Permit „ , ;
CITY OF TIGARD
MECHANICAL PERMIT
. I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00001
'''I • 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/3/2005
PARCEL: 2S112CB -11600
SITE ADDRESS: 15358 SW 81ST AVE
SUBDIVISION: ASHFORD OAKS NO. 2 ZONING: R -7
BLOCK: LOT: 130 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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 OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: furnace
Owner: FEES
GOLDSMITH, RICHARD E /SOHYON M Description Date Amount
15358 SW 81ST AVE [MECH] Permit Fee 1/3/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 1/3/2005 $5.80
Phone: 503 620 - 0635 Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 1441
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: i Permittee Signature: C��1��
/vd Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
FROM ` �a• ..obsHeat i mg FAX N0. : Dec. 31 2004 09: 41AM P2
M: ch4 ....7. nical Perm a ja- '' ' lf ,
•� 'jai,- J.�, a I'OR.()L'I�IC'F, USE ONt.%'
City of Tigard Ranaivod 01 natcB 1 - -•�0 5 PennIt NO. ; a O �/ (�" l � �/� /
13125 SW hall Blvd., Tigard, OR 97223 Plan Review
503.639.4171 Fax 503,598.1(R A 2005 h,,..A,. ,r : . ;;� Da /BY: OtherPennif:
Inspection Line; 503,630.4175 I M IV 3 41 t • ji�, _
Internet: www.ei.tigard.or.us
a;+ [)ate Ready/Fly: .pinto ® tine Pmgn 7 for
Notifled/Method: i/L Supplemenrallnformation
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_ a Mechanical permit fer are; based on the value of the work
❑ New construction • Addition /alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: 1 l
y � . mechanical mntcrialA, __ -. d ptofit_ _ -
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► • r : nd 2- family dwelling ❑ Commereial/industrial ❑ Accessory building , i_;�p'i+ d l M 'k1 t ;. = z' 1•• r N�• ,- . . I .. . .... .
■ Multi - family ❑ Master builder ❑ Other: _ -_ special information use checklist.
For P motion u eckl'
a "� i� k I + o f , Ora r t r r ,a t .z , w nt ft t Description I Qty- i Ga. I'otrtl
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lob site address: - Air conditioning or heat pump
.. • .,,. _.. .. (requires site plan showing placement) M 14.00 l -
City /State /ZIP: �$��
2 Furnace 1o0 000 BTi l (duets/vents) 1 ... __ 14.00 1
rnace 1170,0001' BTI l tt,rt9 /v,•nta 17.90
Suitc/bldg. /apt, no I Project n xme; /A� sm.
,, Fu
- - • .5 ? ) _ - -.
'i 1 / _.. " �./.. ti..1�11 Oas heat pump 14.00 --
Cross street/directions to job site: Duct work _ 14.00 -
14ydronic 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: Lol no.: Fiue /ven f o r any of above 10.00
Tax map /parcel tto.. _._ ........ -y t _ ....... _.
Other: 0,00
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'�' • ' ' t> .i. .a� �„ i �;l•:�tr; ' ; I l. l , e l � , .I.:',!
x t 3 >i! , W ater heater . ,_ 10.00 • (las fireplace 10.00
-- -. - -- --- - - --•- Flue vent On- water heater or gut
fireplace -
__....:... -- -- l og lighter (gas). 10.00
-,. __ Wood /pellet stove 10.00
Wood fireelace/ingcrt 1 _ .,_.,..•. 10.2
1 ,;a � 9g i ''4;'. :,1.9 :',Vir N 4, ), ; ) ;!'. of n . . ; ' 1 ,. t..himnc /liner /flue/vent 10.00 - -
l tr ide sd abl .>a..?. = 1 ,, • r eI D4 . 'a a i 1,,1. I • r ,i ..�'k t ' ° ; Y r ( I..:. ',i il %,31: , ,,� -- - -
ri • ` � : , . . Y, : , ';..e.:101...1:4:" Other: 10.00
Name: � � - _ . .,_ _......_...._._.
.• • _ � - Envirmnntetltal cxhanst anti ventllet
Address; • t flange hood /other kitchen
t��r"..._.. eltiprnent 10.00
City /State /Z r 1 1 Clothes dryer exhaust 10.00 •
Phone: ( ) Pax: ( - ' ..._ Single - duct exhaust (bathrooms,
k- toilet Compartmen utility ) tR, 1113 sty roorns�
,. ,,, i„ ,...� ��y, , . ,y�a va �s�.tr; !�it��;;;. ',qs '•1.21 "y• , \.,• -, ..•.... - .... ,
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' I �•, .., • . • �lw, cF+., r 'rr`e'.., Y '?C:. u. �'Jsti r I Attir - - -- - __ 1000 -
Business nom• : V)• ..L -.,1. p ' 1 • _ Other; 10.00
. _ t _.._ _,....... Ituel plpin
Contact Warne, , - ....,.• -- - -..... -.... _.__...
�n 01 , $5.40 for first four) $1 .00 for each additional
Address: / V Q „ / � , Furnace, etc, ...,..(g..._.4:5.2_,_ / - ° V Gas heat pump
City/State /ZIP: - A QJ _ a Wall /suspended /unit heater
Phone: • .� , . Fax; ; ( ) bC Water heater eip
" "` - � � Fi , �lace
.... -
E-mail: - _
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+ ."� .a wrsRivu nh;� •„ i(+ :' c i (LrXi{s.,�� � . � �( J�$_H , ',..1.;"6 , 4
Business name: Clothes dyer (gas)
Other:
Address: - - -.---
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City/Stale/ZiP 1 #1"��'p� ° "s'. �4'►)'�7CJi1' ;1.Mf)I;�911:A+:. ,
_ ['total
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SUntQtai ,
Phones Minimum permit fee $ 72 . 50 . 444_ , ( ) Fax= ( ) --^�^^ ..._ p �_......,...,.,�.
,,- ,.,, Plan review (25% of permit fee) 5
CCD tic.: State surcharge (H% of permit fee) •�
- .._.. __ _ TOTAL PERM TT FTC Q •
Authorized signalur• t - A _ I L 141 II This permit application explrex If a permit is • eat ot lee
',r a te: • F ee ' _ days after It lino been accepted no complete. name: `� , l 7 D metoddolog � y let h-v 'fri- County Building Industry service limr4
is\ Rawl ng\Permi„,MAC- pern,,,A 12/91 440.461 7 T(IIt17n:01WWUR f ho h ) A / g 11
CITY OF"TIGARD
BUILDING DIVISION PERMIT #: MFAC2005 -00001
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 1/3/2005
Phone: (503) 639 -4171 m 4Ulm01��i �
Inspection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: _ 5/27/2005 TIME: 7 :10AM PAGE: 65
SITE ADDRESS: 163513 SW B1ST AVE CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 130 TYPE OF USE:
PROJECT NAME: GOLDSMITH
DESCRIPTION: furnace
OWNER: GOLDSMITH, RICHARD E/ SOHYON M, PHONE #: 503 - 620 -0635
CONTRACTOR: JACOBS HEATING + NC PHONE #: 503 - 2347331
Inspection Request Scheduled For: Date: 5/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 007B61 -01 503 - 620 -0635 N
Corrections /Comments /Instructions:
G r/3 _?5.5
PASS El PARTIAL APPROVAL ❑CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _ Date: S Z 7- z 7 Phone #: (503) 718-