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Permit � I v CITY OF TIGARD MECHANICAL PERMIT 1114 s • COMMUNITY DEVELOPMENT Permit #: MEC2013 -00010 T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/07/2013 Parcel: 1 S133DA02000 Jurisdiction: Tigard Site address: 11045 SW SUMMER LAKE DR Project: McCroskey Subdivision: AMART SUMMER LAKE Lot: 42 Project Description: (1) gas fireplace installation, (1) flue vent and (1) gas line Contractor: LUDEMANS INC Owner: MCCROSKY, WAYNE L 12675 SW BEAVERDAM RD 11045 SUMMERLAKE DRIVE BEAVERTON, OR 97005 TIGARD, OR 97223 PHONE: 503 - 646 -6409 PHONE: 503 - 579 -4713 FAX: 503 - 646 -8034 FEES Specifics: Description Date Amount Gas Fireplace 01/07/2013 $33.39 Type of Use: SF Chimney /Liner /FlueNent 01/07/2013 $23.32 Class of Work: ALT Type of Const: Fuel Piping 01/07/2013 $14.15 Occupancy Grp: 12% State Surcharge - Mechanical 01/07/2013 $10.80 Stories: Minimum Fee Adjustment - Mechanical 01/07/2013 $19.14 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 or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: /` , Permittee Signature: o/ll 4 PP u � -n 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. 01/04/2013 16:19 503 64668034 RECEIVED #4095 P.002/003 1 . Mechanical Permit Application 1:012 (WI. ICE 1 NE ()`,1.1 City of Tigard JAN 07 2013 Reeeivtd i No : Ili 13125 SW Hall Blvd Phone: ,Tigard, OR 97223 . ma y" I I l 3 r C .mil ow i AI Phone: 503.639.4171 Fax: 503.598_ l 960 CITY OF TIG • 1 . p�D 12eview Other Peres T I G A . P. D Inspection Lire: 503.639.4175 ISI Ready/BT. .he. See Page 2 ror Internet; www.tigard -or.gov BUILDING Notificd/Metbod: I,6 I 1D Supplemental Information „ r ❑ New construction Addition/alteration/replacement Mechanical permit fees` are based on the value of the work performed. Indicate the value (tvimded to the nearest dollar) of 1 ❑ Demolition Q Other: mechanical materials, equipment, labor, overhead, and profit. d r S l .r t , S 7 t fi.. r d' T r f. Valuer $ l{«, i"+�'rT� «, ����..y.... �, - �.' , •, 1� C r� C .'i � ..1..7w..•.7i a n.,1'1... .. _.....» .v.. ....:. ... f:: ,d •.x.v..'..,.M. ._. ..ww,l �j�5t '. .: � • r 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessety building :,':...,...':.z..:;:: , ~: .` ".' _R ,3. '....., .. For special information use chedd ist. © Multi- family ❑ Master budder ❑ Other: Description Qty. Ea. T. - I i +� i1H,M�i ' b. e} ). .11..r. ...... ` . -. :41t' .. ' ar ....� _ .'.i . ea V A ir b `�- Job site address: / /'0 , = u e• site •Iansho laecment 46.75 City/State/ZIP: l / 6 0 r ' q / 0. f Furnace 100,000 BTU (duels/versa) 46.75 _1. Furnace 100:000+ BTU (duets/vents) 54.91 III_ 5uite/bldgJapt. no.: Project name: 72/ C , � Had , • 61.06 Cross strooUdireciions to job site: / Duct work 2332 Hydros c hot water system 2332 Residential boiler (radiator or h drone 23.32 , t r.,U. ( . I . el C . c), in -welt, induct, susp etc- 46.75 Flue/vent for any of above 2332 Subdivision Other. 2332 Tax map/parcel no.: Other thei appliances ir. 'Pwx ° : _ z ; < °" 3 1, ° , , :9 c , Z r r h r ti}- I -rr r n Water heater 23.32 ,T scE tv... , - &4 -, , , " :. .:.1... -..__ .�..., . -.,r . ._. . . , - . . �. �,,,, .., .. [ -,,,,'.. l fireplace / 33.39 33 . - oaa µY ' L - -- /J . - - - / � - C - qr7 Ci Flue vent for water heater or gas • •lace / 23.32 , d _ _ 23.32 �_ ' Wood /. Iletstove 33-39 _■ Wood • laceftnsert _ 23•32 y � ' z , , ChiameOiner/f UthCnt 23.32 • t- F. 1 :' , :-; t.. `_' ' :, .,. . -- .... 1_..7:1 :t....,.w Y J.. 2.. : :" :!:�- :r.S s� Hi,:,:l. S.. . ,.. :4i.: }..J :!.,: o t h er: 23.32 rw e t , -� , . � ._. Name: 1 4 ,, , . , /` C � 4 , /� � Environmental exhaust and ventilation Range hood /other ldtchen Address: //,, ,5 ,,s , L , - AFL /- A ,' •Vj•meut . 3339 I t J City/State/ZIP: / &CI / OR 7 a a 3 Clotho exhaust 3339 I_ t Singlo'ductlexhaust (bathrooms, Phone• (,Sn'A) 7 713 Fax ( ) toilet compartments, utility rooms 23.32 -N4,-.1.2'.;2,, 'x t J r ? ,^ u;st Atbdc wlspace fans 23.32 1 1 y } : C s .� 2 m : : ::: .. :.._.. - ,�.... , , ,: 4.. ...z.: . a .ti 1 ...,^>? r. w ■ 23.32 L,. a r.,.._.� c F�, , >.- ._.... .. . ... . . - . .... otter Business name: // 1 - III Contact name; 41� $14.15 for first tour, $4.03 for each additional Furnace, etc. Address: /.. Co 7 ^' , _ _.4, - ■ Purr, • Gas heat , - City /State/ZIP: `,< < d/Z - 700' wall/- •- . . dedhmitheater 1111110 water heater .1111Milli Fax: Phone: �. J � (p. CO 0 ' o .61 .-- 31/ F' � � lace E-mail CD /C/C74 qi • 1'.'i Ran. e _r__ On r ti w Barbecue 111 IIII f *' r .n? w .�r. ':i , .�,. 1,....i..�_.r<. a , . - Clothes dryier (gas) Business name: 0 e ,-, 4 , . 5 Off _ c d' r i - .. 1_:. i, - . _ ... i V - Address: .. -1?-•' Sabtntal 4. City /s farce: Minimum permit fee ($90.00) 9,0, in Phone: ( ) Fine: ( ) Plan review (25% of permit fee) i CCB lie.: _ / (p? State surcharge (12% of permit fee) /0 . TOTAL PERMIT FEE /Oz, • , � j � , This permit application expires if a permit is not obtained within 80 Authorized signatory: 7 days after it has been accepted as (=piece. e..l -- th 4 — oriz «.. • / - � -. . e- -X G-., //w! — I Date: / —, l • Fee methodology art by Tri•Cermty anadmg Industry ` ` 01/04/2013 16:19 503 64668034 LUDEMANS #4095 P.001 /003 . ! 6464409 12675 SW CANYON ROAD BF.AVERTON, OR 97005 11.8@0.886-':83 _ ::_ _.... FAX 5O3.6464824 FACSIMILE TRANSMITTAL To: eq O 7 /,a:2 Date: /— y /3 (3' %59V /910 00774 ; 71ccAgn/co./ Perm/ From: Joni Hacker CUSTOMER SERVICE Pages including this: 3 Ph: 503 - 646 -6409 Fax: 503 -646 -8034 jonih@ludemans.com • Re: • , GA - n /CQ/ se . /r c: cocs -ee • • • I � 7274peyirs . . •