Permit 4�
CITY TIGARD MECHANICAL PERMIT
�,� DEVELOPMENT SERVICES
PERMIT #: MEC2005 -00635
��ll 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/6/2005
PARCEL: 25111 DB -02600
SITE ADDRESS: 15435 SW ALDERBROOK CIR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.8 LOT: 485 JURISDICTION: TIG
Project Description: Install gas insert - no new gas line.
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:
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
HELEN EARL Description Date Amount
15435 SW ALDERBROOK CIR
TIGARD, OR 97224 [MECH] Permit Fee 10/6/200` $72.50
[TAX] 8% State Surcha 10/6/200E. $5.80
Total $78.30
Phone: 503- 968 -8829
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Phone: 503- 692 -5563
Reg #: LIC 126881
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: - j,, ; ;� Permittee Signature: y„? , s ,
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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503-691-6855 p . 1
Oct 06 05 08:55a Scott Shamburg
.... . . .. ._., ':--
Mechanical Permit . , 1 4 1 i I t , ,..- 1 VE:. , FOlt OFFICE USE O Y
NL
' City of Tigard luccivv _ 715 -- 63$ .7
13125 SW Hall Blvd., Tigard, OR 97223
Hen Rerieot
Phone: 503.639.4171 Fax: 03..59& 1960 OCT - 6 •20':•••• .- iY Dacday: Oder rtiMit:
Inspection Line: 503.639.4175
..... . .......2.. nave Ready/dr , I 10 See Page 2 fur
Internet www.ci.tigatttor. us
Notified/Method: -- Supplonentat iotermadon
CITY OF TI(3A
. -
:.
--' - ' • . - - • ': ' '*. ' obitikteiewl sluciseksoms a iisstipmaisr
mesh.i.iperntit fem atc based on the value of the work
0 New constructioo L Addrnotetezoicmu
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other
mechanical nosteriato, equipment. labor. overhead, and profit
... .r •-.1101Pititget:01411'104±-143rSME*0141'.'".-;;:•::
Er(end 2-fsmily dwelling 0 Commercialrindastrial 0 Accessory building
For special agbritunion axe chase:411m
0 Multi-family Li Master builder ID Other:
Description I Q11/. 1 Ea. Tont
''. '; ' . '.." • -. .-'. '• : : :,:, • i lb il 4 . strt itOcknok :•::,::: • i ...'":-. : .: ' Heatin
Air conditioning or hem puozp
Job site address: ,/ .. e- I.,9_ 1 2,.cz6/2v i e,..... (...„//i-Cle..) keens site plan showittgelscernent) 14.00
..
City/State/ZIP: - 77,, /ei o- 1 L2 2-7V Funtecc 100.000 BTU gluotAiszus) 14.00
Suite/bldg./apt no.: Ll I Project namt Purace 100.000+ Bill talett/vms)
Gas hear pump 14.00
Cross street/directions to job Site: Duct work 14.00
Hydzonie hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall. in-duct, suspended, etc. 10.00
Floc/vent for any of above 10.00
Subdivision: I Lot no.:
Other: 10.00
Tax map/panel no.:
Other fuel appliances
• • • .: • • ."• • : -: ;; ::-... -, :.6Eb49.0711ON 00 r: : : /1 C.:. ;" ! - ' . . •', ...... Vitit healcr 10.00
/ GaS fireplace 10.00
ez2 -. .5eit /70 /9t_eja.. 5 ez/z4) J Rue vent for water heater or gas
fireplace 20.00 .
_Lo411ghter(tras) 10.00
Wood/pellet siove 10.00
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_ Wood lireplacermsert 6i / 10.00 /0. .?•-
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•:'17 ...;•!.',.• .; :: .1.: chi maevilm / moo
Other:
Name: c44. _ ea,../
_Environmental exhau 10.00
st and ventilation
AddresS: At15105. 759'55) /9/Ciehist-061c:-C.;-, 1 Range hood/other kitchen
equipment
City/State/Z1P: -- 73i'ated 0/Z..• 972.2V Clothes dryer exhaust . ::
Phone: ( ) ga 1 Fax: ( ) Single-duct exhaust (bathrooms,
toilet compartments, utility zooms) 6.110
. . . . . . . .
• • • • • ' :[1:- - - - ' . . •• ..:;.' •.•: i':-:'Ll•toNt,icT PERSON • - : :: : . Anickrantspace fens moo
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Business naname: Other: 10.00
Fuel piping
Contact name:
$5.40 for first four; $1.00 for each additional
Address: Furnace, eft.
Gal heati/11131
City/StatelZIP:
Wel/suspendal/writ hater
Phone: ( ) I Fax: : ( ) I Water heater '
' .- .
Fireplace
E-rnsit:
-
Re
Barcincss name: %._944 /an J " t. - ..-,- • _____ Clothes dryer (PO
other!
Address: 10 igox• ga ... -
al _ •
: ',...? '. .: • .-. . "":: Wilikoirisi -..*: •;,..,
city/state/nit •---raittlearju 07Z.- .9 7,rb,i,'.- .. subtow
Phone: (. &9.9 - 5 - 7.40_3 1 F3X1 (6Z(3) .5- Maim= peattit fee (S72.50) ...
cco oc.: .... /.gz a ,gy/ Pion review (2574, a/penult fee)
State surcharge OPSS of permit (ee) 5 . Ye
Authorized signature: .
. permit sopucaavu unp a P perst ElWir lt is nne ta?S w MO
Print nama - ....S
"24... 4jr c ........------
days after it tom beim accepted es complete.
Daretiliggla • Fee methodology set by TA.County Buiftiins h)d Sa aixspd .
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005 -00635
13125 SW Hgti Blvd., Tigard, OR 97223 DATE ISSUED: . 10/6/2005
Phone: (503) 639- 4171 ur�pa�i�lj�l�l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/7/2005 TIME: 7:05AM PAGE: 33
SITE ADDRESS: 15435 SW ALDERBROOK CIR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.8 LOT #: 485 TYPE OF USE:
PROJECT NAME: EARL
DESCRIPTION: Install gas insert - no new gas line.
OWNER: EARL, HELEN PHONE #: 503 - 968.8829
CONTRACTOR: *HAMBURG HEATING LLC PHONE #: 503 - 692 -5563
Inspection Request Scheduled For: Date: 10/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 017739 -01 503-692-5563 V
Corrections /Comments /Instructions:
I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL r CALL FOR INSPECTION . n ADDITIONAL FEES ASSESSED
,r
Inspector: ,
Date: / - C' --- Phone #: (503) 718=