Permit r CITY OF TIGARD MECHANICAL PERMIT
1 DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00123
r�lll 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/21/2005
PARCEL: 2S114BB -15900
SITE ADDRESS: 16110 SW 103RD AVE ZONING: R -7
SUBDIVISION: RIVERVIEW ESTATES LOT: 005 JURISDICTION: TIG
Project Description: Replace gas furnace with same.
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:
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
PARKER, SCOTT E + NINA A Description Date Amount
16110 SW 103RD AVE [MECH] Permit Fee 3/21/200E $72.50
TIGARD, OR 97224 [TAX] 8% State Surchaq 3/21/200E $5.80
Phone: Total $78.30
Contractor:
SERVICE NOW OF OREGON INC
404 SE BEAVERCREEK RD #228 REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045
Phone: 503 655 - 7558
Reg #: LIC 161582
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: � �L� Permittee Signature:
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.
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Mechanical Permit Application ; �k ' ,, n� i ;� "aF,,; ,, : - , .
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C r i v •„ a t e /B - 3 �/' t% S 11C;1(.... Pemut No.:n,� •+✓ 2 •�-
13125 SW !-tall Blvd -, Tigard, OR 9722'} A 1" `Ve ��
Phone: 503. 639-4171 Fax: 503.598.1960 Plan Review
/m,;1h t ,1 ItA Date/By. Other Permit: Tvspection Line: 503.639.4175
MA ,�I� i 1
Internet: www.ci- tigard.or.us H ^►✓ ..,.w,,,, l7atc /t3y: ivrre: [Jv $ce Rage 2fur
Notified/method: SUpplementai InformnNon
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0 New construction Addition /a terat,on rep acement Mechanical permit fees are based on the value of the work
❑ Demolition . ❑ Oilier'
performed. Indicate the value rounded to the nearest dollar) of all
lti ;;K" „ <:
mechanical materials a labor, overhead, and .roftt-
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® I- and 2- family dwelling 0 Commercial /in 1 A c try buildin . -: . •P, ,:''' ,'> ,, .,e; 'J,, , Etij ;- i; , V ' :,_ t
Commercial/industrial ill /-1 2'('r tiff ,I' n �t��' .� n �rf.. � ,r•. :• : • �.
[] Multi -family
For special Information use checklist.
Y ❑ Master builder ❑ Other:
Description
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Job site address: tk„p `` O 5L1/4,..) \03'x' Air conditioning or heal pump
iceurres site .Ian slmwin_ nlocen,cnt) w 14.00
City /State /II': , O, 12. Furnace 100,000 BTU (ductskents) ME 14.00
Suitelbld /a L no.: Furnace 100,000+ BTU duels /vents) t 7 90
S P Project name:
_
mmemmilmommimmom
14.00
Cross street/directions to job site: raj ^Y Duct work 14.00 .
H dronic hot water s stem 14.00
Residential boiler (radiator or
h (ironic) IIII 14.00
Inuit healers (111e1 -type, not electric),
in -wall, induct, suspended. etc. - 10.00
Subdivision: Lot no.: Flue /vent for an of above 11.111 10.00
'Pax map /parcel no.:
Other: 10,00
*) .$1 1 '
r, ', -`arf� , n l : .,. : # £ "'4' „i,Li•I:: IVir N �316 • ; *.; :
'e P\c' Q.A— Giu-s Ft.) Mg.t►_t,,,_ 'A-NN. S� I i•'l vent for water heater or 1 0 00
� !� f gas
lire lace 10.00
- IMMEM111111 10.00
_ , Wootl />tllct stove NINE 10-00
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°°her- 10.00 NM
Name:
• • tf • Environmental' exhaust and vctttfIatian
Address: ' w 11 p S • o Range bond /dither kitchen
hen
c ui»m of 10 -00 MI
City /Statea11,; o� 0 (L 7�� Clothes d er exhaust 10.00 Mil
J �' Single -duct exhaust (bathrooms,
Phone: ( O 5 FEIN: 5 � �� q l � • l x: ( ) • toilet compartments, trttlil rooms) 6.80
e � s ��, y 1 , ' ' : .c f24 - �•, .t 7(q µ s�
"F7>> fir. ":Y1 ,t�1'' 4.• 4 :A `• Tike " � i il7'r P , ,�,g,�'%� .§ r +genii, g'V}�c._.,^ t X 10.00
Business name � .__fLY.�: . � . 1 Qa. Other. lO.Op
`_ Fuel i in;
Contact name: $540 for first four $1.00 for each additional
Address: � �
City /Stale /Z1 P: Wall /sus • ended /unit heater I _ —
E -mail:
; •; ? 1' ; '..: ,;' :,.;_ rC'OjNi..iz::tC•1-OR ., �....w _ _. ... ,.,,.) . r Barbecue _��__ •
Business Hanle: Service Now of Oregon,
Inc. _�
Address: 404 S. Beavercreek Rd 3 228 • 'r, r•; ... .`.x• gl:;' V'.aJ',1:r AR iaG1 J r',.-n ,
X Jt "b7i7r
city /5t;rtc/41P: Oregon City, OR 97045 Subtotal
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Minimum permit fee ($72-5) r
Phone: �Sd ) 655 -7558 Fax: (503) 655- 7533 Plan review (25% of permit i'ea)
C C f 3 lie.: 161582 State surcharge (8% of permit tee) J -
TOTAL PERMIT FEE rjj, ,3 0
Authorized signature: .....--�A ��� 'Ellis permit sllplicsoion expires if a permit is not obtaincd within 180
dNys ,Y ft, .v Irn9 bcr:+ accepted as complete.
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Print name: ^ DS T Date: 1$ 0 6 Fee methodology set by 'Fri-comity 13 uilding Industry Service Board
1: 11. tuhis ,11; WermiislPn:GPcrm iI A pp. doc 1 2/09 440 4d17T /02/co0/VC5)
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CITY OF TIGARD : 1,
- M
BUILDING DIVISION PERMIT #: MEC2005 -00123
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/21/2005
Phone: (503) 639 - 4171 °' p��111 1jII'��
Inspection Requests (24 Hrs.): (503) 639 -4175 - /- Y
"� 0
INSPECTION WORKSHEET FOR DATE: 3/29/2005 TIME: 7 :11AM PAGE: 104
SITE ADDRESS: 16110 SW 103RD AVE CLASS OF WORK:
SUBDIVISION: RIVERVIEW ESTATES LOT #: 005 TYPE OF USE:
PROJECT NAME: PARKER
DESCRIPTION: Replace gas furnace with same.
OWNER: PARKER, SCOTT E + NINA A, PHONE #:
CONTRACTOR: SERVICE NOW OF OREGON INC PHONE #: 503 - 655 -7558
Inspection Request Scheduled For: Date: 3/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
6 699 Mechanical final 003012 -01 503- 655.7558 N
Corrections /Comments /Instructions:
M (;vufIrL 14 (.-1 3 60
I'
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1J 7 i
/ Z
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
� _- 3/ ` lire
Inspector: Date: Phone #: (503) 718-