Permit • ki CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00445
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/23/2007
PARCEL: 2S 110AD -07500
SITE ADDRESS: 14905 SW 106TH AVE ZONING: R -12
SUBDIVISION: LANG HILL NO.2 LOT: 067 JURISDICTION: TIG
PROJECT: VAN HORN
Project Description: Install furnace.
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:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
CARMEN VAN HORN Description Date Amount
14905 SW 106TH
TIGARD, OR 97223 [MECH] Permit Fee 7/23/200 $72.50
[TAX] 8% State Surchaq 7/23/200i $5.80
Total $78.30
Phone: 503- 347 -0667
Contractor:
OREGON HEATING & AC
PO BOX 397
DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -538 -2953
FAX 503 -537 -2172
Reg #: LIC 172126
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 OU NC by
calling 503.246.6699 or 1.800.332.2344.
Issue B (/' 0 i 4L/ / Permittee Signat re: _ �` l 2 y
Call 503.639.4175 by 7:00 a.m. for inspectionsth 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.
Ju1A 0 07 03:36p Oregon Heating & AlC 503 - 537 -2172 P -1
Mechanical Application FOR OFFICE USE ONLY -
City of Tigard 7 .?o D 7
� Plan R fj1-V Permit No.: X !/,,, 7—� 4
D 9' 13125 SW Hall Blvd., Tigard, OR 97 3t i % v�
Plan Review Other Permit: •
Phone: 503.639.4171 Fax: 503.598.1 ® 2007 Date/By:
Inspection nspection Line: 503.639.41 lJ Date Ready/By: Jur • H See Page 2 for
Internet: www.tigard- or.gov N.. ( �]D Notified :Method: /� Supplemental Information
pp� ss� mtflQn i 1I1v
. TYPE OF .% Ume- t7ev w COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
•
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition /alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
®1 and 2- family dwelling RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family 0 Master builder
❑ Other: Description Qty. Ea. I Total
•
• . JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 4q0 ax) (00-h n `► Air conditioning or heat pump
I)� r� V� (requires site plan showing placement) 14,00
City/State /ZIP: i 1 9c' 0 R 97Q aL Furnace 100,000 BTU (ducts /vents) t 14.00 i 1 4 ,60
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite /bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: _______; Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
r/ hydronic) 14.00
Unit heaters (fuel -type, not electric),
______ 1. -' in -wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other. 10.00
Tax map /parcel no,: Other fuel appliances
DESCRIPTION OF WORK : Water heater [0.00
Gas fireplace 10.00
HVAC- � ! s t �/a Flue vent for water beater or gas
1 ! fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
. PROPERTY OWNER .. .
. • ' ❑ TENANT Other: 10 -00
Name: Carmen VGm-tarn Environmental exhaust and ventilation
Range hood /other kitchen
Address: ill q)5 ,%,..) 1 0 GA- } , Nu equipment 10.00
City/State /ZIP: 'i a I C 9 Clothes dryer exhaust , 10.00
ld Single -duct exhaust(bathrooms,
Phone: (5) 31 0667 Fax: ( ) toilet compartments, utility moms) 6.80
E] APPLICANT . . ❑ CONTACT PERSON Atticicrawlspace fans 10.00
Other: 10.00
Business name: Oregon Heating & A/C Fucl pp t tng
Contact name: $5.40 for first four; $1.00 for each additional
Address: PO BOX 297
Furnace, etc.
Gas heat pump
City/State/ZIP: Dundee OR 97115 Wall/suspended/unit heater
Phone: (503) 538 -2953 Fax: : (503) 537 -2172 Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
• Business name: Oregon Heating & A/C
Clothes dryer (gas)
Other
Address: PO BOX 397 MECHANICAL PERMIT FEES*
City /State /ZIP: Dundee OR 97115 Subtotal
Phone: (503) 538 - 2953 Fax: (503) 537 -2172 Minimum permit fee ($72.50) '12 t 50
Plan review (25% of permit fee)
CCB lie.: 172126 State surcharge (8% of pennit fee) _ _: W)
TOTAL PERMIT FEE -' ( 7 ' ?�')
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: /7a5h clip / 0. Date: 7 ... R0 ._ 07 * Fee methodology set by Tri -County Building Industry Service Board
1:1 Buitdineennits \NTEC- PcnnitApp.dec 04/066/ 4:10- 46171(11:02 /COM/R•EB)
CITYLQF:TIGARD
y
� BUILDING DIVISTON PERMIT #: MEC2007- 00445
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/23/2007
Phone: (503) 639 -4171 i ii
Inspection Requests (24 Hrs.): (503) 639 -4175 : . . '• � + W p�ulp� R__..
INSPECTION WORKSHEET FOR DATE: 8/8/2007 TIME: 7:00AM PAGE: 34
SITE ADDRESS: 14905 SW 106TH AVE CLASS OF WORK:
SUBDIVISION: LANG HILL NO.2 LOT #: 067 TYPE OF USE:
PROJECT NAME: VAN HORN
DESCRIPTION: Install furnace.
OWNER: VAN HORN, CARMEN PHONE #: 503 -347 -0667
CONTRACTOR: OREGON HEATING & AC PHONE #: 503 538 - 2953
Inspection Request Scheduled For: Date: 8/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 053593 -01 503-347-0667 N
Corrections /Comments /Instructions: / � /
#/ 6 — _L• , .1 i. _r ' !! S- j ✓� 7 I 8 6 2a e.+ /r1.-
R/i r54- r , 71.1 c4-z, ri.4�41-
/PASS PARTIAL APPROVAL ❑ CANCEL LESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: F Date: &' B — o> Phone #: (503) 718- Zq
r r 4
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2007- 00445
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/23/2007
Phone: (503) 639 -4171
A Inspection Requests (24 Hrs.): (503) 639 -4175 .L.
INSPECTION WORKSHEET FOR DATE: 8/3/2007 TIME: 7:03AM PAGE: 26
u
SITE ADDRESS: 14905 SW 106TH AVE CLASS OF WORK:
SUBDIVISION: LANG HILL NO.2 LOT #: 067 TYPE OF USE:
PROJECT NAME: VAN HORN
DESCRIPTION: Install furnace.
OWNER: VAN HORN, CARMEN PHONE #: 503- 347 -0667
CONTRACTOR: OREGON HEATING & AC PHONE #: 503.538-2953
Inspection Request Scheduled For: Date: 8/3 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 053383-01 503 - 538 -2953 Y
Corrections /Comments /Instructions:
/ .i6
PASS • ❑ PARTIAL APPROVAL n CANCEL VACCESS
❑ FAIL I . CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
-Y
Inspector: Date: .?? 3 --0 "" Phone #: ( 718- Z -4.�