Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2006 -00578
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/17/2006
PARCEL: 2S110DC -90201
SITE ADDRESS: 15605 SW 114TH CT 20 ZONING: R -25
SUBDIVISION: FOUNTAINS AT SUMMERFIELD CONDO LOT: 020 JURISDICTION: TIG
Project Description: Install gas fireplace insert. Existing gas.
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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
ILENE HIBBERT Description Date Amount
15605 SW 114TH #20
TIGARD, OR 97224 [MECH] Permit Fee 11/17/20( $72.50
[TAX] 8% State Surcha 11/17/20C $5.80
Total $78.30
Phone:
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 692 -5563
FAX 503- 691 -6855
Reg #: LIC 126881
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: A di/, / Q 40 Permittee Signature: Ct 2 ' 2 J (1,e „_ 4 -17--.
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 17 06 09: 40a Scott SFlamburg 503- 691 -6855 p -1
uni F yo/ LUVD v r : eo rein, oz o i. ou 4 11 x vr' 11 hA2tL w,i V V.A.
Mechanical Permit J I i fc .a i i e FOR (.)FFJCE - ONLY
City of Tigard Received i i
13125 SW (kill Blvd., Tigard, OR 97223k • - g! / , DatriBy /,. / • •
Phone: 503.639.4171 Fax: 503.598.1960Li r 200 mac" Re i°"
Inspection Line: 503.639.4175 6 ,'4 ^ .ii,'• ∎ Date/By: ()thee Permit
Internet: www.ci,tigard-or.us , , -• Date Ready /8Y. Ed Sea tape 2 for
�. 1 tvod6ed/Method: Sopplcraentat Information
� r .,.-- •TYPE . .
: ; ;.. .: F.W r ::: . . , - C1At;
. . :,. - : _- - .. i , COMI391EIt � tER• scilaEDi>E.S = 1USte-_CJEexlelSr .
❑ New construction E' elition/altetation/replacet>senta Mechanical permit fees' are band on the value of the work
performed. Indicate the value (rounded to the uearest dollar) of all
❑ Demolition 0 Other
mechanics'] m ales labor, overhead, f
. , ni materials, equipment. lobo , ove ca and profit.
... • . • :. - CATEGORY.:OF..CON VCTIOfl. ' :::' • Valy= $
d 2- family dwelling 0 Cortlrltereial/indasnial ❑ Accessory building IDBNIL.L �QU1PlvILNT / E ::.
an
❑ Multi- family El master builder 0 Otter; For special injonnorion use checklist.
. . ::,., IOB° SITE' I]YFOI2MATIOIV . TI
Description na Qty. L'a, Tow I,.00A ON Hearin oaa
Job site address; /5400 5 / /t /t/ e Z(✓ Air conditioning or heat pump
(•equirea site plan showing placement) 14.00
City/State/ZIP: � Ord r
a� � � � Furmtce 100.000 BTU (ducts/vents) 14.00
Suite/bldg./apt tso.: !project saint. furnace 100,000+ BTU (dam/vents) 17.90 .
Gas heat pump 14.00
Cross street/directions to job Site; Duct work
14.00 •
- Hydmnic hot water system 14.00
Residential boiler (radiator or
llydmnie) 14.00
Unit hcatets (fuelaype, not rlectric),
in - wall , in s ate 10
Floc/vent far any of above 10.00
Subdivision: Lot no.:
Other 1
'Tax tnap/parcel no.: 30.00
T
_Other fuel appliances •
. ..' •• ... ',DESCRIPTION. OF' WORX :: . - . Water heater
10.00
Gas .fireplace
II 7) � t ll, l j / /t_54i . 6. -- C, / f CL • �fei Flue vent for water heater or gas 10.00
Fteptace 10.00
Log tighter (gas) 10.00
Wood/pellet stave 10.00
Wood eP sett / 10.00
R O P I R TY O WNER Chi li
mne /ner/ftue/vent t
.. . .. / h ... :: ❑ TENANT 1! 10 . 0 0 0 0 .,./:: y .
t h Other 0 - t
Name: �!'�It %, Cf e Environmental exhaust and ventil ation Address: /r /���) L / / / '� R Inge hood/other kitchen
City/State/ZIP: iJ, / . equipment ! 10.00
1 f �' r� .e;22:54,„.7./ Clothes dryer exhaust 10.00 •
Phone; ( ) ✓ F ( ) Single -dun exhaust (bathrooms,
toilet compartments, utility moms) 6.80
r APBLICAI`1T' . r
U. CONTACT .• • Anic/erawlspaeefarts 1600
Business name: Other 10.00
Fad piping
Contact name: -
$5.40 for Grit four, SLOB for each additional
Address: Furnace, etc -
City/State/23P: Gas heat pump
Wall/suspended/tmit heater
Phone: ( ) I Fax: ; ( ) Water heater
E -mail: Fireplace ,-
•
Rarye
.....: - .. , .: C I)N'I r R/:C]'OR• ' .: : • Business name :�. � // ? 94 c .7 �G barbecue
•
Clothes dryer (gas)
y�Ff -
Address: /20 ,6ox 15a l ather
•
Ciry /State /ZIP: .. MgCHAI4 PEHMITTEGS+ :.: .
0/C___ 9 7osv Sat,to,,l
Yhonc ( ) L t.
_�3 es: ( / — -- Minimum permit fee (572.50)
CCB lie.: A4 ,/ Plan review (25 "3, of pcnnit fen)
� ✓ State surcharge (8% of permit fee) r/
Authorized signature: TOTAL PERMIT FEE /�S{ jet
,( iii, permit applicatio capirea If a permit is not obtained within 190
Print =Me: .. 52`e , s /l�l/�n _bag Z Date: . days �.' it bas Man ate led
. ui us complete.
Pti
f� 7 F ee methodology net by Td.Coo.,ry Building i.,dwny Sa-vize aogrd
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005.00570
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/17/2006
Phone: (503) 639 -4171 -R °�
Inspection Requests (24 Hrs.): (503) 639 -4175 �' � ..
INSPECTION WORKSHEET FOR DATE: 1216/2006 TIME: 7 :01AM PAGE: 67
SITE ADDRESS: 15605 SW 114TH C T 20 CLASS OF WORK:
SUBDIVISION: FOUNTAINS AT SUMIMMERFIELD € OND LOT #: 02 Lt TYPE OF USE:
PROJECT NAME: HIBBERT
DESCRIPTION: Install gas fireplace insert. Existing gas.
OWNER: HIBBERT, ILENE PHONE #: Not available
CONTRACTOR: SHAtMMBURG HEATING LLC PHONE #:. 503 - 692 -5563
Inspection Request Scheduled For: Date: /216/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 040709 -01 503- 692 -5563 Y
Corrections /Comments /Instructions:
/
6 //e____ . e „ ,' .
�j ', SS Li PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: TA I , �� Date: / Phone #: (503) 718- /� �"3