Permit CITY OF TIGARD MECHANICAL PERMIT
311 °: COMMUNITY DEVELOPMENT Permit #: MEC2009 -00128
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 639.4171 Date Issued: 03/26/2009
Parcel: 1 S125DD06600
Jurisdiction: Tigard
Site address. 9580 SW VENTURA CT,
Subdivision: Lot: 0
Project: Lindsey
Project Description: Install wood fireplace and chimney.
Owner: FEES
LINDSEY, LYLE Description Date Amount
3265 SE MADISON ST Wood Fireplace /Insert 03/26/2009 $10.00
PORTLAND, OR 97214 Chimney /Liner /FlueNent 03/26/2009 $10.00
PHONE: 503 - 319 -5210 12% State Surcharge - Mechanical 03/26/2009 $8.70
Minimum Fee Adjustment - Mechanical 03/26/2009 $52.50
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062
PHONE: 503 - 692 -5563
FAX: 503 -691 -6855
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuan , or if work is`s pended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Util' Notification Center. hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. •u obtain a copy of the rules
Is ued By: // l-CX `^th Permittee Si; nature: :02, 4'
•
Call 503.639.4175 by 7:00 a.m. for an inspection that b • -mess day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
25/2009 09:02 5036916855 SHAMBURG HEATING LLC PAGE 01/02
7 •
Me hanicai it _ rd . 0 l-(nt.i)rru is 1 , ,.,,NT.) .
DIED DR ° ?amt. No. 0 0 26 09 — DD /A
IN f 9 City W Hall d., Tigard, P. 97223 Plan Review
a e q 5 A 2009 Other Punic
Rom. 503.G39A171 Fax: SD3.54�i N
Inspection Line, 503.639.4175 Date R. ft: E Ste Pine z ter
i <: F' Tntx ,vww.tfgaTd-ot,$bv
;, CITY O F TIGAR� N TlotilieAlMetl,ad: M � FIE' � gyppla,aomtal Information
, "
�r? � . - CO MERCIAL ' SCHEDULE - USE CHEL KL1CST
• Meehattteal potion •used on the vahte of the work
New construction 5 • dditton/altcreti00 /replacement pelt rrmed. irldie= 01c value (rounded to the neared dollar) gall
In Demolition [a Other: mtcbavioal materials, aouipment, labor r overhead. and .rofit
Value' S
CATEGORY EGt7RY of CONSTRUCTION
r RESIENT IAL EQUIPMENT / SYSTEMS FEES'
G • and 2- family dwelling ❑ Commercial/industrial El Accessory building Foryeeta/ *►nnath:m use c)mcfo isr.
❑ Muttifernily Q Master builder 0 der: Description l Qty, Ea. Total
JOB au INFORMATION AND LOCATION Head coolie:
�/ f Au conditioning of hen pump III
Job site address; ' V dE Y, •ireg sit, , an : • , cement 14.00
i 0 . / Furnace 100.000 BTU (daoh/vcnta) ill 1400 1.1
Cily/9[atelLil'' / d vie. ?i� Furnace 100.000+ 911.1 Ands/vents 1'740
Suite/bidg /tpt. no.: Projeotname: 14.00
Ceoss street/directioms to job site! Duct wort MI 10.00 ME
drone hotwater • 1 4.00
Rladdential boiler ad . . or
hydronic) 14.00
Unit heater (fuel -type, trot a catric),
i"al4 irtdpe6 suspended, etc' 14.00 J11
Fineem nt for any of above . 4.80
Subdivision: Lot no.: . ter 10.00
Tax map /parccl no.- Other fuel a .. liatleer
I?ESCRW1 QN OF WORK Water healer 10.00
10.00 MEI
I � _ r / B . / -� . / / Flue vent for water hoer or gas t t
firnplaoa
1.og lighter (gas) _ 10.00
Woodpctict otovc 10.00
W .. d fi ... laceratsatt 10 -00 •,. G Q
chi • 111neditue/vent IM 10.00 1
r. •• OPERTY o R O 'SAN' Other r 1 0,00
Environmental exhaust and ventilation
Ranger hood/ofner kitchen
r• •1, crt 10,00
City/StateCCF. 0 f., i ot, g J2 / (mites dryer exhaust MI 10,00
single -duct exhaust (bathrooms,
Phone: (3) ,�/ 9 - 5Z-10 Fax: ( j, (p � toilet c. . , ., util' . ro0+tla MI 6.10
❑ APPLICANT ❑ CONTAt2T Attic/crawl, , , a Bins r 10.00
Other. _ 10 00 NM
Ihlel pi➢iPQ
Contact name: 55.40 for first !burl 51.00 f each , dtidonal .�
Ftiuttacc, ox
Gas heat pump
CityfStetc/ZIP: Wa11/susponda sinttboater
water heater
Phone: ( ) Ftrt pJecs _.
Eill Ran.
1y'♦ sr CONTRACTOR L Barbecue
EMEM U J r..• Clothca dryer (IjAS)
other:
MECHANICAi PERMIT FEES*
City/State/ZIP; / _, -_ ., . A ' cep 4 /Q6, sasto>9� Q .
Minimum permit fee (372.50) 4 2 j0
Phonc: ( ) _ j Plan rmicw (2596 of permit fez)
State surcharge (12% of permit its) g,10
_ TOTAL PERMIT FEE J7, LC'
This permit apptitattoa expires if a permit Is ant pptninee within ISO
Authorized signature: Any. after it bas hear aeeep d es samplers_
Date: _ - i • Fee matltedelogy set by Tri-Coanty Imams Indust y Service Baird
1 %HulldirePr min %tSCCPumrtApp ex 01 s er 4404417701/a]1COM/wS6)