Permit .�. CITY OF TIGARD MECHANICAL PERMIT
j4, DEVELOPMENT SERVICES PERMIT #: MEC2006 -00143
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/12/2006
PARCEL: 2S 103CB -00500
SITE ADDRESS: 12185 SW JAMES ST ZONING: R -4.5
SUBDIVISION: WILLAMETTE LOT: 007 JURISDICTION: TIG
Project Description: WOOD STOVE INSTALL.
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:
OTH 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
WOODSTOVES: 1
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
GROSSE, E R E F Description Date Amount
12185 SW JAMES ST
TIGARD, OR 97223 [MECH] Permit Fee 41121200E $72.50
[TAX] 8% State Surcha 4/12/200E $5.80
Total $78.30
Phone: 503 - 590 -7219
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 646 -6409
FAX 503- 646 -8034
Reg #: LIC 51469
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 :6 1 / Permittee Signature: a i z X 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.
APR .11.2006 11:50AM 0.552 - .2/3
?Mechanical Permit Application 1.()It (HA It I. 11I. t) 1.1
Received Ii
\lait of Tigard _ - D1 y _ I PamitNo,: �t 6'�"atDVb mil'
'13125 SW Hall Blv. T__. }L, sR 9 2 r Plat Revie
ether Permit;
Phone: 503.639.4171 - ' v 5 L 2 ' 9 0 ii i *�" 6 1 , 101I I . any aria: 6d See Page 2 for
inspection Line: 503.43'.4175 u _�.i4 --` •I 1 Date Readyn3y:
Internet: www.ci.ligard.or.us i 1 � Notified/Methed: 7 Supplemental Infermanou I
APR U _ 1,
' : f 11 . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST 1
0 New consttuctiot�fi I AdditiFigu , l eplacentent
Mechanical permit free• arc based on the value of the work
Pi m � ,S 1 y r « E performed. Indicate the value (rounded to the nearest dollar) of al
❑ Demolition B 41 -'" - • Other: mechanical materials, equipment, labor, overhead, and erotic
CATEGORY OF CONSTRUCTION Value: $
• RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1: - and 2- family dwelling ❑ Commercial/industrial 0 Accessory building For special IOformatron use checklist.
• ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea, Total
JOB SITE INFORMATION AND LOCATION Reefing/cooling 1
Air conditioning or heat pump
Job site address: -1 i ;
/ /. .S 4) .- n•! (requires sitepton allowing Placement) 14.00
City /Statc/ZXf f /C9Qr a a � '7aa Furnace !00,000 BTU (ducta/vcnt� 14.00
Furnace 100.000+ BTU Iducta/vensl 17.90 ,
Suite/bldg./apt. no.: Project name: a x S e Gas heat . um. 14.00
Cross street/directions to job Site: Duct work 14.00 ,
- H drortic hot water system _ 14.00
- Residential boiler (radiator or
h dronic 14.00
- _ Unit heaters (fuel -type, aot electric), � l1
in -wall in -duct. sus . ended, etc. 10.00
Subdivision: Lot no.' Flue/vent for any of above 10.00 ii
Other: 10.00 !I
Tax map/parcel no.: Other fuel a .. linnets I
I
DESCRIF ION OF WORK Water beater _ 10.00 1
Gas fireplace 10.00
..X fill co Art#. _ Flue vent for water beater or gas
fireplace 10.00 1,
Log lighter (gas) 10.00 1
Wood/pellet stove / 10.00 - /a - A
Wood fru.lace /insert 10.00 11
PROPERTY OWNER - C /flue/vent / 10 0 /t2 D
Other. 10.00 1��
Name e h C C' eb e .p h f 4} Gees a ' Environmental 'Exhaust and ventilation
Range hood/other kitchen
Address: /s /, 4 - �r I'1 - equipment _ 10.00
City/State/ZIP: 7/ 640 �,� p 9 7 aZs Clothes . r exhaust 10,00
Singleduet exhaust (bathrooms,
Phone: (543) 51 7? / 1 Fax: ( ) toilet compartments. utility rooms 6.80 II
r APPLICANT LI CONTA ER_ SON +`1 e Islam fans 10.00 1
10.00 1 Business name:
�G e M4 h g �'
F .
Contact name: 5, ,9/ ' �/qc J S& 40 for iirdt four; £100 for each additional 61
Address: /a 5 A lea" Furnace. etc. -
t!o 7 � t'1�t 4 n'1 t3as heat .tun•
City/StaterZ 1' nit Ar. vrr 764 OR 4 f 70a , , '1 Waivsuspended/unitheater 11
Phone: (, 03) 05/6 - ( - Fax:: (5Q 3) , s/ - cPet.3 Wa er heater - _ I I
Fireplace 11
E -mail: Range I!
CONTRACTOR Barbecue_ -
Clothes dryer (gas)
Business name: _ _ M Other:
Address: MECHANICAL PERMIT FEES* y
City /State/ZI : _ Subtotal Q ,j' p, or, 1I
Minimum permit fee ($72.50) __13, S.1
Phone_ ( ) Fax. ( ) Plan review (25% of pennit f lo) �'
CCB lic.. / y[p ;*— r; cr... j Stele surcharge (S% of permit fee) 4' �'
TOTAL PERMIT FEE 'f 3 "
Authorized si t t1rL•' �. Tina permit application expires if n permit is ant obtained within 1a 1
1 dotes after It has been accepted as complete,
Print name: ry ( j �(/`� Date: •., , n _ 0 � ' Fee methodology set by Tri -Cowrry auilding Industry Service Board 1
CITY OF TIGARD
BUILDING 'DIVISION PERMIT #: MEC 00 00143
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/12/2006
Phone: (503) 639 -4171 4�i��i '
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/0/2006 TIME: 7 :06AM PAGE: 69
SITE ADDRESS: 12185 SW JAMES ST CLASS OF WORK:
SUBDIVISION: WILLAMFITE LOT #: 007 TYPE OF USE:
PROJECT NAME: GROSSE
DESCRIPTION: WOOD STOVE INSTALL.
OWNER: GROSSE, E R E F, PHONE #: 503590 - 7219
CONTRACTOR: LUDEM.AN'S FIREPLACE & PATIO PHONE #: 503-646-6409
Inspection Request Scheduled For: Date: 9/6/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 - Mechanical final 036053 -01 503 - 590-7219 V
Corrections /Comments /Instructions:
•
I/ ASS I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: , "7 Date: �f Phone #: (503) 718 - `L�-