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Permit gp; �� �I MECHANICAL PERMIT 5 COMMUNITY DEVELOPMENT PERMIT #: MEC2006 -00597 0C1r,p 'r DATE ISSUED: 11/27/2006 TWwA4RD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S133DD-10100 SITE ADDRESS: 11782 SW 125TH CT ZONING: R -4.5 SUBDIVISION: VILLAGE AT SUMMERLAKE NO 4 LOT: 138 JURISDICTION: TIG Project Description: Install NG fireplace insert. 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: NAT 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: WOODSTOVES: GAS PRESSURE: 50 + HP: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1 GAS OUTLETS: > 10000 cfm: Owner: FEES CROSBY, RANDALL P AND GINA R Description Date Amount 11782 SW 125TH CT TIGARD, OR 97223 [MECH] Permit Fee 11/27/20C $72.50 [TAX] 8% State Surcha 11 /27/20C $5.80 Total $78.30 Phone: 503 -524 -5842 Contractor: LUDEMAN'S FIREPLACE & PATIO 12675 SW BEAVERDAM RD BEAVERTON, OR 97005 -2129 REQUIRED ITEMS AND REPORTS Contact #: PRI 503- 646 -6409 FAX 503- 646 -8034 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: i g f( ' Ej Permittee Signature: P 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. NOV .24.2006 2 :50PM NO. 830 P.2 /2 r , l�iecpanical Permit A - �: 4 �• , : KkW 1 Application ..;: '., w , ti a � . City of Tigard Received 2^ Oh pateBy: 017 049 p eat No.: tGC�� -vt"� t7v 13125 SW Hall Blvd,, Tigard, OR 97223 ! Plan Review Phone: 503.639.4171 Fax: 503.598.19611 � ,w a ar 4• °! ' DoteisY: Other Permit, Inspection Line: 503.639.4175 • ', ,I� ' ! k Internet: www.ci,ligatd.or.us 'f 1I Date � ®Bee Page 2 for Notified/Methobo d: Sapplemmant Infonaut:km TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction ditiot/alteration /replacement Mechanical permit rhea° are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all 0 Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION — _ Value: S L and 2 family dwelling ❑ Commercial/industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES• © Accessory building For special information use checklist. Q Multi - family ❑ Master builder ❑ Other: Description 1 Qty. Fat Total JOB SITE INFORMATION AND LOCATION Heatingteonlli Job site address: // !�t TN Air conditioning or heat pump // • S �tTr� e (requites sine plan showing placement) 14.00 City /State/ZIP: /Cop e try Q 7A a 3 Furnace 100,000 BTU (ducts vents) 14.00 Furnace 100,000+ BTU (ducmtvent 1 17.90 Suite/bldg,/apt no.: Project name: 0 ros 4 Gas henryump 14.00 Cross street/directions to job site: Duct work 14.00 Hydronlc hot water system _ 1440 Residential boiler (radiator or hydron(c) 14.00 — Unit heaters (Nel -type, not electric), in -wall, induct, suspended, etc. 10.00 Subdivision: Lot no.: Flue/vent far any of above 10.00 Other: I0.00 Tax map/parccl no.: Other fuel appliances • DESCRIPTION OF WORK Water heater _ 10.00 Gas fireplace 10.00 = // _ 4s F/ r a p /4C ., Flue vent for water heater or gas fireplace 10.00 -- - Loglkliter (gas) _ 10.00 Wood/pellet stove , 10.00 - Wood fireplace/Insert / 10.00 _ /Q RI I"ItOPERT O WNER N Chimneylliner /lludvent / _ 10.00 /Gt OO Other: , 10.00 , Name: R4,, C / ► Cj ,s 6 Environmental exhaust and ventilation ' Ran hood/other kitchen Addres L C i ' -] S � s c2. equipment 10.00 City/State/ZIP: 1 /CO APate OR f7 a e2 3 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: 30 $ S V se y ax' ( ) toilet compartments, utility rooms) 6.80 lir APPLICANT ❑ CONTACT PERSON Attie%rawlspace 03ns_ 10.00 Business name: G�C MA n 5 _Other 10.00 Fuel piping Comm name V C n / • e7 C /tie A _ S5.4) for first fbur, SLOP ter each additional _ Address: /A 40 7.6' J egve +y1 Furnace, Furnace - etC City/Statc/Z G as heat pump ell err 7 ' 7 / _ a 9' 70d WioI /suspended/unit heater Phone: (S ) Cp Ve e,,01/e I Fax :: ( 543 ) G ye„ - d3 7 Water heater , E - mail: Fireplace - Range CONTRACTOR _Barbecue Business name: ��� M Clothes dryer (gas) Other; - . MECHANICAL rERMIT FEES* City /State/ZIP: Subtotal c p c k 00 Phone: ( ) Fax: ( ) Minimum permit fee ($72,50) 7a...5-0 CCD lie.: q - Plan review (25% of permit fee) �f / p < a �� State surcharge (S% of permit tbe) ,S #¢ TOTAL P ERMIT FEE 78 _� t i Authorized ailrrature: Ibis permit application <an ima do permit is not obtained widen LAO days after it has been accepted as complete. 1 Print man' n / C ,d e -- `�� mite. , O: 2 „0 / _ 1 • Fce methodology set by 'Ili - County Building Industry Service Board z G