Permit CITY TIGARD MECHANICAL PERMIT
oI DEVELOPMENT SERVICES PERMIT #: MEC2000 -00418
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/23/00
PARCEL: 2S 104AC -01400
SITE ADDRESS: 13090 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT:. JURISDICTION: TIG
CLASS OF WORK: ALT 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:
WOD 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: 1
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of wood fireplace.
Owner: FEES
WHITE, ELLEN E Type By Date Amount Receipt
13090 SW WALNUT PRMT CTR 10/23/00 $72.50 2720000000
TIGARD, OR 97223 5PCT CTR 10/23/00 $5.80 2720000000
Total $78.30
Phone:
Contractor:
LUDEMAN'S FIREPLACE + PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Woodstove Insp
Phone: 646 -6409 Final Inspection
Reg #: LIC 51469
EXPitEt
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 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246 -9
Issue By: Permittee Signature: ery/ ( - - jFtiGQ�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
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fM Check #
i CITY OF TIGARD ,` Mechanical Permit Application Recd AYz-
13125 SW HALL BLVD. Commercial and Residential oo Date Reed / /' /w
TIGARD, OR 97223 G Date to P.E.
(503) 639 -4171, x304 Print or Type 1� ') Date to DST
Incomplete or illegible applications will npt lip`TICC 4 Permit U /7 C ' Zoo° 194) ila
°
Called
Name or Development/Project Table 1 A �'t �
Ea
flJ�lJl Table 1A Media " ,, 1∎ 6 '•••e Qty Price Total
Job Street suae a 1) Furnace t o 1 rr , r r r TU
B 1 3 d/ O 3 UJ W�l n LA: F urna ng duds vents 14.00
Address 2) Furnace 100.000 BTU+
Bldg* cayrstate • Zip q including ducts & vents 17.40
1 1 G}�sv<.-� O R (7ZZ 3) Floor Furnace
Name (or name of business) � including vent 14.00
Owner EL EJj (,(�t(rl r�-.- 4) Suspended heater, wall heater
or floor mounted heater • 14.00 _
MaiWtg Address .
1309 0 51,0 G00 (\L> 5) Vent not included in appliance permit 6.80
-T1 C p r - u3 5q " 6) Repair units , 12.15
~'LJ Check all that apply: 'Boiler Heat Air
Name (or name of business) For items 7.10, see or Pump Cond Qty Price Total
� CJL_ footnotes 1,2 Comp -
Occupant lasing Address 7) <3HP: absorb unit to
100K BTU 14.00
city/slaw Zip Phone 8) 3-15 HP; absorb unit
100k to 500k BTU 25.60
9) 15-30 HP; absorb
Contractor 1. p ? - p unit .5 -1 mil BTU 35.00 _
3 10) 30-50 HP: absorb
Prior to permit Marling Address 1 -1.75 mil BTU 52.20
issue a 1 5 .A-Ai c � ti� 11) >50HP. absorb unit >1.75 mil BTU
87.20
copy 12) Air handling unit to 10,000 CFM
of all Licenses /slate f `1 zw Phone b O3 g
are required if .Q F n A, 10.00
expired in COT Oregon Cond. d Exp. Date 13) Air handling unit 10,000 CFM+
database 5 i 4 ( �1 Zg 3 17.20
Architect Nance 14) Non - portable evaporate cooler
10.00
15) Vent fan connected to a single duct
or MadetgAddress 6.80
16) Ventilation system not included in
Engineer "At" zip ' Phone appliance permit 10.00
17) Hood served by mechanical exhaust
10.00
Describe work to be done: 18) Domestic incinerators
A'DD lTl O n) 17.40
New 0 Repair 0 Replace with like kind: Yes 0 No 0 19) Commercial or industrial type incinerator
Residential Commercial 0 . Modification O 69.95
Additional nformation or description of work: 20) Other units, ine/tiriing ood stoves I
2-4nf✓ c_- to..-c. 1 10.00 1
NOTE For Commercial projects only; Units over 400 lbs., located on the 21) Gas piping one to four outlets
in 5.40 _
roof, require structural talcs. prepared by licensed engineer. 22) More than 4-per outlet (each)
Type of fuel: oil O patural gas O LPG a electric 0 1.00
�17 ' Minimum Permit Fee $72.50 SUBTOTAL ;.4. r? '1? - 1 2 50
I hereby acknowledge that I have read this application, that the • . 5 $0
information given is coned, that I am the owner or authorized agent of 8% SURCHARGE . ; . 3.' ' , ` '7
t owner. that plans submitted are in compliance with Oregon State PLAN REVIEW 25% OF SUBTOTAL k' _
Required for ALL commercial permits only 1.,...-..-1..,,T.4,:- -gyp
. ' • O a 0 - /� 0 0 TOTAL ti . = , ,
.C;"`- 1 D'
b , �, U �,/`O2 / Fall C D 641414-1U s
�It7[ '^ ,� ! /� `� ' 3 - 0 - 3 to � Other Inspections o ns d and Fees
:
'. I� ( � 1. Inspections a of eennal business hours (minimum charge-two hours)
Contact Person Name Phone 372.50 per how
2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
$72.50 per hour
Footnotes for commercial projects only: 3. Additional plan review required by changes. additions or revisions to plans (minimum
1. Prairie full schematicot existing and proposed gas line and pressure. charge-one -half hour) $72.50 per hour
2. Provide drawings to scale showing existing and proposed mechanical State Contractor Boiler Cenificabon required
units. "Residential NC requires site plan showing placement of unit
1.1dsts formstmechperm_rev.doc 9/8100 EXPIRE j :