Permit III v
CITY OF TIGARD MECHANICAL PERMIT
I : , ., COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00001
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/2/2009
PARCEL: 2S 104C D -00201
SITE ADDRESS: 13553 SW HILLSHIRE DR ZONING: R -7
SUBDIVISION: HILLSHIRE ESTATES LOT: 002 JURISDICTION: TIG
PROJECT: AGNEW
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: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
BARBARA AGNEW Description Date Amount
13553 SW HILLSHIRE DR
TIGARD, OR 97223 [MECH] Permit Fee 1/2/2009 $72.50
[TAX] 12% State Surch 1/2/2009 $8.70
Total $81.20
Phone: 503 -430 -1523
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -557 -0230
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: 4eyetals �, � QJ `
PermitteeSignature: l '1 I Calt[bVi
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.
7.3'Alig- ■-2009 09:20A FROM: s T0: 5035991960 P.1
3
Mechanical Permit Applica. ► ECE V i FCIR OFFICE USE ONLY
City of Tigard Received
) (�' l'. j Date/By: SW Hall Blvd,, Tigard, OR 97223 JAN 0 e -. =i� Y •2 -> Pcrmit Nn - Ili __ 0 00001
°1 I! . Phone: 503,639.4171 Fax: 503.598.1960 Plan Review Other Permit:
CITY Date/Ry.
I v c n h D Inspection Line'. 503 639.4175 4 1• ®F TIGARD Date Ready/By: 5G see Page 2 for
Internet: www.tigard-or.gov Notified/Method, Supplemental Information
BUILDING oIlfiVIO
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
New construction 61 Addition /alteration /replacement Mechanical permit fees' are based on the value of the work
perfonned. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
6
t - and 2- family dwelling ❑ Commercial /industrial El Accessory building
Multi-family ❑Master builder ❑ Other; RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist,
Description I, Qty. Ea, Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: X3053 e V V ► " V U0h,i r{� W . Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: Tigard l� ce22e Furnace 100,000 BTU (ducts /vents) I 14.00
Furnace 100,000+ BTU (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 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
� qO itiirfiLtrf,) Gas fireplace 1000
O �,1 l�) 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 � y OWNER ❑ TENANT Other: 10.00
Name:
barb rt.v
i 'Iy neA4 Environmental exhaust and ventilation
) Range hood /other kitchen
Address, FJ� l l f Ite" equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms,
Phone: ( 1 ) Lim it Fax: ( ) toilet compartments, utility rooms) 6.80
A APPLICANT ❑ CONTACT PERSON Attic /ct awtspacc fans 1000
Q) Business name: - rr+ CO(� 1'1 hf T� }��h con-h Other:
ll. Fuel piping 10.00
`^ - M I 1 ^ _I`
F Contact name: vary_ � r l , $S.40 for first four; $1.00 for each additional
-- I Address: 1.'7,t 60 S C:�l,����� C a6 �' 4 �r- � Fumace, etc. _
�/ 1) C+ Ca04- Gas heat pump
L � City /State /2IP: Wall /suspended/unit heater
1- � Phone: 51;6) 557 O A': : M) 1 l r. 1 en VI Water heater
Fireplace
E -mail:
• Range
CONTRACTOR Barbecue
Business name:' - rot-au t in , 1 ` o vi Clothes dryer (gas)
Other:
Address: l3 tSo 6• i ' . mug I I l �r j (�, I,
V„J r v MECHANICAL PERMIT FEES* City /State /ZIP: o eq 0 n Og_ t l'<..4 Subtotal
Phone: (so 5 7 e7 4, Fax: (^ 66? Qg Minimum permit fee ($72,50)
��� �� Plan review (25% of permit fee)
CCB tic.: State surcharge (12% of permit fee) Q 2 /) , ,
�,• TOTAL PERMIT FEE U I • �/
Authorized signature: , c j:a � L� • / This permit application expires if a permit is n ot obtained within IRO
days after it has been accepted as complete.
Print name: ,T , �` I. Q • • Fee methodology set by Tn- County Building Industry Service Board
r
I \Building0'erm s\M C- PermnApp dot 01/19/07 440.461Tr (11 /02 /COM/WEB)
CITY OF TIGARD
BU LNG DIVISION PERMIT #: ME 2()0 9-00001
131'' 5 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1p /2()0c3
Phone: (503) 639- 4171'��1���1
Inspection Requests (24 Hrs.): (503) 639 -4175 � �
INSPECTION WORKSHEET FOR DATE: 1/•2W 009 TIME: 7:00AM PAGE: 23
SITE ADDRESS: 1 ME.3 SW HILLSHIRE DR CLASS OF WORK:
SUBDIVISION: 1111 l c I.l ESTATES LOT #: 002 TYPE OF USE:
PROJECT NAME: AGNLW
DESCRIPTION: t eo ce fuenace.
OWNER: AGNEW, [ ARBA 2A PHONE #: 603-430-1623
CONTRACTOR: 1 R! COUNT' TEMP CONTROL PHONE #: 603-567-0230
Inspection Request Scheduled For: Date: 1/20/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
69:9 Mechanical final 07983'1 -01 603 -657 -2220 Y
Corrections /Comments /Instructions
t i k) '''t
C C
i
i
1 ' ASS n PARTIAL APPROVAL J CANCEL n NO ACCESS
❑ FAIL ___ n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
:
i
Inspector:, ■ >� / Date: ( 20 ei Phone #: (503) 718- 436?
CITY TIGARD
BU " ri G DIVISION PERMIT #: MEC200 0(th)i
1312(5 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/212009
Phone: (503) 639 - 4171 ������r,�� Ati,
Inspection Requests (24 Hrs.): (503) 639 -4175 � p'
INSPECTION WORKSHEET FOR DATE: 1/1612009 TIME: 9:07AM PAGE: 3
,...1,4.^ XIV"'
...1, ,Lr X15 ° `
SITE ADDRESS: 13553 SW HILLSHIRE DR CLASS OF WORK:
SUBDIVISION: f LSHII.'E ESTATES LOT #: 002 TYPE OF USE:
PROJECT NAME: AGNEW
DESCRIPTION: Replace f
OWNER: ACNEW, BARBARA PHONE #: 603.4301623
3
CONTRACTOR: 'IRI COUNTY TEMP CONTROL PHONE #: a:03->,f.o..0230
Inspection Request Scheduled For: Date: 1/161 2009
Pour Time:
Code # Inspection Description Confirm # Contact # Message
E, �) Mechanical final 079752-01 50:.657 -2220 0
Corrections /Comments /Instructions:
Arr . � .
❑ PASS , A PARTIAL APPROVAL ❑ CANCEL �,/ O ACCESS
______)
jk j��ltr. A _ALL FOR INS ON ❑ ADDITIONAL FEES ASSESSED
/ — -----'
Inspector: A `__ l Date: ( I& el Phone #: (503) 718- 2--6.t/