Permit MECHANICAL PERMIT
CITY OF TIGARD
1:: ' COMMUNITY DEVELOPMENT Permit #: MEC2009-00610
" TIGARD 13125 SW Hall Blvd., Tigard 01:2.97223 503.639.4171 Date Issued: 11/17/2009 •
Parcel: 2S110AA90761 •
Jurisdiction: TIGARD
Site address: 10807 SW CANTERBURY LN 102 •
Subdivision: Lot: 0
Project: Hieb
Project Description: Install gas fireplace andassociated gas piping.
Owner: FEES
HIEB, CHERRIE A Description Date Amount
10807 SW CANTERBURY LN #102
TIGARD, OR 97224 Permit Fee 11/17/2009 $69.06'"
12% State Surcharge - Mechanical 11/17/2009 $8.29
PHONE`
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062
PHONE: 503 - 692 -5563
FAX: 503 - 691 -6855
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressue: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $77.35
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: 1 Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: 1 Other Desc:
Duct Work:
Fire /Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State ofOR.Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work ' is`notstarted 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or1 :800.332.2344. S Issued By: 1 Permittee Signature: X
Apr)
Call:503.639.4175 by 7:00 a.m. for an inspection 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.
. .
1..., .
11.1N. 6/ 2009 14: 25 5036916855
ir SHAMBURG HEATING LLC PAGE 01/02
Mechanical Termit.Applicati
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City of Tigard • • ritUtIV Permit No.: .
13125 Nall Blvd , Tigard, OR 97223 ,,,,,- 7 .1 -J evic " w -- -a
_. . 5 03.39.4171 ka
. . . . 50 .
Il ,59.1960
h
,, }tone- 6 33 )
NOV 16 20C ': Vay; - - POther emit: ..s,litta _ 0 .. _
Iiis Peenooline: 503.639A175
lutie: i la sc rige 2 far
,41,,,marixo(aN Internet: www.tigard-oteov NotifiedNethod: g Stinplementat hiformation •
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_ - _
...., — : :. • . • . iryrE 4 i
1 . .,V?,K BUILDING 'DIVISION ......••••'. ...coimsR,ttia'FtEf.•scuou4'•-•usEciiEocE0f
• . •
,McchaniCal permit ' es'' are based. on the value of the work "' -
0 New construction 2
performed. Indicate the value (rounded to the neare,st dollar) otall , .
ID Demolition 0 Other; ' mechanical materials. equipment, labor, overtiead, and profit •
---. . , ------------ . Value $ 'LOO --
r .-, .. .. 1 0. 11 WN -1 3A14010P14CNT4'SYS:1111T.S'FEES*,, ..:;
0 1- and 2-family dwelling 0 Commercial/ind.usnial Li Accessory binlding
For special information use checklist,
0 Multi-family 0 Master builder [J- DeicriptiOn 1 Qty. i Ea_ 1 Total
'
; . • . . .. .. • • '. JOB SnT, INFORI4T110N. Ar . .; . •. . . ..•:: . . •• Heating/cooling
. .
•
Job site address: /OS0/ 3,3 Cm, jed , ' 4, , ° : (41dti .. alli .
(repines sitc:z shoivinL Laccuoau() Ell 46:75'
City/StatearP: --
— 947d_ ne q 7 7—I ‘11 Furnace• BTU IlLiit.. 46_75
—
FUITIKC 100,0001- BTU kdactstvetus) 54.91
Suite/bldg./apt, no.: 1Projeet name;
iiealputup 61.00
Cross street/directions to job site: Duct work 23.32
, 1 hot WatEi system 23,32
Residential boiler (radiator or
. • Itydroijc:.) _ 2332
Unit heateo'(fuel-type, not electric),
in-wall, in-duet, 811Spended, EtC. 46.75
--- Flue/vent for any of above 2332
Subdivision: Lim no.: '
Mg .
— Otlier'
Tax map/parcel no.: Other fuel appliances
III 23.32
//13tate-ii _... r lka , V 1 - NZ-,- Flue:vent for vvater heater er g;s
ftr!place 23.32 2 3 J - e-
- • . ..._,_ Log lighter (gas) ..--
23.32 III
Wood/pellet stove 11111 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
• ' , • . •PROf'FIATY OWNER. . • • .. • ...' 0 , TENANT • , - • , • - ,
23.32
Name: ch theb Environmental exhaust and ventilation
-
Address: [o7 9) 6 61. -F (0 a Range hood/other kitchen
equipnent - 33.39
- (:ity/StaterZ2: "7 0,,e Q,ZZ5/ Clothes dryer exhaust 33.39
-. .- Single-duct exhaust (bitTiOcn,
Fax: ( ) tc,,s_oxiieartinerits, util i rooms 23.32
--
' MI 2132
Other: 23.32
Business
. - - ..... fuel
Contact name: . S14•15 for first four S4.03 for each stItiftional
........
... .
1-urnace etc. MEM.
Acklress: -
_ -_—_------- Gasleiusuirtp MIME:
.
City/State/LW: Wall/suspended/wait heater
Phone: ( ) LFax: : ( ) ' liVater, heater IIMI
Fire lace MillEriall
E-mail:
. -..,._
Clothes dryer (:, )
13usitle5s natne:jh & at 0 .,„ . 4.te„7:29 64-i- - Other: .„
Address! f, 60) r 2 ,1 . . ..
city/statezIP, -77; j OtC 104 1.... Subtotal - o /
----
Minimum unit fee ($90.00) •--, -, • • i 9 d,
Ph°nc: < 9?3) ‘92-55.te 2 ._ .
. I .
ax. (3Z4g) 679/- 49,,S--- Plan review (25 of_perrnit fee) -
-
CCB lic.: 0 7/1 r f/ State surcharge (]2% of pernilt fee) EFI_ Fl .;(421: .29
., .
TOTAL PERAIFF FEE J / 1
Authorized signature: <r 7 ..,___—____ ., , mil permit application expires if a permit ia aat phtaiDed within 180
clays after il has been accepted as complete.
.„,.„
Print tiame:sbartli--$-416,47A.-473 Data / 7-74' T o ni
--- • Pee nterhodolosy set by id-County Building industrY Service 70
a RCLIAN VX(/kr S -e_sct..si\g - 1,,c._