Permit - r ,
CITY TIGARD MECHANICAL PERMIT
I , DEVELOPMENT SERVICES PERMIT #: MEC2005
°'�'I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/15/2005
PARCEL: 1 S 135DC -06100
SITE ADDRESS: 11690 SW 92ND AVE ZONING: R -
SUBDIVISION: BARBEE COURT LOT: 009 JURISDICTION: TIG
Project Description: Replace furnace add AC.
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: 1 DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
MCCORMACK, STACY Description Date Amount
11690 SW 92ND AVE. [MECH] Permit Fee 4/15/200E $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 4/15/200E $5.80
Phone: 503- 737 -4470 Total $78.30
Contractor:
CLEAN AIR ACT, INC.
16582 S. CARUS RD. REQUIRED ITEMS AND REPORTS
BEAVERCREEK, OR 97004
Phone: 503 632 - 1563
Reg #: LIC 144650
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: 4 a / 4 Permittee Signature: „9-- . -
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.
Apr- 14 05 04:27p Nixon Knight 503 656 -7250 p.2
mit Applicatilon
Mechanical 1er � c;.ca / Permit No.: ���-- y
City of Tigard � Q� �°, o�t�sY
1,L,I D
r V�� ` Platt Review Other Puma:
13175 SW Hall Blvd._ Tigard_ OR 97223 �. tla°
Phone SU3.639.4 t7l Fay: 503.598.19 nt ' `"'' ' ' j ' `' Dat twin: to See Page 2 ror •
s 1. n - �- Date Ready/By /r�t� Su pplemeatat Infarmativ++ •
Inspection Line: 503.639. �np - lverirrcdlr+tcthod:
Weimer www_ci.ti8ard.or•LL+ r[�
{ IG 1 ' II COM1 1rtAL .FEE`; SCggn .. ti.LB ,USE .C13ECKLIST .
TY t i' -' �' F `��' ii ` Mechanical permit lea* are based on the value of the work
�Additi t " • acement • performed. I e i i ta the value (rounded to the Hea=th dollar) of all
New construction mechanical materials. c • ut • m eat_ labor. overhesei and . r nfit.
0 • Demolition Ocher. • •
CATEGORIC •4W CONSTRDCTIOIK' �tjES1DEN L7AL: EQiJjpMEbl; l SYSTEMS F£ES`
jai- and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building Total
Multi family ❑ Master builder ❑ Other. Descripti
JOB siTF INFORMATION A D LOCA'YION
Air conditioning or hear pump 15.00 1 J
Stac McCormack (te• iressite • •lacemenrl 1400
lob site address= 0,0
00 d ents) BTU (duos/vents) 11690 SW 92nd ave Furnace 100.000+ ,BTU (vc&v /vrnts) 17
Suite /tatdJap - Furnace 10 14.00 Tigard, OR 97223 Gas heat pump
Suitc/bldgJapL no.:
Duct work 14.00
Cross street/directions to job site : 11 i tonic hot water stem 14.00
Residential boiler (radiator or 1 d.00
h dronic
On heaters (fuel -type. not electric), 1 0.00
in - watt. induct, suspended. etc.
Flue/vent for any of above 10.00
Subdivision: Lot no.: Other. 10.00
O fuel apQl'urnecs
Water ther heats 10.00
DESCRIPTION OF WORK Gas firep]tddx 10.00
A ,(d 4 �_ Flue vent for water heater or gas 10.00
e • i� ��' fireplace
Lo: ti: ter _as) 10.00
Wood/pellet stove 10.00 .
Wood fireplace/insert 10.00
❑ PROPERTY OWNER
Chimney /liner /flue/vent 10.00
❑ _TENANT Other 10.00
Envifoo rncntalexhaust and ventilation
Name: Stacy McCormack Range hood/other kitchen
e quipment 10.00
Address: 11690 SW 92nd ave
c;rylstacd Clotho dryer exhaust 10.00
zIP: Tigard, OR 97223 Single -duct exhaust (bathrooms. _
toilet compartments, utility rooms) 6.80
Phone: ( I Aatie/crawlspacc fans _ 10.00
❑ Other: 10.00
Business name; Fuel piping
55.40 !or first tour, SI.00 for each additional
Contact' name: Job Tel 503 737 -4470 _ Furnace. etc.
Address: Gas heat pump •
WalVsuspendcdlunit heater
City/Statr/Z1P: Water hearer
Phone: ( ) Fttix:: ( ) Fireplace
Sian • c
Barbecue
CONTRACTOR Clotrics dryer (gas)
Busitt Tt i1E 16582 S Carus ercreekOR rd Other
• Clear' B ea v, 97004 MECBAli1iCAL PERMIT FEESe
Addl.( � � 01
S ubtotal
503 632 -1563 503 632- 7158Fax Minimum permit C« ( ubtou )
C ¢ � � #144650 Metro #7397
Rodger P lan review perm of permit fee)
Phone Rod Brown 3 State surcharSe (8% of par,n;t tae)
Gl a 0 PERMIT FEE (E' 7-0
CC8 L. TOTAL
Thu ',truth application cspirm ifs permit is not obnlned within 180
days alter it has been accepted as eomptat
AuthofiZt d siyn3ture: � J� ' FCC methodology $ct by Tri Building tadusay Service Board
Date: Y —! y US ��
f !b
Apr 14 05 04:29p Nixon Knight 503 656 -7250 p.
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CITY OF�TIGARD ° ... ,
BUILDING DIVISION PERMIT #:
' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: MEC2005 -001 / 1
Phone: (503) 639 -4171
A l�o�l 4/15/2005
' Inspection Requests (24 Hrs.): (503) 639 -4175 "_' ' "..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
5/11/2005 7 :12AM 56
SITE ADDRESS: CLASS OF WORK:
11690 SW 92ND AVE
SUBDIVISION: LOT #: TYPE OF USE:
BARBEE COURT 009
PROJECT NAME: MCCORMACK
DESCRIPTION:
Replace furnace add AC.
OWNER: PHONE #:
MCCORMACK, STACY, 503- 737 -4470
CONTRACTOR: CLEAN AIR ACT, INC, PHONE #: 503 -632 -1563
Inspection Request Scheduled For: Date: 5/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 006589 -01 503- 632 -1: V
i 56:3
Corrections /Comments /Instructions:
O ___ ="/A t ,L o ,t iiJ— L- t� 5- 30 7 i 7/ 7s
4,axi 'Gi__ a 2 Gc. r7-'
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 5-7-
7/ -6 Phone #: (503) 718-