Permit CITY TIGARD MECHANICAL PERMIT
rt I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00552
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/16/2004
PARCEL: 1S133AD-03500
SITE ADDRESS: 10760 SW SUMMER LAKE DR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 009 JURISDICTION: TIG
CLASS OF WORK: OTR 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace furnace.
Owner: FEES
GILBERT, JOSHUA P Description Date Amount
10760 SW SUMMER LAKE DR [MECH] Permit Fee 8/16/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 8/16/200 $5.80
Phone: 503 - 521 - 8480 Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 62196
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: f pJl/ Permittee Signature: ^ Qy
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next bi day
4 Mechanicail Permit Application
FOR OFFICE USE ONLY
• tity of Tigaid R i6 09 „ ict....,
Permit No.1A6C
13125 SW Hall Blvd., TigREGEIVED
Plan Review
Phone: 503.639.4111 Fax: 503.598.1960
ate/y:
Other Permit:
A ATI N:101
Inspection Line: 503.639.4175
9004 A,.. , ...1- Date Ready/By: tnternet. Internet: www.ci.tigard.orus A! !. 1 3 .._ _
1
Notified/Method: ›,t, i , I Z 2 f r o ation
) (T
y oF Ttp4RD
lltNil!ipt:1 "fi.tt,l,' ::::.::L :;::::..-:; i; : .-'• ...:-.. ,•::. •:cotroga;0,44,:;:pwi:IK1IOwENT:;•:OV:efWC19-3-51:-
New construction ddition/alteration/replacement
Mechanical permit fees* are based on the value of the work
p t3 .
performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition El Other:
mechanical materials, equipment, labor, overhead, and profit.
iiiI41:::.:!!1:1: .............................. : . ,, . . .
Value. $
- and 2-family dwelling D Commercial/industrial D Accessory building
/ /g /i
ulti-family 0 Master builder 0 Other: '? ' :::!:RF,SIDENTIAtTQUIPIVEENINSVSTEMS,TEES,:,:1!-,1-
. Description For special information use check(ist.
Qty. Ea. Total
iT :00 - • :: :.. ": :1!::: Fleating/cooling
Air conditioning or heat pump
Job site address: t 01 40 "1,k,) Li wv/Vt.e ) ..4. k '.--- C-- • (requires site plan showing placement) 14.00
City/State/ZIP: T ,y)._c r CY\K S Furnace 100,000 BTU (ducts/vents) I 14.00 14.
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 14.00
Hydronic hot water system 14.00
lit3e6+ 6 C1/10 II 5 ''e-C1r Residential boiler (radiator or
hydronic) 14.00
5t1vlavqes Le\V__p '-k
- Unit heaters (fiiel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: ! Lot no.:
Other: 10.00
Tax map/parcel no.:
Other fuel appliances
. Water heater 10.00
g ..............................
......... ........................ .. WORK .. - . : • , -, : . , ; • - ,.
Gas fireplace 10.00
9.. eilet-c-e-- c rict_C,e--
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
4604000 MOONO 2 4 . ' , IElltNANT : : ' ' oCthhimney/liner/flue/vent
10.00
10.00
Name: 3
Environmental exhaust and ventilation
Range hood/other kitchen
Address: 10 7( .5 ,) .5 kvmme _ L --\-- .
equipment 10.00
City/State/ZIP: - 716 \ , 0 \ 0,7;").. Clothes dryer exhaust 10.00
i
Single-duct exhaust (bathrooms,
Phone: (9J3) .5 9.30 Fax: ( )
toilet compartments, utility rooms) 6.80
AXON71ACT • : :.. Attic/crawlspace fans 10.00
Other:
10.00
Business name: C,1;utkA:1-f..- LC 1/1 CO k _ _ Fuel piping
Contact name: Ket`t P-- 1-14a
S5.40 for first four; $1.00 for each additional
Address: 1 ( 500 .5 uo vNi.. A Furnace, etc.
Gas heat pump
City/State/ZIP: T - exklus.t. C 1 - 7 - 1-1 Wall/suspended/unit heater
Phone: ( 5773 4 53- e.-/ 2 3D a ! i Fax: : (503) c! ( - 7dQ Li Water heater
_ Fireplace
E-mail:
Range
:..;:.;•:...: ggg'' , : : .q• !?. ! ; : : !q:::ji , :si,:w.',',2: ! ;:0.0*!,.iwt.01.,.. : : ,. Barbecue
Business name: C ‘,,,,,,...4._ • Clothes dryer (gas)
Other:
Address: li-50 - 5 t,..) - 73 , -A.. ,40_
• .
. . .. , , . .. .
City/State/ZIP: ,...k.k _ A
Subtotal
Phone: (563 ) 1,/:5 - e_./1 e3- Fax: ( c.-3 ) q f 2, .. Li Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CC B lic.: 6 1 9 e
•
State surcharge (8% of permit fee) +.--. S 0
- Ct
-,01..f--. ----.44/1/1M-/ TOTAL PERMIT FEE 71s :3 o
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Z e _
Date: tg • Fee methodology set by Tri-County Building Industry Service Board
i:\Buildine\rermits\MEC-PermitApp.d 12/03 .
\ ,....._)
440 I 7 ! ( 1 uovcom/wEe)
t•22L 896 EDS I° aq.ew T 3 B80:1I b0 ET 2 nil
I'd
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2004 -00562
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/16/2004
Phone: (503) 639 -4171 � a, ` �l1l
Inspection Requests (24 Hrs.): (503) 639 -4175 - -
INSPECTION WORKSHEET FOR DATE: 3/21/2005 TIME: 7 :10AM PAGE: 71
SITE ADDRESS: 10760 SW SUMMER LAKE DR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 009 TYPE OF USE:
PROJECT NAME: GILBERT
DESCRIPTION: Replace furnace.
OWNER: GILBERT, JOSHUA P, PHONE #: 503-521-8480
CONTRACTOR: CLIMATE CONTROL INC PHONE #: 503.453.4822
Inspection Request Scheduled For: Date: 3/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 002281 -01 503- 453 -4822 Y
Corrections /Comments /Instructions:
0 4:C6cria 6. vim- i . .1 -4 /kz- - '7 I- 3
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ri CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - Date: 3— 2-/-dam Phone #: (503) 718-