Permit f CITY OF TIGARD MECHANICAL PERMIT
y, :r DEVELOPMENT SERVICES PERMIT #: 2/3/04 4 -00042
r��Jl 13125 SW Hall Blvd., Tigard, O 97223 (503) 639 -4171 DATE ISSUED: 2/3/04
PARCEL: 1S133CD-10800
SITE ADDRESS: 11674 SW WILTON AVE
SUBDIVISION: COTSWALD MEADOWS NO.3 ZONING: R -25
BLOCK: LOT: 140 JURISDICTION: TIG
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:
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: 1
Remarks: Install NG stove.
Owner: FEES
GERDES, DON W AND SONDA C Description Date Amount
11674 SW WILTON [MECH] Permit Fee 2/3/04 $72.50
TIGARD, OR 97223 [TAX] 8% State 2/3/04 $5.80
Phone: Total $78.30
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
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.
Issued By: .'/ . : , 9 Permittee Signature: e7
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Jan -30 -04 04:39P P_O1
IC) " •.n• RECEIVED :,
Rn tier.: Ee-dooy o ar , 'g'"
:ity of Tigard FEB 0 2 2004 _ a �
3125 SW Ilan Blvd.. Timed. OR 97223 Other Pamir
5°3.639,4171 Fax: 503.598.19(+° CITY OF TIGA- .. u dBy
tt Uric: 503-63 er. us
;. ,,I, . I lade Reedr4BY' j I ® q e ; ter
tenet: „rwcr t r.ugJrd rw.us BUILDING DIVI ` .'. _ t1 //0
ry E OF WORK COMMERCIAL FEE SCHEDULE - USE CHECKLIST
Mechanical permit fees' ate based an the value attic wort
��/
3 New construction !r Addition /alteretion/replarxrnenl performed. Indicate the value (rounded to the neatest dollar) of all
O mechaaiml mtAQisls, equipment, labor. ovatKed and profit.
3 Demolition Value: S
CA IE4ORY OP QOl' fRUCt10N RESIDENTIAL EQUIPMENT / SYSTEMS FED'
B - and 2- family dwelling 0 C(wnmacial/Wdustrial ❑ Aoomerory building Fcr apaclaf ud6stama^ we checklist.
] Multi - family ❑ Master builder ❑ Other Description A Qty. Ern Total
JOB SITE INFORMATION AND LOCATION
d Air conditioning or heat Pump 14.00
bb site address: / /Co 7 y .34) eel Non ? vG trod ,„, sae OM showing p e )
Furnace 100,,1100 B711�� 14.00
,:;ry/stat�rP: T /tor -” da 9 7aa _ �,,,,aa I00000+ltTUsa ► , 17.90 -
—. ect name: G. e r aOc S Qas hem pump 14.00 ,
�� ta.00
Cosa street/directions to job site: 14.00
Iiydronic hot water sin
Residential boiler (radiator or
— - lydrenic) 14.00
Unit heelers (fend -type. not tJhxuic).
io ail. in-duct. suspended. dc. _ _ 10.00 ,
Flew/vent for any of above
iubdivision: : _. (ter. 10.00
Other fad applianon
fax map/parcel rte_: water heater 10.00
DILWRIFIION OF WORK 10.00
(las ftcpla�ce _
...Z.. n z 7 4,// /7 G S 7 t u t Flue ■eM for water heater or gas 10.00
fireplace _
-. _. _ • Log lighter (gau) 10.00 • -
�- Wood/pellet stove 10,00 --
Wood fueplaa/inaat 10.00 ,
(lranoey/linafnu&Vcnt 10.00
- *ROPER Y OWNER ❑ r: r other _6. S 1 c . ) 10.00 10.a0
Nam: Don G- r G(/ /� - E+tvirvrtreatal exhaust and veatlhdoa
Range hood/011m kitchen
Address: //& 7 V S cJ GJ// n 19 uC equipment 10.00
City/State/ZIP: T � / / f o r �Q O / � 9 w as I . drier-
exhaust Vim. 10.00
Phone: (53) o Z 7 . «a O / Fax: ( ) toilee compartments, utility mums) 6.80
2-APPLICANT 0 CONTAC f PERSON Attiricrawlsrce fans 10.00 -
_ - Other: 10.00
Business name: 4 a c e i n 4 /7 S. . .
Contact name: O 4/ 4 G ,e c- /0T - SSA for firer leen ; Slag for each addldonal
Fu nac_. etc.
Addiess: / a eta 73 Sl.� 43 cover ca' Rte _ Om hear pump
City/Staterup: eaver cn OR 9 7 OO Watlr::ospeadtegund beater
W>otor
Fbooe: (.St,N) 64/o - C0V/ 6 j Fax:: " 0. CI 5 6P434/ Witch he ems
E -mail: _f .
CON7RAC I OR _ Berbca
• • Clothes Player (pas) Business name: /h �. Other:
Address: MECHANICAL PERIIQT FEES'
City/State/ZIP. r Subtotal /O. e1 O
minimum permit toe ($72.50) 7� D
Phone; ( ) - I Fax: ( ) , _ Plan review (25% of permit fee)
CCII lie.: .5 / V t r 9 - a ea ( 8 %
TOTAL PERMIT FEE x
- ',30
Amhorized signature: / / CV Mb pen* aP�o das eip el der penal/ et act ablaut within 180
�^ / c gays after it bas been accepted at complete_
Prim I Date 1
1 • Fee unimmeez, eel by TriCoanry nuibdxos Weary Service Hosed
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175 r
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received �- S �Zi Date Reques ed R /2VO9' AM PM BUP
Location f / (p 74 � ) 1/�.. Suite
Contact Person i (L4'l d_0. Ph ( 3) b — &'1 PLM
Contractor �— . . . ' � i& _! iA . t / - Ph 620 iWR
BUILDING Tenar(/Ow R Al S? 4Ld _' ■ ) LC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: , 4 SIT
Post & Beam /l2 ed ' ' ' S Are
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing C' %. acc, a•c aLv ✓C-
Insulation
Drywall Nailing � 1'--€S L[.`EiZ e -# �rT� c.✓ �L1�`.�' -'-iS
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ,, - t
/
Root (q 2,. `M
Final
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
PASS PART FAIL
(CHA IT AL)
Post & Beam
Rough -In
-s Li
Smoke D. pers
�i� PAR =A
RICAL"
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City , 13125 SW Hall Blvd.
PASS PART FAIL
SITE D Please call for reinspection RE Unable to inspect — no access
Fire Supply Line
ADA Z 3 -- e �-,
Approach/Sidewalk Date 2— Inspector • Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL