Permit 4 CITY OF TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00015
" 6."111 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/11/2005
PARCEL: 2S103DB -11200
SITE ADDRESS: 11240 SW ARBRE CT
SUBDIVISION: GENESIS NO. 3 ZONING: R -4.5
BLOCK: LOT: 065 JURISDICTION: TIG
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:
LPG 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:
> 10000 cfm: GAS OUTLETS:
Remarks: Install gas stove & gas line.
Owner: FEES
CLUKEY, GLENN C AND Description Date Amount
1 240 SW ARBRE COURT [MECH] Permit Fee 1/11/200: $72.50
TIGARD, OR 97223 [TAX] 8% State Surchari 1/11/200f. $5.80
Phone: Total $78.30
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005-2129 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 51469 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
JAN .10.2005 6:40PM N0. 111 P.3i4
? ee . aaicai Permit Ecein' ' Ecll;fllflf! c,i ll\l
(,,ity 0 f Tigard Received .�G�
_ � - 13 t25 S Hall Blvd., Tigard, OR 97223 Dacet, "�f ' () Permit No. C
!'
Phone: 03.639.4171 Fax 503.593.1960 JAN 1 200 pia Review
Inspecti i n Line: 505.639.4175 ''Ary7wk I]otdBy: Orther Permit;
Internet: ww�v.ci.[i$grd or.as _ 1i ' I>am Rent,* arks ® Sec Page 2 far •
CITY OF -r`I- 1 • Notifiat/ ethed:
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17 /��7 S11pplctnenUtlleformartoo
•i - - - DI +V iSIC y V
a Cam, 'FF,(l Bi l.E C.t:Rfrt'lti�T
0 Net construction u Addition/altetation/repiacement Mechanical permit fees* are based on the value of the work
1:3 Der olititur perfotttrod. Indicate the value (rounded to the nearest dollar) of all
0 Other: mechanical materials
tit t r e equipment, labor, overhead, and profit.
,�..,� ' V OF CONSTRUCTION Value: $
Ir- a d 2- family dwelling [] Commercial/industrial 0 Accessory building • � 71 ' t `� • � .0. Pig '
O Mul ' - filthily 0 Master builder 0 Other: For vertu! in,(ormatlon use checklist.
.101t Description Qty. Ea. Total
_ 1ly l�'D7�MAT1►I AND LUCfii�'1bh1 Mating/cooling
Job site . dares: ,/` a S' 5 w 6P1-6,. e e Air ime conditioning Im or treat pump
city/St8 ' 1' : . - irss sire bra sbnw' facenneot) 14 (10
��noo c.2 O 7,c2 3 Furnace 100 000 BTU du tt/venrs 14.00
Project name; Ca r �C . ' Fumeec 100,000+ BTU (duct/wars) 17.90
Suite/b141 apt, no l
Cross a , • Udlrections to job site: j hem wn 14,00
Duct work 14.00
- Hydronic hot water system 14.00
, Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in-aull, in-duet, suspended, etc. _ 10.00
5ubdivisi' — Flue/veld fbr any of above _ 10.00
Tax map/, areal no.: Otter: 10.00
Other fuel appliances
inisclur ai3N or 'WORK . ' ' . Water heater 1000
J/ (s • et e C ' Gas fireplace _ 10.00
t/ I �1 Flue vent for water heater or as
• g 44.e.. -�.� 10.00 _
y Log Lighter (gas) _ 10.00
Woodtriellet stove _ 10.00 A7.00
Wood fireplace/insert 10.00
• rY PRaPl'l3 4v4 � f TilYA11i'I" - - - - Chimne9/Ileer/Auelvent — / _ 10.00 /Gt 4Q
Name: Other: 10.00
�9 /eh ►7 cm k v k _Environmentnl exhaust and ventilation
Address: � e�Yet L� Range hood/other kitehon
�/
eqr 4.0 C— et . equipment 10.00
city /sea • t : j p? '7 2 i 3 Clothes dryer exhaust '
10.00
Phone. 6-, ) 61.3 � (� Single -duct arhaust (bathrooms.
7 Fax: ( ) ( toilet compartments, utility rooms) 6.80 . -
APPLICANT I Q CONTAC1 R�(3N - Rrttic/arewlspace fans _ 10,00
Business : me: 4 aap M 017 S Other:
10.00
,� f �J��
Contact n FUCI piping
5)
3'V! /z y n SSA for first four- SL00 for each additional
Address: / - 7 ' 4 , - a/ M Red! Gas heat etc.
Ci /Sea , Al' Gas heat pump
ty .t et* vi /J O2 9 7 0 .05 — WaWsuspended/imit heater
Phone: (s„ ) Co c/6.- too S/O j Fax; ; (543) G Yla - e:PQ3 [f Water heater
E-mail: ! Fireplaces 4701
• £ONt[IiIcrtAt ' �- —T �
Barbecue
Business n: 1c: t�5'cp M ,e_ � Clothes dryer (gas)
• Address: - Other:
City/State/Z r' . r ti '
�� r� 9 u6total
Phone: ( ) Fax ( ) Minimum permit fee ($72.50) _
CCB lie.: / �� �+ 0.3 Pier review (2546 of pctmit fee)
State surcharge (8% of permit Rte) ,5'Re
TOTAL PERMIT FEE , 78.3 O
I Authorized _ ■ attire: Ills j erIDlr ■ppIkg inn e:pttr If a permit is obtained within 180
Print mimic: days n11cr it hqg been a ccept d as complete not
•
r107 5 44C ier/C' I Date; /.....442 - CS I R Fee methodology set by Tri -Coumy Building Indtwiry Service 13onrd
°7'I .
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: —(503) 639 -4171 MST
BUP
Received Date Requested ° A PM BUP
Location 1 / a, £1 Suite
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner -/C1- ELC
Footing L P - 7- 3/6 r
ELC
Foundation Access: LS/ E , s c—P
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors vI
Ext Sheath/Shear 30 %�'�- 4'J J
Int Sheath /Shear
Framing
Insulation / J� - ` /0
Drywall Nailing l —
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof SfJ r' -VW (`i3. re, /PS
Other:
Final e .� ..
PASS PART . FAIL
PLUMBING =
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PAS RT FAIL
n M CHAN AL
Post &Seam
Ro h-I� .�
as
Smoke Dampers
4V PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: 4 r 0 Unable to inspect — no access
Fire Supply Line J" firf ADA
06. -4111111111. Approach/Sidewalk Date l`L — �' Inspector Ext
PP
Other:
Final DO NOT REMOVE this inspection record fr ' he job site.
PASS PART FAIL