Permit CI TY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00515
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/23/2006
PARCEL: 2S114AC -00400
SITE ADDRESS: 16545 SW 93RD AVE ZONING: R -4.5
SUBDIVISION: CAFFALLS CORNER LOT: 004 JURISDICTION: TIG
Project Description: Replace gas furnace, run gas line to stove.
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: DOMES. INCIN:
NAT 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: 1
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
ADRIAN LETHBRIDGE Description Date Amount
16545 SW 93RD
TIGARD, OR 97224 [MECH] Permit Fee 10/23/20C $72.50
[TAX] 8% State Surcha 10/23120C $5.80
Total $78.30
Phone: 503- 352 -4597
Contractor:
BEN'S HEATING & AC
PO BOX 80607
PORTLAND, OR 97280 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 233 -1779
FAX 503- 651 -3345
Reg #: LIC 64597
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:
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business y\
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.
OCT -23 -2006 08:06 AM BENS HEATING 503 651 3345 P.02
• 14 IsR,
�' -- -`' C Mechanical Permit Application OFFICE OF 11'.. Orel v
rr • Date Received: `_ m.11 .
._ r ' , '1O o it Date Issued;
r r t..,.. 1. .._ _ ,. 103, - COC1 9 : t i t L
+}i,� LIO bite. , w. ?' ed w
ei ww uvt % itatei Payment Type:
N.``.'' n it L L"J i ."' —
i
TYPE OF WORK � ' 7- 1' COMMERCIAL FEE° SCHEDULE - USE CHECKLIST
0 New construction Addition/alteration/rep
ration/replacement Mechanical permit fees* are based on the value of the work
perforated. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ■ Other: mechanical materials, equipment, labor, overhead, and profit.
CA EGORY OF CONSTRUCTION Value: S
R ESIDENTIAL EQUIPMENT / SYSTEMS FEES'
g.,
1 -and Multi-family ❑ ly dwelling ❑ Masts erei ustrial 0 Other: building Fo T I AL EQUIPMENT
tr}j PMENT cue checklist.
Multi - family Master builder ❑ h Descrip Qty, 1 Ea. 1 Total
JOS S E INFORMATION AND LOCATION Hegitlny,/cooling
Job site address: S W 9 - rtl • Furnace or add-on air
conditioning w •
City/State/ZIP: --r 6 . 9 --) Q A 4/ Heat pump 47,50
Duct work 18.15
Suite/bldg./apt, no.: [ Project name:
Hydronic hot water system • 18.15
Cross street/directions to job sl • : Residential boiler (radiator
cc hydronic) ••
Unit heaters (fuel -type, not
electric), in -wall, in -duct,
suspended, etc. 36,35
flue/vent for any of above 18.15
Subdivision: 1 Lot no.: Other: 18,15
4 Other fuel appliances
Tax rmap/parcel no.: Water heater , 18.15
DESCp1PTION OF WORK Oita fireplace 26.00
Flue vent for water heater
C t is e, 6 AS , MQ"lee or gas fireplace . 18,15
Log lighter (gas) 18,15
• is. . . 1a' S ,D Wood/pellet stove 26.00
Wood fireplace/insert 26.00
Chi nmey /liner /flue/vent 26.00
Other 18.15
■:• - ROPERTY 0 NER ■ TENANT Envirotunentel exhaust and ventilation
Name: A , C ' n � l ,O ^ 1 1` Range hood/other kitchen
c � tri orient 26.00
Address: j J ,J q 3 e Clothes dryer exhaust 26.00
City /StatefZLP: ,_r Q f q '1 a . Single -duct exhaust
(bathrooms, toilet
� � ,) 2s a — // .
Phone: ' 7 Fax: ( f ) compartments, utility rooms) 18.15
APPLICAN 74 CONTACT PERSON u�aawt space fans 18.15
Other: 18.15
Business name: 0for piping_
Contact name: $11,
$11. 00 for first four S3.15 for each additional
WWW�����i��_ Furnace etc, N /outlets
Address: Gas heat pump # /outlets
City/Stale/ZIP: Wall/suspended/tmut heater 0 /outlets
Water heater 0 /outlets
Phone: ( 3/3, • g oo I Fax: : ( ) Fireplace _ # /outlets
E -mail: Range / tt /ottlefs
CONTRA TOR Batttecue 0/outlets .
z ' Clothes dryer (ass) A/otttlets
Business name: (, A I 11 . , 4S . 1 �
Other; M /outlets
Address:
P roc g 0 & p '7 ' MECHANICAL PERMIT FEES'
Subtotal
City/State/ZIP: I. • v.. 4 �j q gO Minimum permit fee
hone: 613) 'a . i ! Fah: (t�- `f ) , $"1' 114 Commercial plan review (25% of permit fee)
'•j -<'CR lie.: b / � _ + State surcharge (8% of permit fee)
TOTAL PERMIT FEE 7' " 5 C
Authorized II i ,r / - This permit application expires If a permit is not obtained
signature: ` . �I within 180 days after it has been accepted as complete. • Pee
Print name: t Date: • rifi D , •w See Pee Scdhedule set by MI-County Building Industry Service board
440 -4617T (11/02ICOM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2006-00515
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/2312006
Phone: (503) 639-4171 :hAtvi
Inspection Requests (24 Hrs.): (503) 639-4175 ,„111- 1J—
INSPECTION WORKSHEET FOR DATE: 10/30/2006 TIME: 7:05Atvi PAGE: 78
SITE ADDRESS: 16645 SW 93RD AVE CLASS OF WORK:
SUBDIVISION: CAFFALLS CORNER LOT #: 004 TYPE OF USE:
PROJECT NAME: LETHBRIDGE
DESCRIPTION: Replace gas furnace, run gas line to stove.
OWNER: LETHBRIDGE, ADRIAN PHONE #: 503-362-4597
CONTRACTOR: BEN'S HEATING & AC PHONE #: 503-233-1779
Inspection Request Scheduled For: Date: 1013012006 Pour Time:
Code # Inspection Description Confirm # Contact #
699 Mechanical final 038843-02 503-233-1779
Corrections/Comments/Instructions:
410
rv r
PASS I PARTIAL APPROVAL n CANCEL I I NO ACCESS
FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Date: /OA*, Phone #: (503) 718-1.-‘rfrf