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Permit R • CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2003 -00692 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/4/03 PARCEL: 2S1 11 AD -00800 SITE ADDRESS: 14590 SW 87TH AVE SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5 BLOCK: LOT: 005 JURISDICTION: TIG 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: LPG 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: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Replace gas furnace. Owner: FEES DENNIS, WENDELL D NAOMI L Description Date Amount 14590 SW [MECH] Permit Fee 12/4/03 $72.50 9 TIGARD, OR R 9 7223 [TAX] 8% State Surchar€ 12/4/03 $5.80 Phone: Total $78.30 Contractor: COLUMBIA HEATING + COOLING INC P.O. BOX 230397 8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS TIGARD, OR 97223 Phone: 503 Misc. Inspection Final Inspection Reg #: LIC 76359 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 -00 Issued By: i� i t Permittee Signature: f�� ���� /4_ (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day Mechpnical Permit Application Received , DEL 4 2003 Dat , -y� �3 Permit No.:MeG�'pc - DOG V . City of Tigard V Planning Approval Building Date/By: Permit No.: 13125 SW Hall Blvd CITY OF TIGARD Plan Review Other Tigard, Oregon 972238 LDIN r "!ON Date/By: Permit No.: Phone: 503- 639 -4171 ax: 503 -598 -1960 Post - Review Land Use Internet: www.ci.tigard.or.us 4,..ati i '`i Date/By: Case No.: • I I 1 Contact (1lis.: See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: (� �r- pplemental Information. TYPE OF WORK = YCOMMERCIAL FEE* SCHEDULE = USE CHECKLIST ,,: New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work Addition /alteration/replacement Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OF CONSTRU _ mechanical materials, equipment, labor, overhead and profit. 1 & 2 Family dwelling ❑ Commercial/Industrial Value: S See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family ` RESIDENTIAL. EQUIPMENT /SYSTEMSFEE*SCIIEDULE Description Qty Fee(ea.) Total ❑ Master Builder _ ❑ Other: Heating/Cooling . JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** / 14.00 Job site address: /.../.5.9, S 6„) �- Gas he um `� � �� pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: Hydronic hot water system 14.00 Cross street/Directions to job site: Residential boiler (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Subdivision: Lot #: Repair units 12.15 Tax map /parcel #: Other Fuel Appliances Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 /l j__/,4�C� y*44 0c,t,y > Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 himney /liner / ROPERTY OWNER - I 0 TENANT Other: 10.00 Lii‘ ame: We/Vet-1.2i �! Environmental Exhaust &Ventilation 10.00 s flue /vent Rang hood/other kitchen equipment 10.00 Address: /44S,D -5A) �7 City /State /Zip: -7-794.4 Q/ Clothes dryer exhaust 10.00 Single duct exhaust Phone: 4. ,6 4 ,1 47 Fax: ❑ APPLICANT (bathrooms, toilet compartments, (`CONTACT PERSON utility rooms) 6.80 Name: I P AM 6ALihy Attic /crawl space fans 10.00 Address: Other: 1 0.00 City /State /Zip: ** Fuel Piping (55.40 for first 4, $1.00 each additional) Phone: _,3z RA/ a 7,0 ,c/ Fax :5,33 594, D.? 90 Furnace, etc. ** E -mail: Gas heat pump ** Wall/suspended/unit heater ** CONTRACTOR Water heater ** Business Name: 6 0JUN,wa. ,4(,L i-t0O�j,Y9 =We - Fireplace ** Address: p (60X d3 _ 07397 Range ** City/State/Zip: BBQ ** Cit y P 77 AA.Q D Q'I.'l 5 Clothes dryer (gas) ** Phone: S63 L it ail I Fax: ,5-03 395 02 70 Other: ** CCB Lic. #: "14. 9 Total: Authorized Mechanical Permit Fees* Signature: ,t. L6 Date: ��l! -1/./ Subtotal: $ A O l Minimum Permit Fee $72.50 $ ,i7 A 6 Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection I, 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST / BUP Received �Y. F -' Date Requested / ! / 5 / c) `' AM PM BUP Location _ /'V5 �� Suite (o 92_ Contact Person � CA-4/t/A Ph ( ) z q — -Z 77 PLM Contractor CI4A- ir-C- 7 q 1 / 9 Ph ( � 3 ) ' �n 3 I - `--P° . LSWR BUILDING Tenant/Owner (J ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling ?� Roof / Other: Final PASS PART FAIL PLUMBING ' Post n Under Slab (' � ©( P`PO Under Slab Water Rough-In Water S ( Sanitary Sewer D Rain Drains I I Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PART FAIL RICAL Service Rough -In UG /Slab Low Voltage ills Ei C Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE LI Please call for reinspection RE: LI Unable to inspect — no access Fire Supply Line / ADA Approach/Sidewalk Date /- /. Inspector Ext Other: Final DO NOT REMOVE this inspection record fr m the j b alts. PASS PART FAIL