Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00524
e�l� DATE ISSUED: 10/30/2006
r..:W. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135CD-07900
SITE ADDRESS: 09731 SW LONDON CT ZONING: R -25
SUBDIVISION:, LONDON SQUARE NO.2 LOT: 031 JURISDICTION: TIG
Project Description: Install pellet insert and flue.
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:
OTH 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 0
> 10000 cfm:
Owner: FEES
BILL ANDERSON Description Date Amount
9731 SW LONDON CT [TAX] 8% State SurcharE 10/30/20C $5.80
TIGARD, OR 97223 [MECH] Permit Fee 10/30/20( $72.50
Phone: 503 891 - 9074 Total $78.30
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97005 -2129
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
throu • • *AR 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1 :00- 332 - 2344.
Is ed By: „ / / ' Permittee Signature: I Ali
Call 503- 639 -4175 by 7:00 a.m far i�hat, - 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 .27.2006 2 :50PM O. 651 .2/3 •
Mechanical Permit Application `° - ' , -, ; . M � ' _ w ,1 i ;_ 0 �
x � . -^" � , 1 1 ) I� (1 I f I l f'''f � 1 () ` I 1 - ,
City of Tigard IE ! p e y AO a7 • • ' Permit ttNo.:ktec & -- 60 5 „ 4
, .13125 SW Hall Blvd, Tigard, OR 97223 pl Review
Phone: 503.639.4171 Fax: 503.598.1960 ®� L x D ow1By: Other Pamir
Inspection Line: 503.639.4175 �� ° �- k. :.; l � J la See Poe _ for
Internet: www.ci .ti onus �� = __ Dote dtMed fud +
g� � "{�� ��' Norsfied/Mcdsod: � Supplemental Information
1 7-o
C1 N o, / , �% pp -
TY 0 ' . 1. t ' AR COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
El New construction a: Ad.: . ~ : 1 : • 1 p seement Mechanical permit fees* ate based on the value of the work
0 Demolition Other. permed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUC'T'ION VaJUc $
land 2- family dwelling ❑ Commercial/industrial 0 Accessory building
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Master [] ti -�mily (] ister builder
For special information use checklist
❑ Other: _ Description L Qty. 1 Ea_ f Total
JOB SITE INFORMATION AND LOCATION _ Henting/cooling .
9 7 3 S
Air conditioning or heat pump
Job site address: O h� Y1 f . (requires site plan showing placement) 14.00
City/State/ZIP: 7/6,47,442 aR 9 y, Furnace 100,000 BTU (duets/vein) 14.00
Furnace 100.000+ BTU (ducts /vernal 1 7.90
Suite/bldg./upt. no.: I Project name: 62601,„_5.,„„) Gas heat pump 14.00
Cross street/directions to job Site: Duct work 14.00
Hydrant hot water system 14.00
Residential boiler (radiator or
by 1roaic) _ 14,00
Unit heaters (fuel -type, not electric),
in -wall. in -duct, suspended, etc. 10,00
Subdivision: J Lot no.: Flue/vent for any of _ above , 10.00
Other: 10.00
Tax map /parcel no.: Other Ihel appliances _
DESCRIPTION OF WORK Water heater _ 10.00
Gas treplace 10.00
— 1 / '4'/ _ Pe//el _X ice/,.' _ Flue vent far water heater or gas
fireplace 10.00
- _ Log lighter (pac� _ , 10.00
Wood/pellet stove 10.00 .
' Wood fire placelmswt / 10 -00 /d . O D
) PROPERTY OWNEA L i ❑TENANT Ch' mnaylliner /ffue/v u / 10 ,00 / O.Gp
Other: 10.00
Name: / /, elegy sop Environmental exhaust and ventilation
Address_ 973 1 . oS Gel 4 n C Range hood/Ether kitche T
v �� �, equipment _ 10.00
City /State/ZIP: 7; p+2 ^y ?A 'A a Clothes dryer exhaust 10.00
Single-duet exhaust (bathrooms,
Phone: _ f 9 - , Fax: ( ) toilet comportments, utility rooms) - 6.80
,X APPLICANT 0' CONTACT PERSON Atticicrawlspace fans 10.00 _
— Business name: 4�C # 4 /7 5 Fuel 10.00 _
- Fuel Qipig
Contact name: C h , ' QC lee' /C - 55.40 for that four: SLOO for each additiona
. Furnace, etc _
Address: /a 4!..7 e ,, y,,t e
Gas heat
Pip
City /State/Z et vi r 76/! f O2 4 7C70.5
Wall/suspended/unit heater
Phone; (,) c 9' - 6d6,5407 I
p3 Fax: : (5 ) Co Vets'. ,PlaL3 5 Water heater
E -mail: Fit�lacz
Ram I
CONTRACTOR Barbecue I
Business name: �A M Clothes dryer (pas)
Other.
Address: MECHANICAL run= FEES*
Ciry/State/ZIP: Subtotal o?o,Gca
Ktoirourn permit fee ($72.50)
Phone: ( ) Fax ( ) Plan review (25% of permit fee)
CCB tic.: Ycp 9_ a 41,..3 p... jo ( o a State surcharge (8r6 of permit fee) 5:
r - _ TOTAL PERMIT FEE , ��.' e,
Authorized signature: This t ermiI applfention expires if a permit is not obtained within ISO
days after it has bceb ecccpted as complete.
1 Print nAMe:
?bli-c--
�� I f)AIC: /0 7_66, ,_� ' fee methodology set by TA- County Building lndusuy Service Board
d / l C iB �