Permit CITY F TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00513
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/22/2005
PARCEL: 1 S125DB -00500
SITE ADDRESS: 09285 SW 70TH AVE ZONING: R - 4.5
SUBDIVISION: SHADY DELL LOT: 005 JURISDICTION: TIG
Project Description: Replace gas furnace & A/C unit.
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: 1 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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
WALLACE LLOYD Description Date Amount
9285 SW 70TH
TIGARD, OR 97223 [MECH] Permit Fee 8/22/200f $72.50
[TAX] 8% State Surcha 8/22/200f $5.80
Total $78.30
Phone: 503- 244 -4733
Contractor:
MILWAUKIE HEATING & COOLING
PO BOX 220716
MILWAUKIE, OR 97222 • REQUIRED ITEMS AND REPORTS
Phone: 503 -557 -5562
Reg #: LIC 104102
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: A ��
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.
Aug 22 05 10:43a Milwaukie Htg & Clg 503- 557 -0790 p.1
v' ,::
Mechanical Permit Application FOR OFFICE l SE ONLY
City of Tigard � t� E'V Y- 'mitNo. =_ „ el /J ED
13125 SW Hall Blvd., Ti t , plan Review
Phone: 503.639.4171 Fax 503.598.1960 Other Permit:
Inspection 503.639.4175 nspec Line: 5 �� Date/By:
I nspec t: Line: 5 onus , AU G 2 `Z 2 UI .s ;1 I _' Date Ready/By: UM RI See Page 2 for
!'mod Notifed/Method: Supplemental Information
ci
jg01 COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction B t Mechanical permit fears are based on the value of the work
❑ Demolition Other performed Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1- and 2- fancily dwelling ❑ Comtnercial/indushial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Multi-family ❑ Master builder ❑ Other
special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION gea��R
707-1 � Air conditioning or heat pump
Job site address: G
2 5 W • Aue. (requires site plan mowing placement) ` 14.00
City /StateJZIP: I rgr1rcl o'g q 1- 3 Furnace 100,000 BTU (ducts/vents) 1 14.00
Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat putnp 14.00
Cross street/directions to job site: Dud work 14.00
Hydromc 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 10.00
Other. 10.00
Tax map /parcel no.: Otter lhel appliances
Gas fireplace
DESCRIPTION OF WORK Water heater 10.00
Q
h Fit �/CO C P L- Flue vent for water heater or gas 10.00
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
X PROPERTY OWNER 1 ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: \,, ) a I � .. L ) Q G} Environmental exhaust and ventilation
Address: q (� l [ c! i m Range hood/other kitchen
`I $ 5 J ( r l l i /too 10.00
city /state/ZIP: -,-,,,,, /i q r3. 2 3 Clothes dryer
exhat (bathrooms, 10.00
Phone: ( 5p3 ) • 3 44 _ t.l 3'3 Fax: ( ) toilet comparunenus, utility rooms) 6.80
f. APPLICANT 12( CONTACT PERSON Attic/crawlspace fans 10.00
'A Other 10.00 .
Business name: wt k t44 :A he .1:1 ka 4- t k r Fuel piping
Contact name: 1 e I , r. ,i is pk k S5.40 for Hrst. four, 51.00 for each additional
Address: P D f j(. .2a0716 Gas heat tip
City /State/ZIP: M 1 1 b,b, k, e. ni q ' 211 Wall/suspended/unit heater
Phone: ( 503 ) C r'1 - 5 S(-3 2, Fax:: ( ) scri .- Q Water heater
Fireplace
E-mail: - .
- Range
CONTRACTOR Barbecue -
Business name:
Clothes dryer (gas)
. Other.
Address: £ A H P t MECHANICAL PERMIT FEES* l-,
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 104 1 State surcharge (8% of permit fee) , ()
TOTAL PERMIT FEE
This permit application expires V a permit is not obtaloed Authorized signature: l - jiz'�._ /f,419 days after it has been accepted as complete
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CITY OF TIGARD •
BUILDING DIVISION PERMIT #: MEC2005 -00513
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/22/2005
Phone: (503) 639 -4171 Ant141111
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/26/2006 TIME: 7 :12AM PAGE: 58
SITE ADDRESS: 09285 SW 70TH AVE CLASS OF WORK:
SUBDIVISION: SHADY DELL LOT #: 005 TYPE OF USE:
PROJECT NAME: LLOYD
DESCRIPTION: Replace gas furnace & NC unit.
OWNER: LLOYD, WALLACE PHONE #: 503-244-4733
CONTRACTOR: IvMILWAUKIE HEATING & COOLING PHONE #: 503- 557 -5562
Inspection Request Scheduled For: Date: 8/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 014269 -01 503.572 -3971 Y
Corrections /Comments /Instructions: ,
e FL .l
G e/A.L IA- -1 IL b 6 /L 5 51 X7/ se ,t9-, nee, ,ST
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , , Date: ? " 2-5-2—°5-
-:m v5— Phone #: (503) 718-
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