Permit d �
. CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00016
TIGARD DATE ISSUED: 1/12/2009
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S114AB -13600
SITE ADDRESS: 16245 SW 93RD AVE ZONING: R-4.5
SUBDIVISION: KNEELAND ESTATES NO.2 LOT: 111 JURISDICTION: TIG
PROJECT: HILDEBRANDT
Project Description: Install gas line for 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTO UNITS:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
CAROLE HILDEBRANDT Description Date Amount
16245 SW 93RD AVE
TIGARD, OR 97224 [MECH] Permit Fee 1/12/200c $72.50
[TAX] 12% State Surchai 1/12/200c $8.70
Total $81.20
Phone: 503- 684 -8012
Contractor:
A 1 INSTALLATIONS
8116 SW DURHAM RD
TIGARD, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 620 -5657
FAX 503- 620 -1696
Reg #: LIC 150109
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.
Issue By: , . l / , d' I . Permittee Signatu ± ! e
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.
RECEIVED
Mechanical Permit Application FOR OFFICF USE ONI.1
City of Tigard -- 7 -- JAN 0 9 KIN Date/B I 9 0 `t - l"---. I crmil No.: F 071:10 " -c/,
I II . u 13125 SW Hall Thud.. Tigard. Olt 97 Plait Review • Phone; 503.639.4171 Fax: 5(13.59� OF TIGARU Dat° /tiy, Oho Permit:
TI L A hU
Inspection Line: 503.639.4175 j }eke Read /B I ions: Sec Page Z fur
Internet: www.tigtud- nr.goV g�UILDINC DIVISION Notified/Method; I / Gt Supplemental Information
I •
TYPE OIL WORK . FEE'", $C1gDULE •USE C;111P:C:4Cl+1ST
' Mechanical permit fees* arc based on the value of 1 e work
❑ New construction Additional t eration/replaccment rl'urmcd. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Q Other: I mechanical materials, equipment. labor, overhead. and profit.
Value: $
CATEGORY OF C NSTRLJC 1ON _ '
- . --- ._ RESIDEN'f1AL EQUIPMENT/ SYSTEMS ;TEES! '
- and 2-family dwelling ❑ (:omntt rent!/intlustrial ❑Accessory building For special information use checklist.
! Multi - family [f Mater builder [] Other: pescriptiun I Qty. 1 La.: 1 Totul
JOB SITE INFORMATION AND LOCATION • • , Mahn: eosin •
r Air conditioning or heat pump
Job site address: t / _ �r9 J ev T7 ? ,� (termites site .lam showin .laetlittcot) 14.00
Cit /State /ZIP: (�L� % rtn�ia.c 100.000 OTU tducr/...:ri :) 14-00
y , ' di � / T - . .
' Furnace 100.000+ BTU (dams/vents). 17,910
Suite/bldg / t_ n o.: P roject name:
b aP j�) j bus heat pump G4,ti0: •
Cross street/dir'ections to job site: I_luL work 10.00
I
•- -- t °° j- lydronic but water sVStrm 14.00
Residential boiler (radiator or
_ - hydronic) 14.00 ,__
! Unit heaters (fuel -type, n electric),
{ � fn -wall, in -du s us ended, etc. 14.00
_
luc/vent tar any of above 6.80
Lot no.: 10.00
Subdivision: Other: --
Tar rr /rarcA.l no : Other fuel appliances
-
D SCRIPTIOI4.OF WORK.. heater 10.00 10.00
rim livlace •
( l.. C 1 F a `.r S ,••(.. Flue l ant 1'or water heater or gas
- - 10.00
Loa lighter (gas) 10.00
IWuud /pell�t SWvr. • 10.00 ._
1 _ - firepluce/inscn 10.00
i --- !Chimney/liner/flue/vent 10.00
- �PROPCIR'f1' OWNER ' 0 TENANT f Other': 10.00
w
Name: r G a Environmental exhaust and ventilation
( G n Range hood/other kitchen •
Address: d d. 7' Lt/ 9 n Q eyuitintent 10.60 •.
C lothes dtyrr exhaust 10.00
City/Statc/Z1P :. 713 0�. 9 7 R)- - _ _ ._ -
- Smglc - duct exhaust (bathrooms, 6 R ��_
(toilet com urtmcnt unlit rooms)
Phone: ( ) c j '� Tar: l 1 - atti / fans 10.00
9- APPLICANT • • ❑ CONTACT' :PERSON
- 10.00
- I other;
Business name: I IFuel pip
•
Contact name: y $5.49 fur first four; S1.01) for each additional _
i Furnace. etc
Address: Corti ); )eat pump -
City /State /c1P; _
Wall /suspended/unit heater
( Fax: : ( ) water heater
Phone: )
Fireplace _ -
E -mail Range _
r Barbecue
CONTRACTOR . '
Clothes dryer (;
Business name: A 7 l h S i k f 7Gh S y Odter:
MECI•IANIC4 (PE ($73. bE al ' •.
Ste O� t,a�. v � tJ �.: ....• .
Address: g 1 t G
City /State /ZIP: 44_, �.1 [s`j2 9 74- a LI J tvli perntit fix 0) i . �.
Phone ) S tq . r I Fax: ( ) �2< 1 �� W Plan review (25 %of perm fee)
CCB tic -: p ' State surc (12 %rmit fee) I.
L� TOTAL PERMIT PEE I
- 1 - This hermit appticatiun pepirm if a permit is not obtained within 180
Authorized Signature: tature: days after it has been accepted as emote c.
•- .._ - r► 1 ~ I /� /� C�u • Nu ineIhodolt'i I SCt oy I ri- county Building ludwrr] .cryie. Board
Print Hume? t P 5 --. [ I `r I Date: / , [J
l:Uluildius\PerntitslhlCC' L'trm tApp.Juc 01119107 7 6171 ( �AiJCOt /W13)
CITY of TIGARD
BUILDING' DIVISION PERMIT #: MEC2009 - 00016
'13125 SW Hall BR,d., Tigard, OR 97223 DATE ISSUED: 1/12/2.009
Phone: (503) 639-4171 iell � �j���j +�
Inspection Requests (24 Hrs.): (503) 639- 4175
INSPECTION WORKSHEET FOR DATE: 1/13/2009 TIME: 7:0OAm PAGE: 4
SITE ADDRE 1G24 9380 AVE CLASS OF WORK:
SUBDIVISION: KNEELANL) ESTATES NO, 2 LOT #: TYPE OF USE:
PROJECT NAME: HILDEBRANDT .
DESCRIPTION: Install gas line for range:
OWNER: HILDEBRANDT, CAROLE PHONE #: 50a•664-8012
CONTRACTOR: A 1 INSTALLATIONS PHONE #: 503.620.5557
Inspection. Request Scheduled For: Date: //1312009 Pour Time:
Code # Inspection. Description ' Confirm # .Contact # Message
610 Gas line • 079643 -01 503-084 -8012 N
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Corrections /Comments /Instructions:
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4 sP ('ARTIAL APPROVAL ❑ CANCEL n NO ACCESS
1 1 FAIL W CALL FOR INSPECTION ❑ ADDITIONAL FEES AS SE SSED
Inspector: : Date: Phone #: (503) 718-