Permit II : NI CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00585
TIGARD DATE ISSUED: 11/26/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S10366 - 03700
SITE ADDRESS: 12153 SW 125TH AVE ZONING: R-4.5
SUBDIVISION: BROOKWAY LOT: 037 JURISDICTION: TIG
PROJECT: LAUZON
Project Description: Replace furnace and a /c.
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: 1 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
THOMAS LAUZON Description Date Amount
12153 SW 125TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 11/26/20C $72.50
[TAX] 12% State Surchar 11/26/20C $8.70
Phone: 503 - 590 -4641
Total $81.20
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. Specially 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 OU NC by
calling 503.246.6699 or 1.800.332.2344.
Issued c : I ' e Permittee Signature
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.
NL') -25 -2008 03:47P FROM: TO: 50359E31950 P.1
Mechanical Permit AppliR E ED ,()„ Oi'l l(E t'sI:
City of Tigard Received
// l� Permit No.: 14 e g 5g-,..;* S� v,
II/ II II " 13125 SW Hall Blvd., Tigard, OR 972410V ?j' Date/By.
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit:
Date/By.
1 I C. A R D Inspection Line: 503 4175 CITY OF TIGARIJ Dale Ready/By 1u !a See Page 2 for
Internet: www.tigard- or.gov Notified/Method, Ca Supplemental Information
g!JItr1i I( !SION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* arc based on the value of the work
❑ New construction X Addition /alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Multi - family ❑ Master builder ❑ Other; For special information use checklist.
Description l Qty. I La. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
I
Job site address: '-+� �Y O .kt .) Air conditioning or heat pump
2 - V v • - 6 V V �' y (requires site plan showing placement) I 14,00
City /State /ZIP: -ii e x122 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
liydronic 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
Flue /vent for any of above I 6.80
Subdivision: Lot no.: Other, 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
▪ � r p � fj i t q /rp Gas fireplace 10.00
1� 1 rll lVV Flue vent for water heater or gas
• R e /e. Q,� 1 C3':` fttiO fireplace 10.00
T�"'U 11P111..JJ [,1 C�'J I' Log lighter (gas) 10.00
Wood /pellet stove 10,00
Wood fireplace /insert 10.00
A
Chimney /liner /flue /vent 10.00
PROPERTY OWNER 0 TENANT Other: 10.00
Name: M } t�L.1A.l U 14 Environmental exhaust and ventilation
Address: 11V Range hood /other kitchen
p, �
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
.�(��, Single -duct exhaust (bathrooms,
Phone: (+fit �Q ) e i L t ` Fax: ( ) toilet compartments, utility rooms) 6.80
,APPLICANT ❑ CONTACT PERSON Attic/crawlspacc fans 10,00
Business name: Other: 10.00
Fuel piping
Contact name: I W t WW1 $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater -
Phone: ( ) F x:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:) art I Clothes dryer (gas)
�' �� +� `�� � Other.
Address: 13 ` �I met6 V C N/ a l y l,p ) MECHANICAL PERMIT FEES*
City/State /ZIP: o�' �1 4 O Subtotal . —
Phone: ( 1 ry Fax: ( `l 4 Minimum permit fee ($72.50)
5 r 1 Plan review (25% of permit fee)
CCB lic.: l State surcharge (12% of permit fee) yl i y �
TOTAL PERMIT FEE fl►
This permit application expires if a permit is not obtained within 180
Authorized signature: days after i t ^ has been accepted as complete.
Print name: :V Jahn )Qat Date: 0,11Z1,61 ' Fee methodology set by To- County Building Industry Service Board
1 \ nuildmg1PermniMEC- PermitApp.doe 01/19/07 440.4617T (11/02 /COM/WEB)
N.OU - - 2008 O3:47P FROM: 70:5035981960 P.2
0 4/22/2004 07 00 FAX @j002/002
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______________a_ 0UTSrDE UN J'r)_ 5i 12 S ` >'T P, L. L
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC?-00t3- 00585
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 y/.? 2008
Phone: (503) 639 -4171 ,
Inspection Requests (24 Hrs.): (503) 639 -4175 ...:
INSPECTION WORKSHEET FOR DATE: 12/2/2008 TIME: 7 :00AM PAGE: 28
SITE ADDRESS: 12153 SW '125TH AVE CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: 037 TYPE OF USE:
PROJECT NAME: LAUZON
DESCRIPTION: Replace furnace and a/c.
OWNER: LAt1ZON, THOMAS PHONE #: 503- 590 -4641
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503,567 -2220
Inspection Request Scheduled For: Date: 1212/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 078668 -01 503 -557 -2220 N
Corrections /Comments/ Instructions:
) CZ C 12..► C. 4 Ate .5D _Th_
‘'' c>' /1 ■ OU ' . et) r e l. _ '1' . ' _ _ _ /
O t -1-1'Z1 A u lJ i 1-
❑ P' ! PARTIAL APPROVAL n CANCEL El NO ACCESS
I'" // CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: _ Date Ph one #: (503) 718-
p ` ( )
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