Permit CITY OF TIGARD MECHANICAL PERMIT
a : COMMUNITY DEVELOPMENT Permit #: MEC2012 -00687
T WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/31/2012
Parcel: 2S103BB10500
Jurisdiction: Tigard
Site address: 12240 SW KATHERINE ST
Project: O'Sullivan Subdivision: YE -OLDE WINDMILL Lot: 25
Project Description: (1) gas insert installation, (1) fuel piping and (1) chimney/liner /flue /vent
Contractor: LUDEMANS INC Owner: O'SULLIVAN, EILEEN
12675 SW BEAVERDAM RD 12240 SW KATHERINE ST
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 646 -6409 PHONE: 415- 425 -9905
FAX: 503 - 646 -8034
FEES
Specifics: Description Date Amount
Flue Vent for Water Heater or Gas 12/31/2012 $23.32
Type of Use: SF Fireplace
Class of Work: ALT Type of Const: Chimney /Liner /FlueNent 12/31/2012 $23.32
Occupancy Grp: Fuel Piping 12/31/2012 $14.15
Stories: 12% State Surcharge - Mechanical 12/31/2012 $10.80
Minimum Fee Adjustment - Mechanical 12/31/2012 $29.21
Fuel
Fuel Types:
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
4 - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: A I 1 (jJ Permittee Signature: DJ PL-it 4 ti () J 417
Call 503.639.4175 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.
ti
12/28/2012 13 08 503 64668034 LUDEMANS #4036 P 002/003
•
Mechanical Permit Application' ECEI VED FOR OFF 1( USE;: ON 1.)
1114 City of Tigard t Received !� '3 i �i ., .
i 1312 5 W Hall Blvd., Tigard, OR 97223 I 31 2012 Plan Review
Phone: 503.639.4171 Fax: 503 - 598.1960 DateBy Other Permit:
F I c, n 1. D Inspection Line: 503.639.4175 CITY OF TIGARD ' Ready /By: IIIIIIEEMIll
Internet: www.tigard-or.gov Notified/Method:
BUILDING DIVISION
New construction Addition/alteration/replacement : , � �� N r e �
i ❑ mechanical permit f arc based on the value of the wart:
performed. Indicate the value (rounded to the nearest dollar) of all
I ❑ Demolition Q Other. mechanical materials, equipment, labor, overhead, and profit
it
Q 1 - and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building
❑ Multi- family ❑Master builder ❑other For special information use checklist.
Description Qty. Ea. Total
4 V c . .._ ., ... .. .::: r .... ✓::...,a � _ t , Heating/cooling
Air
Job site address: /C(9 96 4) A r/ C° r7 � (requires ices conditioning site
Oan showing placement) 46.75
City/State/ZIP: j io ,. `i / Q/ 5 7 3 Furnace 100,00 BTU (doors/vents/ , 46.75
1 Furnace 100,000+ ETU (duets'vents) 54.91
Suite/bldgJapt. no.: Project name: u- .Lyle,/ py Heat pump 61.06
Cross street/directions to job site: Duct work 1 - 2332
_ Bydronic hot water system 23.32 _
Residential boiler (radiator or
hydronic) 23.32 .
Unit heaters (fuel -type, not electric),
I in -wall, in -duet, suspended, etc. F 46.75
I F1uelvent for any of above 23-32
i Subdivision: Lot no.: '
Other: 23.32
Tax map/parceI no.: Other fuel appliances
�, t . lZ r 7 aGt3 , 777;,«-113;: W �1r " Water 1 2332
± - . :YA_. «47V.i;4 - .11 51 gla-oh.rei 7 _1 F e ^, .tfL Zstr ', ?Ain. i' -, � '.. -,- c i ° . ; .
Gas fireplace 33.39
h _S7 9 /J . 72 6 -. �, s',--r -4 9 c r 4//-7 Flue vent for water heater or gas - .
fireplace , 2332
Log lighter (gas) 23.32
Wood/pellet stove , 33.39
Wood fireplace !insert /) ( / 2132 .),33 -
y Saw^ ;_veoc p,v . r f. a F >. Chi ttmey/liner /fluc'vent _ / 23.32 073.30P-.
r• m "'iGi
7krct,,. ' t A x; :3rlw . Egw .r:a a.,; L4 ... a . .+ ...,. ,r_ .... _ Other: 2332
Name: l f c 0 / a /hv q , Environmental exbanst and ventilation _ _
Address: j 0 / / equipment hod'other kitchen
/�4v.4��ri�e. 7 equipmennt 33.39
City/State/ZIP: 77 c2 a iP 9 -7a Clothes d exhaust 33.39 I
Single -duct exhaust (bathrooms,
Phone: (y /5) V (7 Fax: ( ) toilet comprtments, utility rooms) _ 23.32 .
Attic /crawlspace fans _ 23.32
Other: 23.32
Business name: ` „ 5 Fue! tin
Pp R _
Contact name: 41111P..yi ,9G KG / C $1415 for first four; 54.03 for each additional
r Furnace, etc,
Address: /a C0 7S 4 // , __�3.q 4czv zet -- {Z ems heat pub . _
sl
City/StateiLIP: J9!/rf 7Ivri C9 / 9' 7dp,5 Walls .. dedhtnitheater
Phone: (5 ?) `fLo 7 ) Fax:: ( S4 . 6 S/eo - ,3/ ' Water ter
�// Fireplace ... /5 1
E -mail: Oil /CI 47, . do t'el Range
v; Yt : - Barbecue
;. ......._.. Clothes dryer (gas)
Busin ■
ess name l?C] C'/rl�Q S
Other $� `'7
Address: e 1Z _- sacs esSR .. ..r._ r_r._..
City/State/ZIP: - Subtotal Or), 77
) Fax: ) Minimum permit fee ($90.00) 90 OZ; ,
Phone:
( ( Plan review (25% of permit fa)
CCB lie.: J �/ 6,? State surcharge (12% of permit fee) /O. _ 1
TOTAL PERMIT FEE / co ., 7(}
This permit ppliea8on expires if a permit Is not obtained within 180
Authorized signature: // / !days after it has been accepted as complete.
I Print name: �f"ir,) O< fin / �iC . I Datc: / 7. 7 5 La 1 • Fee methodology pet by Tti- County Buildin3 irdw'ty Service Board
12/28/2012 13:08 503 64668034 LUDEMANS #4036 P.001/003
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12675 SIN CANYON Mrs
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FACSIMILE TRANSMTITAL
To: ( /p d, 776■2 Date: /2 - v /c9—
G-4.5 398• /9670
ATTIJ ; perm/AS
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From: Joni Hacker
CUSTOMER SERVICE P ages ' uriuums this:
Ph: 503 - 646.6409
Fax: 503 -646 -8034
jonih@ludemans.com
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