Permit CITY '0i F TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00065
�;�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/2005
PARCEL: 2S 115AA -06200
SITE ADDRESS: 16423 SW 109TH PL
SUBDIVISION: REBECCA PARK ZONING: R -4.5
BLOCK: LOT: 019 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:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Push/Pull furnace.
Owner: FEES
I NG RAHAM Description Date Amount
16423 SW 109TH PL [MECH] Permit Fee 2/18/200f $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 2/18/200E $5.80
Phone: 503 430 - 1155 Total $78.30
Contractor:
SUPER SERVICE MECHANICAL
5555 SE SUN MEADOW TERR. REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97267
Phone: 503 659 - 2937
Reg #: LIC 90093
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�i Permittee Signature: 5 n p
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Feb 17 05 08:57a Daniel P. Jennings 503-654-1931 p. 1
IVI(72%iarqc al Permit Application --,9 ,,,,,p,,.,,., ,,,, J . tog.p,45, - .Ticwiikk::aiiitattrmo t
:t? . :.!: , : , i'l FO '_pf.F k 11; 1•.;...0NLY,:..tl';4('YrriTler:
City of Tigard
11125 SW I rail Blvd.Tigard, OR 97223 '4.C4111■
nmejny....,e .) T7J1- E7-1,_ Permit Na \\ 6 ",ti .) -- a 66,5
, Plan Review
Phone 503.639.4171 Eax: 503.598.1960 n - ( a her Permit-
!, 1 ,"*Naeli i ' l " 1,illY:
Inspection [Inc 503.639.4175 ,,'„It,..11÷:, ;" LI; • '1 r
, ' qtd Ready/By: Jwis: Ell See rage 2 for
Internet: www.ci.tigArd.orus . ‘--- f *,---- ; 4 ' . N Oli FUANC1h0d.
1 .... (r .. SUPPI4M entail WO n21•1■00
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TI Of M() •
11 l*C1 CONINIEW Tkl, FEE* 1( MEDI ll,F, - ItNE vElEckitist*
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ID New construction El Additionialteration/repitnWit - Mechanical permit fees* are based on the value of thc work
peribrmed, (ndicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other; mechanical ma eria
tls, equipment, labor, overhead, and profit,
. - V 4 3Y 1.16 Pl' - :
C'ATECORI' Oto CONKER( I lt)i. 1, . - AS ' Value $
RESIDENTIAL EQUIPhlENT / SYSTEMS EEEs•
M 1 - and 2 dweliing In Commcreiallindustitin `ssory building
For special inlormaiion toe checklist.
0 Multi 0 Master builder El Wier; Description 1 Qty. 1 Ea. 1 •fotal
.1011 SITE INFORMATION AND LOt.'ATION Reating/coolin ,
Air conditioning or heat pump '
Job site address: 16423 SW 109A — Pl.
(it.quiles mite plan atiowinr, ?law men!) 4 14.00
City/Stater/AP: Portland. OR 97224 Formica: 100,000 BTU (ducts/vents) / 14.00
_..
Furnaec_100p00+ liTILOuctsivents) 17.90
Suite/bldg./apt. no.: Project name;
______ _.. .... .... . Gas heat pump 14.00
'
Cross strixt/directions to job site: Duct work 14.00
_11xdronic hut vvatersystem
— Residential boiler (radiator or
hydronic) 14.00
Unit haters (fuel-)ype. not electric),
in-wall, in-duci. suffndod. etc. 10.00
Flue/vent for any of above 10.00
Subdivision: 1 hti no
Other: 10.00 ....... ..., .
Fax map/parts:1 no,; __ Other fuel appliances
DESCRIPTION OF %IOW:. Water heater 10.00
< fireplace - 1 — , 10.00
Push/Pull on furnace - Isluc vent for water hciter or gas
fireplace 10.00
. 1 mg lighter (gas) 10.00
Wood/pellet move 10.00
_... .
•---------- --- • --
Wood rue2lace/inscart 10.00
Chimney/liner/fludvent 10.00
1:3 PROPERTY (MISER CI TEN.tN'E
(Act T 10.00
Namc; Ingraham Environmental exhaust and yeotilation
Range hood/other kitchen
Address: 16423 SW I 09 P1
equipment 10,00
City/State/Z1P: Portland. OR 97224 Clothes dryer othaust 10.00
Singlc-duct cshuto (bathrooms.
Phone: (S03)430-1155 1 Fax: ( 1 toilet compartments. utility rooms) 6lt0 .. _ _ ... . ..
- . . .
El ,\I'll'I.1( '.■NT 0 CONT,‘l T PERSON .Attic./craiec tans 10.00
Other: 1 10.00
Business name: Super Service Mechanical
Fuel piping
Contact name: Daniel P. Jennings $5.40 for first four: $1_00 for each mdditionni
Furnace, etc.
Address: 5555 SE Sun Meadow Terrace
Gas heat pump
City/Statc/ZIP M ilwa laic, OR 97267 _ _ _ Wall/suvencicd/unit heater
__ _ _. ...... . .. .... _. .. ....
Phone: (503) 659-2937 Fax: : (503) 654-1931 Water heater
Fireplace
E da nnao mi(ii;comcast.net • Range
--
('ONTItut TOIL Barbecue
Business name: Super Service Mechanical C7lothes dryer (ga.$)
•-•------------ ( Af!P1 - -______
Address: Same 1111.:(11.%NIK '.11. rElthlIT EEE..S•
... .
City/State./7.1P: Suhtntal
---- . ---------- MTM - m -
Minimum pc:rmit fcc ($72.50) 7Z
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
(('13 lic,: 90993 State surcharge (It% of permit fee)
" ........_.........j
TOTAL PERMIT FEE 7 g..3 0
This permit application expires if a perniit is not oriTained
Authorized signature: . ithin Ilto ture: •
Joy" OW it bits been acceptant au complete.
1 Mini mow: Daniel P. Jenninvs 1 rhitc• 02/16/05 I • Fee IndhOdOlOgy act by 'hi-Cm:My Huildnig latlusiry Nervux Ruud
CITY OF TIGARD
BUILDING DIVISION PERMIT #:A loS- I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
A 4 ,,i� ` I I �
Inspection Requests (24 Hrs.): (503) 639 -4175 ); '! � ..
INSPECTION WORKSHEET FOR DATE: 3 - 7 -05 TIME: h 4 OW / PAGE: ,
Du214A7✓1 , to8, G/4.--re") (Ike- SITE ADDRESS: 1 Co Li Z 3 /.0 ` r l -� CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: - • PHONE #: q "5-C--
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
b91
Corrections /Comments /Instructions:
M,Na �� S 31 z88
C
` p. - • SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL M CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
, /
Inspector: Date: ` ,- ' ` 0 Phone #: (503) 718-