIELD CIR
TIGARD, OR 97223 [MECH] Permit Fee 10/12/20( $72.50
[TAX] 8% State Surcha 10/12/20( $5.80
Total $78.30
Phone: 503 -579 -1056
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED ITEMS AND REPORTS
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 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: SLIL,
K
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
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.
OCT.12.2005 12 :07PM 0.454 - .2/3
Mechanical Permit Application l ()I: c► l l l( l. t l, (). I t
• City of Tigard Davey: /d `/. -0 PaodtN' e. q• idSPO, ,1
• 13125 SW Hall Blvd., Tigard. OR ,,• ^,•
.. Phone: 503.639.4171 Fair 503. •). : :i+ . C E E V ,. _. 1.1411(wkw Other Perreir,
l apection Line: 503.639.4175 , 4 , �i) We Re
ww
Internee w.ei.tigurd.or.us - -� Noti6ed/biedied. tilleffitESI
OCT 1 2005 .
-
TYPE OF WORK , FEE* SCHEDULE -- USE CHECKLIST
❑ New couSI1111ot10n gall , . �- : �. „. ` Mec bees` are based on the of the work
G tj -� performed Indicate the value (warded to the neatest doller) of all
r] Demolition mechanical material equipment. labor overhead, and profit.
CATEGORY OF CONSTRUCTION - V°l $
SYSTEMS FEW
and 2- family dwelling ❑ Commereialindust ial 0 Accessory building / �
Far special udon radon use clew/dist
❑ Multi - family ❑ Master builder 0 Othct Description I Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION /� Heating/tuft .
.. 7 / pS 4) C / a;,. • Air conditioing or• PAP
Job site addres / t"t' (r sitop h ow p(aeemmt► 14.00
City/State/ZIP: " 7"Cparpc.e. O'12 917,0701.3 Furnace lo0,000 BTU (dac& s) 14.00 ,
Su;te/bldgJapt. no.: I Project 1181 r�C �n�piU Gus heat 100000* BTU (ducs�ve�l 14.00
Gus beta pump 14,00
Cross *eel/directions to job site Duct work 14.00
Hydmnic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
- Unit heaters (fuel-type. not electric),
in -Val , in- duct., suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: ( Lot no.:
- Other. J 10.00
Tax map/parcel no.: Oth fuel nppMlancea
DESCRIPTION OF WORK , Water heater ' 10.00 ,
/1" Gm fireplace 10.00
- /1 S 7 //C 7 ..= /!S r � Flue vent for water heater or gas
fireplace _ 10.00
Lop�llpatoer ) 10.00
Wood/pellet store 10.00
Wood Steplace/lnseit Pe//e f / . Loo /d Oa
PROPERTY OWNER ❑ TENANT _ChimtiegAiner/thie/veatt / 10:00 /0.017
Other: 10.00
Natnery)1 4 A s 0 402 4::::ea443 Eavlronmentn ) exhaust and ventilation
r / X1/7 Range hood/other kitchen
Addtnss:
//J 7/ A eP /c- /€ C //G . equipment 10.00
City/Stater/1P: r c.12 exe. .7 7c2.33 Clam dryer ohms 10.00
Single-duet exhaust (tathcooras,
Phone: (5 67 9 .. /056 Fax_ ( ) toilet compartments, utility moms) _ 6.110
APPLICANT ❑ C ONTACT PERSON Attic/ctawlapaee 10.00
Other 10.00
Business name. A. efcP M a h 5 _ _Fuel piping -
Contact name: pm/ aC t•R 55. 40 for first four; $1.00 for eacbadditional
Address: /e'. de -74-' J ss t4dCid? Ai RcX Furnace, ac _ . -
Gas heat ptmtp
City /Stnte/Z r • i esp Yrr - 4 On 50 74d WNUsuspendedhmk heater
Phone: (S ) 6)5/6_ & 5,0 -- Fart:: ( 61.5) G WO - ePG23 Won heater _ -
E-mail:
Fireplace
CONTRACTOR Barbecue
Business name: s;=.5A M Clotho dryer (gas)
Other
Address: IracamoCAL P>E1GUT Firs' • City/State/ZIP: _ Subtend aQdD 1
Phone: ( ) I Fax: ( ) Minimum permit Fero ($72.50)
Plan review (25% of permit (be)_
CCB fie.: .47 yC,0 Qr 0 jp3 State surcharge (8% of permit the) .5:80 ,(
TOTAL PERMIT FEE 7d 30 I
Authorized signature: % n u permit application expires if a Henna 1s not obtained within 180
days after ft has been accepted so cent ate.
Print Rime: / 44 C t ' rate: / a •• o f t ? .C45"" • Fm methodology get by Tri.r amty Building Industry Bard
Service Bd
CITY OF TIGARD
MECd005 -00652
1 D ATE ISSUED:
BUILDING DIVISION P ERMIT #: 10/12/2005
13125 SW Hall Blvd., Tigard, OR 97223
Phone: (503) 639 -4171 a �tilli ii
Inspection Requests (24 Hrs.): (503) 639 -4175 � I_..
10/24/2005 7:02AM 65
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
11571 SW SHEFFIELD CIR
SITE ADDRESS: BRITTANY SOUARE NO. 2 057 CLASS OF WORK:
SUBDIVISION: SWANSON LOT #: TYPE OF USE:
PROJECT NAME: Install pellet insert.
DESCRIPTION:
SWANSON, MITCH & JAN 503 -579 -1056
OWNER: LUDEMAN'S FIREPLACE & PATIO PHONE #: 503.646 -6409
CONTRACTOR: PHONE #:
10/24/20055
Inspection Request Scheduled For: Date: Pour Time:
C a# I vighopapaription Rgi f S83-tgaM056 Meiage
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL . ❑ CANCEL ❑ NO ACCESS
❑FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /6 - Z'>~" aS Phone #: (503) 718-
w
..•
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00652
nil I I DATE ISSUED: 10/12/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S133DB -03300
SITE ADDRESS: 11571 SW SHEFFIELD CIR ZONING: R -12
SUBDIVISION: BRITTANr SQUARE NO. 2 LOT: 057 JURISDICTION: TIG
Project Description: Install pellet insert.
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:
> 10000 cfm:
•
GAS OUTLETS:
Owner: FEES
MITCH & JA SWANSON Description Date Amount
11571 SW SHEFFIELD CIR
TIGARD, OR 97223 [MECH] Permit Fee 10/12/20( $72.50
[TAX] 8% State Surcha 10/12/20( $5.80
Total $78.30
Phone: 503 -579 -1056
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED ITEMS AND REPORTS
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 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: SLIL,
K
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
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.