Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00523
Date Issued: 10/07/2009
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 639 4171
• Parcel: 2S103DB06800
Jurisdiction: Tigard
Site address• 11180 SW EDEN CT
Subdivision: Lot: 0
Project: Bushnell
Project Description: Install fireplace and run gasline
Owner: FEES
BUSHNELL, GEORGE H JR & Description Date Amount
CHARLOTTE C, 11180 SW EDEN CT Gas Fireplace 10/07/2009 $33 39
TIGARD, OR 97223
Chimney /Liner /FlueNent 10/07/2009 $33 39
PHONE 503 - 620 -7593 Fuel Piping 10/07/2009 $14 15
12% State Surcharge - Mechanical 10/07/2009 $10.80
Contractor: Minimum Fee Adjustment - Mechanical 10/07/2009 $9 07
LUDEMANS INC
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005
PHONE' 503 - 646 -6409
FAX' 503 - 646 -8034
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types.
Gas Pressue.
Total $100 80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law 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 the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246 6699 or 1 800 332 2344
a
Issued By: SLAit Li4)-60.
Permittee Signature: 0)& nQ / �� ( �� I � t�
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. ('Ol
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. 2.2009 4 :05PM . 0 644 i
R ECEIVE Y 3
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" 'I 13125 SW Hall Blvd , Tigard, OR 97233 0 � T 0 2 200 Plan Review
� n al . Phone; 503.639.4171 Fax: 503.548.1960 Da[c/By; other Penult:
'r'l ., - Inspection Lind 503.639.4175 CITY OF Rend r/B Jvr 1 See Page 2 for
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BUILDING DIVISIDDDDON - — -
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Mechanical permit fees"' are based on the value of the work
0 New construction 11 Addition/alteration /replacement performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other, mechanical materials, equipment, labor, overhead, and ptaftt,
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Of 1- and 2•family dwelling ❑ Commercial /industrial ❑ Accessory building For spec[nl information use clrecr411sr
❑ Multi-family 0 Master builder 0 Other: Description I Qty J Ea I Total
„,, a a , y L iii , y {• Henna coolie_
� / Air conditioning or beat pump
Job site address: //,/,7,0 ,Eo /e. r! a`f , m.uires the Inn sliewiea •locomen; 1111 14.00
City /State/ZIP: 7 /Cv4 r o c=1/ 7 Furnace 100,000 BTU (ducte/vents) 14 00
Furnace 100,000+ BTU (duets/vents) 17 90
Suite/bldg, /apt no.' Project name: pc. _5 A A Gas heat pump 14 00 Iti
Cross street /directions to job site: Duct work 10 00 -
- - ilydronic hot water system 14 00
Residential boiler (radiator Of
II drontc) 14,00
Unit heaters (fifel -type, not electric),
m •wall in - duct, su fended, etc. 14,00
• -- Flue/vent for any of above 6,80
Subdivision. Lot no ;
Other 10 00
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Tax map /parcel no.: Other fuel a1rpliances
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H 1
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1,1 , �l�nijl , T);i�l�h1; r;';• Water heater' 10 00
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Gas fir lace 10,00 p,av
q /2 ..— r - . C ♦ /) t/ Flue vent for water heater or gas
fireplace i0 00
Lop li - hter las 10 00
1` Wood/ eliet stove 10 00
Wood fireplace /insert _ 10,00
�• t'' ll II ppI ,i tl¢ Z .,� I” i!, , ° >' q.t u' Chimney /line[ /flue /vent / 10,00 /O -CID
,',1; 'r,r7', i ' :'it'' 4 t? a +mtn t ' 4' °`Ial '0. l 'i' &t ! 'Iii ,,,, l'; ,1 :: 1000
Other:
Name: . — _- , e / Environmental exhaust and ventilation
Range hood /other kitchen
Address. 411/i i0 ��7 a ec(utpment 10 00
City /Slate /,ZIP: --- e--PYc./ A, X Clothes dryer exhaust 10 •
Single -duct exhaust (bathrooms,
Phone. (50_3 6p 9Q_ 7z 5)..3 Fax, ( ) toilet com.artments utility rooms 6,80
";1' ' i '�,' 1y +i, 1 r lN9 w ,a ; ,11/7,, ; ', , t ' t rawis fans 10, 00
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, , � i i ,l 1 1 . �� ! 1 1 . ` A '/ Y 't „ fPJ 1 5 i l ` � �I � � , 4. a i '1 Attic /e —.
B usiness nam O 10.00
G Il Q Fuel piping _
Contact name:F /? 1 9 c J(C A $5,40 for first four; 51.00 for each additional
Addre l 4 � zed L3 eel u e r ac Q, , � Furnace. etc 1 _ � �/ - 5/0
Oss heat um.
City /State /ZIP S ad) Jer h • r 9 yOt S' Wall/suspended/unit heater
Phone: jS43) � / � _ [p9 Fax: . f�0a 096. e(3, Water heater
_Fireplace
• E-mail: i o n) II o . emq, i S + Range
,` r IVY 11 I:I { ,f:,,d41 Iia' 11 1 [t�` , i , y�, I ,� ` ,,'i �'' i 7l ( i•'V,, ' +„`
�JIIa r "` °I�i��' a� t �,b,:u �, ":,t Barbecue
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l3usinege name: Clothes dryer ( )
Other,
Address: _... _ ' ' ; , i 4; !I1'6'1 ;∎;'ti iy� .ia �` I1 • r, I ;ih,, . .
City /State /ZiP: Subtotal - ^ .. iiii
Piton: ( ) Fax: ( ) Minimum permit fee (11.73-.107 e • a
— . Plan review (25 °% of permit fee) -_—
CCB lie,: d, p _ State surcharge (12 °'t of Hermit fee) di • 86
TOTAL PERMIT FEE _. r
Authorized ar nature' T his permit application expires lI a pernut is not obtained within ISO
Print seine' >A / geepc� C /C Date - C7
g _ _ days after It has been accepted as complete. /00 r� _ '1
' /e' • Fee methodology set by Tti- Cotmq' Building Industry Sorvioe t3oxrti
1' , nu'Idmg Pcrrmtr\MEC•P!Ritl[App do:: 01/0 /u7 440 --4G 175 (1 t/01 /COM/wi?a)