Permit CITY T I GA R® MECHANICAL PERMIT
I�. DEVELOPMENT SERVICES PERMIT #: MEC2005 -00119
6'1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/18/2005
PARCEL: 1S136AD-03001
SITE ADDRESS: 10555 SW 69TH AVE ZONING: R -4.5
SUBDIVISION: VILLA RIDGE LOT: 006 JURISDICTION: TIG
Project Description: Replace furnace.
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:
<= 10000 cfm: OTHER UNITS:
FURN > =100K BTU: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
BRANT BLODGETT Description Date Amount
10555 SW 69TH [MECH] Permit Fee 3/18/200.` $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar{ 3/18/200f. $5.80
Phone: 503 977 - 1700 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045
Phone: 503 - 557 - 2220
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 -808 -
Issu. • By: 0 . 0 0_1( Permittee Signat �, .
Call 503- 639 -4175 by 7:00 a.m. for inspections that business*. •y.
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 16 05 07: 18a TriCounty Temp Cntrol 5035570919 p. 1
a
Meclianical,Permit Applicati ... • FOR OFFICE USE ONLY. ' ' '
Cl \ i Received t No.: /,' M ��
' ' of igard
e ' !� L DateBy: D �� �t _a [.t/
131_5 SW Hall Blvd., Tigard, O = r Plan Review
Phone: 503.639.4171 Fax: 50 ! 5•:0 Uaat:, ' e?� Date/By:
Permit:
Inspection Line: 503.639.4175 .t rf Date Ready/By: ]uric El See Pave 3 for
Internet: www.ci.tigard.or.us MAR 1 200 �_.a Notified/Method:
/ Supp lemental Information
PE� ( �iVj( 1 3 f : COIINLERCC�,L E" ::SCHEDi7ZE" = USE.CHECKI CHECKLIST •
❑ New construction 1 d [er / r ep lacement � Mechanical perrnit fees are based on the value of the work
{� performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
•
CATEGORY OF• CON ' :• " value: S
1- and 2- family dwell RESIDEN, TIAL EQUIPMENT / FEES*
g ❑ Commercialindustrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total
.OB SITE INFORMATION AND L OCATION.: Heating/cooling
Job site address: ! 6555 sw mac- 4" ic w Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: Ti (8 4 2 Furnace 100,000 BTU (ducts/vents) _ ' 14.00
Suite/bldg./apt. no.: U Project name: • Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat Dump 1 4.00
Cross street/directions to job site: • Duct work 14.00
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. 10.00
Subdivision: Lot no.: Flue/vent for any of above 1 I 10.00
Other: 10.00 ,
Tax map /parcel no.: Other fuel appliances
r:: :eater heater 10.00
_�' - . - •DESCl2TPTTON -0E WORE.
1 1 • Gas fireplace 10.00
1 Flue vent for water heater or gas
fireplace 1 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00 f
lAEROPERTY OWNER - 4 -- ChirnneyAiner ;flue/vent 10.00
y ❑ : TENANT r 10.00
Name: brW It Bl(d Environmental exhaust and ventilation
vim^ , i Range hood /other kitchen '
Address: I equipment 1 10.00
City/ State/ZIP: Clothes dryer exhaust 10.00
�'}� Single -duct exhaust (bathrooms,
Phone: ` 1 1I -111 JO Fax: ( ) toilet compartments, utility rooms) 6.80
c-a fans
n k 7 1];. CONTi,k;c7 ERSON - Aftid wlspace 10.00
Business name: Tr, CO.0 I t
Tc p COI t R t l.' 1 10.00
1 Fuel pip ing
Contact name: ( Diane ) O S5.40 for first four; 51.00 for each additional
^� �� //)) ��i � (� � I Furnace, etc.
Address: 0 l C) J C a(kL n ! lcLS Ri vcr W. Vr'
Gas heat pump I
City /State /ZIP: C►j�C'ri C( f e_ 6(7045 J Wall/suspended/unit heater
Phone: ( ,5) 557._ 2 Fax:: (g. 55 ( 6/ Water heater I
1 Fireplace
E -mail: Range
. :% : :1 i r .COI\RRACTO10 :~ ` . Barbecue
Business name: Try Count/ 'r(.J')') Il Cc�r�rtrei Clothes dryer (gas)
" fir Other: I
I I
Address: ° MECFIANICAt':PE T:FEES*
:)i S a r ncIS ,�' _ Nri��
I CityiState/ZIP: O Cep C.. o _. q 7 E S Subtotal l ,
� (j Minimum permit fee ($72.50) I
Phone: (� C ) 5S7 2220 Fax: lvjO 65 .� ,1 el ! Plan review (25% 01 fee)
CCB lic.: l g 2 1 State surcharge (8% of permit fee) -//T bO
TOTAL PERMIT FE : I.
Authorized signature:
� J' / -77a0 ----- This permit application expires it a permit is not obt ' ed within 131
/ days after it has been accepted as complete.
Print name: Dian �'1�Q?i•') I Date: a(iofr s ' Fce methodology set by Tri- County Building Industry Service Board
BuildingPeru \EC- PernirApp.doc 12 400 '617T(11I/
CITY OF TIGARD
BUILDING DIVISION • ' ^ PERMIT #: MEC2005 -00119
13125 SW Hall Blvd., Tigard, OR 97223
• DATE ISSUED: 3/18 /2005
Phone: (503) 639 -4171 : ,���ioN, lj1l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/24/20* / TIME: 7:09AM PAGE: 37
SITE ADDRESS: 10555 SW 69TH AVE CLASS OF WORK:
SUBDIVISION: VILLA RIDGE LOT #: 006 TYPE OF USE:
PROJECT NAME: BLODGETT
DESCRIPTION: Replace furnace.
OWNER: BLODGETT, BRANT PHONE #: 503.977 -1700
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503 - 557 -2220
Inspection Request Scheduled For: Date: 3/24/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 002716 -01 503 -557 -2220 Y
Corrections /Comments/ Instructions:
M /A/ K L,41 - 4 d Z. -Z -T-c 1 covA/7 �7
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14pASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
/ ...
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Inspector: Date: / one #: (503) 718 -
11
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