Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00513
Date Issued: 10/09/2012
T [ G A.R D 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S 102DC00500
Jurisdiction: Tigard
Site address: 9000 SW OMARA ST
Project: Saidecpane Subdivision: EDGEWOOD Lot: 12
Project Description: (1) wood stove insallation
Contractor: LUDEMANS INC Owner: SAIDEEPANE, SEE & CHANTHA
12675 SW BEAVERDAM RD 9000 SW O'MARA ST
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE 503 - 646 -6409 PHONE 503 - 863 -2766
FAX 503 - 646 -8034
FEES
Specifics: Description Date Amount
Wood /Pellet Stove 10/09/2012 $33 39
Type of Use: SF Chimney /Liner /FlueNent 10/09/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/09/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 10/09/2012 $33 29
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: Permittee Signature: elk APP `/ C4 - l rJ
Dlu
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.
10/08/2012 11'43 503 64668034 JONI- @LUDEMANS #3620 P. 002/003
Mechanical Permit Application RECE r't)li: U11 1 1: l sl: ON1.
City of Tigard - ��T 0 / PlanR r- tO�QlG• � '°""N".: )46'6a@to2r o7S73
71
13125 SW HaII Blvd., Tigard, OR 97223 8 201 Plan Review
a,. Phone 503.639.4171 Fax: 503. 598.1960 DatdBy Other Permit
T I G A RD inspection Line 503 639 4175 CITY OF T , ' .'I t , etc ReadyBy 1 . - 65 See Page 2 for
Internet www.tigard- or.gov BUILDING DiVIS . i1 `- ethod C' Supplemental Information
eav,zi�Mtr. iv'n�.�' " . J y? � f _.. •i "y..t � 1 -� l:!• r �� S r,- 1I,c• - -3• �9.•..- .-�..n 'r•'• S'."Z• 7: ,..2
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0 New construction lti Addition/alteration/replacement Mechanics permit fees are based on the value of the work
I I performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other' i I mechanics materials, equipment, labor, overhead, and profit.
I Value S
rf ti Si R� (y 1. 77 , -0 1 -T .. i s `'; 'e i 4 " , '70-4FR
'F:t'. :.ti�t•Y "y,i1j�," ;'.'0 ."' ^h^h 14 r,✓.2 1 t� :,. V , ill P^r"S' L J1.. �'4 1. .-42 ,
.4..'tr+' y ..y,,,. ,tia' •b.:_..3aa. .: l;.c .,. . , r ...•Gik�.�e!t':�t '.�•'. t_ C_ S' 7. 7 _L i *, `ti
ti ,
..! 1- and 2- family dwelling El Commercial /industrial ❑ Accessory building r — U" '' " '°•m ` "-4,:' -- 1 --/•' =F >r . " ``t L r a =
For special information use checklist,
❑ Muln- family 0 Master builder ❑ Other
OcscnPno J Qri I Fa � Total
a.qn ? �� + +�;� �, ,+ � _�.,,. �:- ,�-. r :. �yy�..t..Y -� t.. L- c ,r'.tr4 +�
¢ ^ .t. 5 hits. ti ., r , s Y' 7 f_si. ,i '.� �. ..5;�,..• Hestia • • • tin'
tom k ` r c - :: 1�riEA,.,�a5`.__ f uuu.Z: -
Job site address: /1 �, _ Air condin• ing
S a o o � [/r,,, rte. -..7 (requites site I•laa showin]S placement) 46.75
City /State/ZIP: / /6Q rod O , /7,7,, Furnace 10 0 ,000 BTU (duCWvcnts 46.75
no.: Project rattle: / Furnace 110,000+ BTU (ductstvents) 54.91
Suitr/bldgJapt
I A> 0�c,,,, te+ " Heat pump 61.06
Coss street/directions to job site: Duct work 23.32
Hydronic h'r t water system 23.32
Residential •tier (radiator or
h dronic 23.32
Unit - (fuel-type, not electric),
• in - wall. in • uet, auspende d, etc. 46 75
Flue/ventf•r an of above 23.32
Subdivision: I Lot no.;
Other:
Tax map /parcel no.' Other fuel
0 ... :, u. yt '` ? r f p n.0 M ,"^•.� ' 2 �M: r.
� 1,� - r - fi:,e ar'1r .. r { t 1, tik '" S y a 1 1,.' ' " . e 4 , ,, As 'E"�'} . .a r e u ',5' y ' '' i �3r Water heat
i^�.� -- �t�• wit'" ii, i; Fs` .«.iYitica.�s:•�b s � 2. �i} � '. ° c.,,s..,r, ..r�d5rr,.r!..4 - m
/ y • c 33.39
,,,-/2 <M /1 a a dd �._S' 7`0 Ufe. , Flue vent f.. water heater or gas
fireplace 23.32
Log lighter gas) 23.32
Wood/. 11 stove 33.39
Wood f • ,. eefinsert -
•
}..,� �+7 . F , r,. � w "` a }. i tr• ` ,.,. a . ' — °' r. � _ v ' -. =
', 2i7 . Chimney/li eflflue/vent / 23.32 M P
i!' ;','.1 , ._,,.G —2 .v.-
.:,:. a.._mt.�i''. ... ..,c.�;.;.�-. 7
.._..:iii. ",'ZiI - . E Other: 23.32
Nam C A oil 7 CZZSA, n __ Environm tal exhaust and ventilation
Range • • .. other latch=
Address: 9 ,s o rte-.. 7 • equipment 33.39
Ctty/Statc/ZIP: / a r Clothes dry exhttrst 33.39
Single -duct exhaust (bathrooms,
Phone: ( j ;6_3 _ ' 76, , Fax: ( ) toilet co r• ents, utility rooms) 23.32
Gri,Y , 0 , N '''4,-1.-:'."' n i 1 3 . , � r r• s �' " : i i ; ;;77, 1 •! F 1 Attic/crawl' race fans 23 32
",�.. .1 1 .s t ; . +`: :. ' ,?e,a,.,....V. L.l, ...+ .�.s 3 , ,A,MA�a. 1 _.u.r. ....�. ; ; d . ,,, . 4 4 r. Other: 23.32
Business name: w 4 t / / 7 G r, S _____, f Fuel pipit' :
Contact name: -
oq f/ 9 C. /1 : Si .15 for first four; S4.03 for each additional
Furnace, et• 1
Address: /c? Co 7 , 154) I3e4:i4<f'Q % /ems Gas heat p •
City /StatefZlP: 9b1e/ 74:777 pn 9' 7 Wall /su ded/unttheater
cjpj y(5 . 6 , 9/O P ax: j l � �Q3� Fireplace
Water hea -
Phone: •
/ - ( yG
E-mail: le, c A c'rr /� Range
r'fG rp.LL 74 : ° •^cr - iiii:. $ •• f Z .aJ � ' ": , , Te o ^ I,
'',0 i. ni SI .+ : r , `h , ••'� Y 7 w 1 d tsi .•, 1 t.., !1 r Z ,s. r 2 {r ,'',' A
;. i - Barbecue j&OSt�:�r'"�r.�i t' .4�'..� ��ws�. ��d. Me:, C.. r_ L•. 1i. n e, �i�. � •: ::a.`a�,.M'Sr.n.."rr�.:a� , . ' ,10,1'":F__,;_.t�-..,:.17�cAs s.. 4..•
Business name Other: dry Ell
Add ress: �� _• ,-.: }
City/State/ZIP: Subtotal _5
Minimum permit fee (590.00)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB Iic.: ! / 6,7 State surcharge (12% of permit fcc) 0.„,
,J TOTAI, PERMIT FEE /�9a
( _ - - -7.- ' / - ' 4 This permit application expires If a permit is not obtained within ISO
Authorized signature: — '7 ter • r - ���, dayf after it has been accepted as complete.
' %
I
Print name: r" `";,, I Date: /Q •,r ��, 1 ■ Pet meth. • • logy set by Tri -Cowtry Building Industry Service Board l i
10/08/2012 11:43 503 64668034 JONI- @LUDEMANS #3620 P.001/003
•
646•6409
12675 SW CANYON ROAD
BEAVERTON. OR 97005
F. � .. , F. FAX 503448 -8834
FACSIMILE TRANSMITTAL
To: c/? ■4642C.C Date: /Q y f
Gq3 59P- /9epo
077-4 ; 7.1ccA'Pnic0 / Perm/;`..5
From: Joni Hacker
CUSTOMER SERVICE Pages including this:
Ph: 503- 646 -6409
Fax: 503 - 646 -8034
jonih @ludemans.com
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