Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00039
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2012
Parcel: 2S110DD11600
Jurisdiction: Tigard
Site address: 10855 SW HIGHLAND DR
Project: PHILLIPS Subdivision: SUMMERFIELD NO.13 Lot: 686
Project Description: Gas fireplace insert installation.
Contractor: LUDEMANS INC Owner: PHILLIPS, SHIRLEY ANN & GENE E
12675 SW BEAVERDAM RD 10855 SW HIGHLAND DR
BEAVERTON, OR 97005 TIGARD, OR 97224
PHONE: 503 - 646 -6409 PHONE:
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Gas Fireplace 01/19/2012 $33.39
Type of Use: SF Chimney /Liner /FlueNent 01/19/2012 $33.39
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 01/19/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 01/19/2012 $23.22
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
•
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/°`
Issued B .'/ - Permittee Signature:
Call 5g by 7:00 a.m. for the next available inspection date.
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.
Mechanical Permit A 1 1 " . -' „ El . ..-,...-„,,,„(SIE ()NIA
I r
4 13125 SW Hall Blvd., Tigard, OR. 97223 i:iii P*14°. —
-
11
• Phone: 503.639.4171 Fax: 503.59SA*1 7 101Z Received ,
Dat/BY: / W M em
Plan Revie‘s
Date/By: Other Permit:
T 1 GAR I) inspection Line: 505,639.4175
Date Ready/By:
JUN' 1 Fil See Page 2 for
Internet: www.tigard-or.gov
11
1 4
CITY OF TI e -D NotifietVMethod.
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MarrittnAgga,1637,:igZtj'aiN45%,4;atAtt'WOFAN irtitifl7.1N1,073175:M17-;---;
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D New construction 14 Addition/alteration/repl', anent Mechanical permit fees* are based on thc value of thc work
performed. indicate the value (rounded to the nearest dollar) of all
o Demolition 1:1 Other: mechanical materials, e ui.ment, labor, overhead, and profit.
l' "' ''• 'i. Vinr , r .: ' .. - --.: .., , - , ;7.. wcet. , Tot-To:44 1 ■0 , „ . , vv.ca=tevKaurtr,,,, .. : :'..!,- i,
• 0 .. ' , • d 1 D b • id. , Y" .' '' , . , gl ' i , : 4 ,iiiggitiayfAi•VatitgliaaajPiii...:.i:
P''..I. 1- and 2-family dwelling Commercial/in usma Accessory ul mg
For special information use checklist.
El Multi-family 0 Master builder 0 Other: '
... . Desenprion Qty. Ea. 'rota!
f.:"C:;:,
.
Air conditioning
Job site address: o,9._ ,541 . I, 4 :? •r7 0 IPA' • wits site 'Ian sbowinL .lacement 46,75
City/State/ZIP: /COOP.° OR- 9 IFIRTM1111111 Furnace 100,000 BTU (44:siva:its) EN 46.75 ME
Suite/bldg/apt, no.: Project name. A '
. A 19PINNIIMIIII Furnace 100,000 BTU (ducts/vett!s)
Heat pump
II 54.91
61.06
Cross street/directions to job site: I Duct work 23.32
- -
I H dronic hot water system
2332 _
Residential boiler (radiator or II 11
- _ I hydrom) 23.32
,_ — Unit heaters (fuel-type, not electric), magi
___________
MN
. .
Subdivision: Lot no : in-wall, in-duct, 511 tended. etc.
F)ue/vent for an of above 23.32
Other: 23.32
Tax map/parcel no I Other foci a. dinoces
Big+Vig „_,, ,itg5 water heater =11E81
a 33.39
A - _ c z• Fhie vent for water heater or gas III
fireplace III
- Lo.; li hter las --
Wood/pellet stove _ III 33.39
I . Wood fir • lace/insert 4 G. 23.
Chi nine ineriii uclven t
1 WillIF 23.32
ISIFIVIPI
O t h er:
- - I -
Name. _ e ,-<..3,, if-/-e/ p4,',/// , i , Environmental exhaust and ventilation
I Range hood/other lcitchen
Address: ej ----
A /Q4 *.‘ ,C)/ . ui•ment 33.39
City/State/ZIP: - 7 - /6 4 , / ... s l 0 i< 9 .- eP ./ Clothes • ere ; ust Eli 33.39
Singlc.duct exhaust (bathrooms,
Phone: (503 6, _ 9/ 9 Fax: ( )1 toilet com•artments, utility rooms) 23.32
fitiii VeiaN C W ;; ;;;MM'FiTr';,;Tgap, : '7:,:pf0, , 75, 7 457.M" , V■c : ',7g.tY - 75: 2 ;ii I NIR:70707,3452A Attie/crawl - *ace fans 2332
I Other: • 23.32
Business name: .
el go _ JO il S
Contact name: •= / , A'e .- I $14.15 for first four; $4.03 for each additional
Address: /0 & 7 --- -- 4 _ . IIIII.
City/State/ZIP: -- R_ , o /P.-- I ESEMBEIMIIIIIIIM • lig e ...
Phone: ki5,b_5 ,, 6._ ' di IMMIIMIMIIIIII COM111111111111.
I -
Fir • lace
E-mail: , ' c ) - / z/o / e/77,7, , 4t , 1=111111=11 Range
_
Firgir,TZW:qqrllielOgt!:21.7•7.517;t14577/37,Falfgtiiii#3i,q7INI1ENTPM Barbecue MI
'''■" ik.% , .. , r1 , 2;a,s,.TC1, , ,..;', , .;n42 , ,xi.....,11..ti...a;ht.w. . —
MIMI
Ma ARIZIII478,1 Clothes d er • as
Other:
Addrcss:
-____lr -re- I
R r.
City/State/ZIP; Subtotal MIMI
— ' Minimum permit fcc (590,00) 9d_ 6
Phone: ( ) Fax: ( )
Plan review (25% of permit fee) / er6
_
i CCB lie.: 4 ,y 6,? State surcharge (12% of permit fee)
-
TOTAL PERMIT FEE de,. 411
( ' c747,--P'---. it Application expires if A permit is not obtained
Authorized signature; This perm within ISO
;
days after it has been accepted as complete.
..--
I Print name: /.". - 41-2,7 - s cze Date: /- / /,..., • Fee methodolo sct by Li•County Building Industry Service Board
600/Z00"ti 698Z# SNVH301110-INOr V60889199 609 617:n. ZLOZ/n/L0