Permit CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2006 -00637
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/13/2006
PARCEL: 2S110DD -11200
SITE ADDRESS: 15550 SW 109TH AVE ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.13 LOT: 682 JURISDICTION: TIG
Project Description: Heat pump and furnace install.
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:
NAT 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:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
BENNETH, JOHN AND BETTIANA Description Date Amount
15550 SW 109TH AVENUE
TIGARD, OR 97224 [MECH] Permit Fee 12/13/20( $72.50
[TAX] 8% State Surcha 12/13/20C $5.80
Total $78.30
Phone: 503- 620 -9113
Contractor:
OREGON HEATING & AC(125185)
PO BOX 397
DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -538 -2953
FAX 503 -537 -2172
Reg #: LIC 125815(SEE OHAC,
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: 6,664, 4 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.
Dec 12 08 09:47a MS Rentals, Inc. 503 - 537 -2172 p.1
Mechanical Permit Application FOR OFFICE USE ONLY
Cl of Tigard Received Permit No _ �- .
�J Date/By: (•2' f5 a 5 (, x'063
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit: '
Phone: 503.639.4171 Fax: 503.598.1960 ("a Da te /B
Inspection Line: 503.639.4175 ■ � ~ "' " Date Ready / By: See Page 2 for
Internet: www.ci.ti ard.or.us "``���
g NNotified/Method: ME ® Supplemental Information
f . c
•
• ' • • TYPE OF WORK ' 1 i, ' ) ,,'„'.c::. t ` C OMMERCIAL FEE* SCHEDULE, H USE CHECKLIST
(11 New construction ® Addition/alteration/replace en Mechanical permit fees* are based on the value of the work
t � • performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition CI Other: t' 1 z n06 mechanical materials, equipment, labor, overhead, and profit.
CATEGORY. OF CONSTRU 141 Y Value: $ •
�� r 1 G l u • RESIDE)\TIAL'EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ID Commercial/industri ' - *,7
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION - . . • Heating/cooling
•
�y ' /�Q Air conditioning or heat pump
lob site address:
15550 5u3 i l J 1 U h A (requires site plan showing placement) 14.00
City/State /ZIP: t t c:jcatrd t OR 4 91 aaq Fumace 100,000 BTU (ducts /vents) I 14.00
Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat pump I 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue/vent for any of above 10.00
. Other: 10.00
Tax map /parcel no.: Other fuel appliances
DBSCRIPI10Pl OF. WORK heater
! i Gas fireplace 10.00
\Jj c ,. Flue vent for water heater or gas
fireplace 10.00
— t 115'111 herxi riu m p E • ft 1 rr t r Cam. Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
0 PROPERTY; OWNER . :::,.:::.:'::J. ' `.0. TENANT 10 00
Chimney/liner/flue/vent Z
Other:
Name: -- T o h n 12., Environmental exhaust and ventilation
1 Range hood/other kitchen
Address: 15555) 5u.) 1( t'- 'vie, equipment 10.00
City/State/ZIP:;; c Ctrd t nR. 91 aaLj Clothes dryer exhaust 10.00
^? ^ � � ., Single -duct exhaust (bathrooms,
Phone: (5 03) b ao ....9 11 F ax: ( ) toilet compartments, utility moms) 6.80
.. t c fans
Li APPI.ICA:'�l'T . . .. ❑ .CONTACi'PERSON Attic/crawlspace 30.00
Other. 10.00
Business name: Oregon Heating and Air Conditioning Fuel r m
p g
Contact name: f helle. $5.40 for first four; $1.00 for each additional
Address: PO Box 397 Furnace, etc.
Gas heat pump
City/Slate/ZIP: Dundee OR 97115 Wallisuspended/unit heater
Phone: (503) 538 -2953 Fax: : (503) 537 -2712 Water heater
Fireplace
E -mail: rasbelle @oregonheating.com
Range _
CONTRACTOR . Barbecue
Business name: Oregon Heating and Air Conditioning 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 -2712 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: I S 1 a 1 `ac.-. State surcharge (8% of permit fee) 1
TOTAL PERMIT FEE 7R, 30
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name:Ra Sv1PIle. g q -yee. Date: i a - la _ * Fee methodology set by Tri-County Building Industry Service Board
is \3u0din,A0.ens'3C- PamiIApp.doc 12/03 440 - 4617T (I1IO2 /COM.'WE D)
Dec 12 06 09:47a MS Rentals, Inc' 503-537-2172 p.2
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CITY OF TIGARD
BUILDING DIVISION ..4.i
PERMIT #: mEc.7006.00637
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/13n006
Phone: (503) 639-4171 I NAPAI#
Inspection Requests (24 Hrs.): (503) 639-4175 , 111.
INSPECTION WORKSHEET FOR DATE: 11612007 TIME: 7 PAGE: 9
SITE ADDRESS: 15550 SW 109TH AVE CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.13 LOT #: 682 TYPE OF USE:
PROJECT NAME: BENNETH
DESCRIPTION: Heat pump and furnace install.
OWNER: BENNETH, JOHN AND BE: i I IANA, PHONE #: 603-620-9113
CONTRACTOR: OREGON HEATING & AC(125185) PHONE #: 503-538-2963
Inspection Request Scheduled For: Date: 1/5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 04185401 503-53&2953 Y*
C rections/Comments/Instructions:
' P■ r ,:._ , _ .0 ..
111,
IA PASS n PARTIAL APPROVAL El CANCEL NO ACCESS
0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: e..--gli Date: i .---.- 0 7 Phone #: (503) 718- Z‘_______
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