Permit " * a CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00163
TJG.ARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/27/2007
PARCEL: 1S133DD-09000
SITE ADDRESS: 12757 SW FALCON RISE DR ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT: 127 JURISDICTION: TIG
PROJECT: DAVIS
Project Description: Gas line extension to range.
CLASS OF WORK: ALT 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:
NAT 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
CARL DAVIS Description Date Amount
12757 SW FALCON RISE DR
TIGARD, OR 97223 [MECH] Pernut Fee 3/27/2007 $72.50
[TAX] 8% State Surcha 3/27/2007 $5.80
Total $78.30
Phone:
Contractor:
ROSE HEATING CO
9945 NE 6TH DR
PORTLAND, OR 97211 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 283 -5183
FAX 503- 283 -5070
Reg #: LIC 2084
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: Permittee Signature: P j
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.
Mar,26 07 08:17a ROSE HEATING 5032835070 p.2
Mech . nical Permit Application
Raeeir / 6 � Permit No ( C � ACV/ 693 City of l igard D,te/ 9!/!IIIIIIMIIMIIIMMIIIIIIIIIIIIII
7 D7 �'`
t 3125 S W • 11 Blvd., Tigard, OR 47223 Plan R Other Derma:
Phone: 503 679.4171 l e.,r 503.599.1960 h y„ t t ,, s Date/By:
„� I I lwir• 0 See /Nee 2 hr
to etioo e: 50).63![41 y.F, Owe nr _
•W Noti CIA/Phased: / SrppMmeuoal t•ror ma Ilea
Internet: w w,ei.tigatd•nr.us �) •
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:.•v .: Y .r i%iCd lERtIAL
,. .• E •' 6tCHEDULi - 'USE�i?9KIJbT
Mechanical permit fees are based on the value of the work
❑ New c nsttuCtiDn AddiCioiUalteltatt ''b6lgeplacetneiit performed. lmlieate the value (rounded to the neaaeu dollar) of alt
❑ Dcrnol Lion Q Other .,- '' mechanical materials, equipment. labor. overhead, and profit
•
. • • - CATEGORY. OP' -.., :; : L .! Value: S
- ritstt .BNTi /SYS Sk EliIZM • `
!: 1- and • - (cannily dwelling ❑ Commercial /industrial ❑ Accessory bwltliug For speciel Information use cheeklisl.
• ❑ Multi - i' mily ❑ Masser builder ❑ Other: Description ( Qty. j Pa. ( Total •' JOB:SPPE.:1NFORMATION AND LOCATION : •:'.' • - Neu1n e,00ling
` _ Air conditioning or heat pump •
Job site a. , ess: / , l-� (requires the plan skowing placement) 14.00
1 G� p 4. Furnace 100,000137U (duc&venta) 14 -00
City/$tatd t' �- r
-
Furnace 109,000+ B71J (ducWvcnlr;) 17.90
SuitcJbldg. apt. no.: Project name: w = Gas heat pump 14.00 .
Cross ere directions in Job site: Duct work 14.00
14.00
Hydronic hot water system
Residential boiler (radiator or
hydroaic) 14.00
Unit heaters (fuel -type, not electric),
in -wall in -duet, suspended. etc. 10.00 •
Flue/vein for any of above 10.00
Sobdivisi • • : I Lot no.: Oahe[: 10.00 1
Tax map / •, cc! no.: Other fuel appliances
. 10.00
pEbCRIYTiOP OF :',.;, .> 10.00 • . a cr to
Gaa fireplace
•
NMI. %. 1 '' e Flue vent for water heater or gas .
fireplace 10.00
• = Log lip.hter (Res) 10.00
- Wood/pellet stove _ 10.00
Wood fireplace/insert 10.00
O Chimney/liner/flue/vent , 000
PROPERTY. OWNER.', ::: - ., 1 . : : •. • :TFI ..4111. Other. 10 0
..
NBC'
\ . ,; • �� Pnviroomental exhaust and ventilation
_ , Rangehood/otherkitchrn
Address: • i ('i I. t e gtupment
10.00 •
t -
9 1Z�� Clothes dryer exhaust 10.00
City /Slat ZIP: �� trooms,
Phone: ( ) + . _ y Fate ( ) toilet compartments, utility room') , 6.80
r . Attldcrawlapnce fart 10.00
APPLICANT' D CONTACT' PERSON Other: 10.00
Business • ....: Fuel piping
55.40 for first four: 51.00 fo r each additional
Contact n • e: Furnace. etc.
Address: '
Oas heat pump
•
WalVsuspcndedhtnit heater •
P City/Su-iv:
one: - �d' : Fax: : ( ) Water heater •
Phone ( ) Fireplace
E -mail: Range . 1 `j C . •
..' t f: ;.: • CONTRACT ■ •
Barbecue ' er (gas)
Clothes dry
Business • . • e: I us . I ' L Other: •
ts�
Address:
9 9'- 1 --14 ter.:1 •' i�i1�e> EirAHtdAI ;'"pltl
Subtotal 5 -�--(
Ciry /Slat • : � • ` (�� a C= c� ` Minimum permit Ice (572.50) a . et
Phone: ( )'•�/. 2 — C.• ) Fax ] Fax• ( � — C 7 � Plan review (25% of permit fce) .
State surcharge (99 of permit fee) ,. [" %
CCB tic.: L:� t TOTAL •
PERMIT FEE /
AuthoriZ••' Signature:'
}
/
- -J P •, r i' - % 1 This portal, application taplrn If a wall to nal • hide 180
T W // 1 1l/r �Lt� days atter11hsi bees accepted rcomp
13"e:- �� - Pee mtthedol Day tat by Trio-County Building ardtamy Service Oogrd
Print nu i, t� QM�
ig . ''') :
i
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MEC2007 -00163
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/27/2007
Phone: (503) 639-4171 u " d�YNgl6' 1 r\ /�
Inspection Requests (24 Hrs.): (503) 639 -4175 J ='' � i1iE�c. Oh ��� 6 3
INSPECTION WORKSHEET FOR DATE: 3/29/2007 TIME: 7:00AM PAGE: 58
•
SITE ADDRESS: 12757 SW FALCON RISE DR CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT #: 127 TYPE OF USE:
PROJECT NAME: DAVIS
DESCRIPTION: Gas line extension to range.
OWNER: PHONE #:
CONTRACTOR: ROSE HEATING CO PHONE #: 503 -283 -5183
Inspection Request Scheduled For: Date: 3/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 045626 -01 503 -283 -5183 Y
Corrections /Comments /Instructions:
•
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I/i' Ni s ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ( I ADDITIONAL FEES ASSESSED
. ,Inspector: Date: 3 -09 a7 Phone #: (503) 718 - �.