Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 - 00066
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/17/2009
PARCEL: 2S114BB - 08500
SITE ADDRESS: 16324 SW 104TH AVE ZONING: R -
SUBDIVISION: SWANSONS GLEN LOT: 026 JURISDICTION: TIG
PROJECT: BREITENBACH
Project Description: Replace furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: 1 VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
SCOTT & COLLEEN BREITENBACH Description Date Amount
16324 SW 104TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 2/17/200E. $72.50
[TAX] 12% State Surch 2/17/200E $8.70
Total $81.20
Phone: 503- 968 -9097
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -557 -2220
FAX 503 -557 -0919
Reg #: LIC 72623
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: 1 n D D1L� Permittee Signature: Si2 V App1 i or dn
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.
,,FEB- 16-cag09 11:30A FROM: TO: 5035981960 P.1
Mechanical Permit Applic4EWED IOlt III I II I I `1 0 N 1
City Of Tigard Received ^ 1 7 20 09 Date/13y: 0- l - • `1 • PermitNo.: ill C - s • ,:
13125 SW Hall Blvd., Tigard, OR 97 Plan Review
Phone: 503.639.4171 Fax: 503.598. 9 Date/By: Other Permit:
III A II n Inspection Line: 503.639.4175 OF TIGARD Date Ready/By: See Page 2 for
Internet: www.tigard- or.gov BUI�ING DIVISION Notified/Method Supplemental Information
TYPE OF WORK COMMERCIAL. FEE* SCHEDULE ,- USE C1IECKLIST
❑ New construction ® Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed, Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CQNSTRIJCTION Value: $
1- 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® y g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: I (24 6vW , O4 -ketenv° Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: Tigard, OR 41.4 Furnace 100,000 BTU (ducts/vents) , 1 14.00
Furnace 100,000+13TU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00 _
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above I 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace , 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert , 10.00
Chimney/liner/flue/vent 10.00
' PROPERTY OWNER D TENANT Other: 10.00
Name: 3C e,rerftniaciciii Environmental exhaust and ventilation
Address: ? C Range hood/other kitchen
equipment 10.00
City /State/ZIP: Clothes dryer exhaust • 10.00
) £ Q - - ao a 7 toilet compartments, exhaust
artm , uti @ality rooms) s,
Phone: F ) t comptmnslity ro 6.80
�$f ., APPLIC 0 CONTACT PERSON ' Attic/crawl pace fans 10.00 _
Other: 10.00
Business name: Same as contractor Fuel piping
Contact name: Diane Mason S5.40 for first four; S1.00 for each additional
Furnace, etc.
Address: Gas heat pump
City /State/ZIP: Wall/suspended/unit beater
Water heater
Phone: ( ) Fax: : ( ) Fireplace .
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: Tri County Temp Control
Other:
Address: 13150 S. Clackamas River Drive MECHANICAL PERMIT FEES*
City /State2tP: Oregon City, 97045 Subtotal
Minimum permit fee ($72.50)
Phone: (503) 557.2220 Fax: (503) 557.0919 Plan review (25% of permit fee)
CCB lie.: 72623 State surcharge (12% of permit fee
, TOTAL PERMIT FEE lCS)
Authorized signature: '251 -A , t� This permit days after It has bee accepted i aa complete. obtained within ISO
Print name: Diane Mason I Date: 2.. 14061 r Fee methodology set by Tri -County Building Industry Service Board
1.Tuilding\PorminM13C- crmitApp.doc 01/19107 4404617T(11 /02/COM/WHa)
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CITY OF
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BUILDING DIVISION PERMIT #: k4EC2009-00060
13125 SW Hall Blvd., Tigar , OR 97223 DATE ISSUED: 2117/2009
Phone: (503) 639-4171
Inspection Requests (24Hmj:(603)G3A-4175 ^�„ W���-�
INSPECTION WORKSHEET FOR DATE: 2y19/2O89 TIME: 701AM PAGE: 31
SITE ADDRESS: 16324SVy1U4TMAVE CLASS OF WORK:
SUBDIVISION: SWANS{)NSGLEN LOT #: 026 TYPE OF USE:
PROJECT NAME: BRE]TENBACH
DESCRIPTION: Replace f urn ace.
OWNER: DRBTEN0AQf. SCOTT &COLLEEN PHONE #: 6O3-9088097
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 603-557-2220
Inspection Request Scheduled For: Date: 211912089 Pour Time:
Code # Inspection Description Confirm # Contact # Message
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699 Mechanical final 080817-01 5U�557222U "^
Corrections/Comments/Instructions:
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PASS i 1 PARTIAL APPROVAL H CANCEL 1 | NO ACCESS
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Inspector: i i � ��n� �� Oatg� [ C'� �^ i Phone /5O3\718' &~^��~
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