Permit ,.
C ITY OF TIGARD MECHANICAL PERMIT
=
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00249
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/16/2008
PARCEL: 2511 ODD -13600
SITE ADDRESS: 15515 SW 109TH AVE ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.14 LOT: 706 JURISDICTION: TIG
PROJECT: SMITH
Project Description: Install gas line.
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:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
WILLIAM SMITH Description Date Amount
15515 SW 109TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 5/16/200E $72.50
[TAX] 12% State Surch 5/16/200E $8.70
Phone: 503- 624 -6321
Total $81.20
Contractor:
A 1 INSTALLATIONS
8116 SW DURHAM RD
TIGARD, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 620 -5657
FAX 503- 620 -1696
Reg #: LIC 150109
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: 6 9 - /✓ /9 L / e -770
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.
1 echanieal hermit Ap plicati oI ECEIVED FOR OFFICE USE ONLY G ' ' + u ' q
Dat f "1 � o �Da
�'� �. .`, Pcrmil No.'
City of Tigard Dato/
n 13125 SW Hall Blvd„ Tigard, OR 97223 Plen Review . Phon 503.639.•1171 Fax: 503.598.1960 MAYO r Other Per
• . = � n,temy:
T 1GARL1 pection Line: 503.639.4175 I Date Rea /Oy
Ins Et See Page 2 for
tnteroet www.tigard- or.gov CITY OF l I,+ ' ' D Notiticd /Method; Supplcmcntat information
1 ■ 1) _
►
: .TYPE OF WORK :' : :;. COMMFRCI(A' FEE°' SC11EDUi.E. —. ifSE CHI<:CK :IST
Mechanical permit fees* are based on the value of the work
0 New conatruCtion 4ddition /alteration /replacement performed. indicate the value (rounded to die ucarest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equipment, labor, overhead, and profit.
yJIIS1
' CATrrOR1f .(1y Co1VfiTRt)t TIoN 1 F F:ti
01- and 2- family dwelling El Commercial /industrial ❑ Accessory Fors coral information T / sY tv
R$SIAEIV"Ixll1.EQ >�
censor} building P rise checklist.
❑ Multi - family Ti I Master builder ❑ Other: Description Qty. I Pa. I Total
OB'.. SITE INFORMATION, A C ATION
J Hentin cooling
Job Site address: / 55/ Q � � A �e._. Air conditioning pin or heat pump
J re. uirts sir? tan chewing pIhCCHlent) 14.00
City /State /ZIP; "-1 04 — Ole. 7 7-,D;?-5/ Furnace 100,000 BTU (ducts /vents) 14.00
J 1 Furnace 100,000+ BTU (d /vents 17.90
Suite/bldginpl. no.: I Project name: . 1 1,.:\ Gas heat pump 14.00
Cross street(dircctions to job Site: Duct work 10,00
1- lydronic hot water system _ 14.00
r Residential boiler (radiator nr
hydronic) _ 14.00
Unit heaters (fuel.typc. not electric),
in in - dual, auspco0vd, etc. 14.00
Subdivision: Lot no.. Ftuchvent for any of above 6.80
Other: _ 10.00
Tax map /parcel no,: Other fuel appliances
.: ,. . ' ..DtSCRIPTION OF WOIRK - heater ,, ,,..... Water /gate
,.,:'...,. 10
t iris Tw `- . �' �� Flue fireplace ent r 10.00 -. 10.00
Q , � Flue vcnf for water heater or gas
fireplace 10.00
. Lo h titer r asl 10. 00
Wood /pellet stove - 10.00
Wood fireplace /insert I0.00
Chin i tev /floc /vent 10.00
. OWNER ❑ 'T ENANT'
PROI'.F ItTY Other; 10A0
Name: �l 11 1 q , � _ Environmental exhaust and ventilation
Address: S I s e� 1 U . 1 , Range hood /other kitchen
e ui ment 10.00
City /State /Zip: (1 :. . _R._ C. 1)? 9 _ Clothes dryer exhaust 10,00
single -auct exhaust (bathrooms.
Phone: (569 G g 2 I Fax: ( ) toilet compartments, utility rooms) 6.80
. c w p c.e fans 10.00
API'LICA,NT .' �; :-�' CONTAG'I' P ERSON :. a Is a'
Attic/ r
Business name: / � Other 10.00
G Fuel piping .
Contact n ame: �� 85.40 for first four: $1.00 for each additional
Address: Furnace, etc. _
Gas heat pang _
Ci ty /State /7.TP: Wall /suspended/unit hooter
Phone: (4110 7')0 f7 Fax:: ( ) G 2,C) i G 2 Water heater
t ` Fireplace
E- alai /: l 3 to t / • Os A y _ Range 1
/hill -: . ....,. ..:. . 'CONTRACTOR ' .: :: : . • . ` Barbecue -
B0aiiic,aliniiic. i l. i. j_v. i sl� U f i 'I Lq , 5 clothes dr ( T
1 Other:
Address'
MECHANICA.L.PE 11TF .08.4'
City /State /ZiP: i ., 0 .- v . _ subtotal
Minimum permit Pee ($72.50) A .5'
Phone.: *3 3) 4 ' L _ 7 Fax: ( ) Plan review (25% n of permit fee)
CCI3 tic.: ' l d State surcharge (12% of permit fee) ?, 70
TOTAL PE.RMiT FEE G P/ e �d
Authorized si dture: - hiv permit application expires if a permit is not obtained within I80
E=at days after it has been accepted as complete.
Print name: £p-;(--- Date: ,/,/. ,, Fee methodology Set by Tri- County Building indiintiy Service Board
1:1P,pildint \Permits \ WIC-Permit App dee 01/19/07 440 -4617T (I I /02 /COM/WEB)
.• • .
CITY OF ��mm m n~�n wm�m�mmm��
BUILDING DIVISION ~°~°.~.~�.nm~~ ~°.°.~~.~°"~ PERN1|T#� h4[�(�2OOP�'OD2W9
| �
| 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/16/2000
Phone: (503) 639-4171
Inspection Requests (24Hmj:(5U3)G3Q'4175 ~��� *�--.
INSPECTION WORKSHEET FOR DATE: 5/22/2008 TIME: 6:59AM PAGE: 35
SITE ADDRESS: 1S515SW1O9[MAVE CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.14 LOT #: 706 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: WWII gas line.
OWNER: SMITH, WILLIAM PHONE #: 503-5240321
CONTRACTOR: A 1 INSTALLATIONS PHONE #: 503-02O'5657
Inspection Request Scheduled For: Date: 5/22/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 070249-01 503-624-6321 Y
Corrections/Comments/Instructions:
.
.
�~
� | l PARTIAL � CANCEL -- NO ACCESS _ _
H | FA|L n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: • ~k Date: ^F� ����'-4:" �� Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC200B -00249
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/16/200f3
Phone: (503) 639 -4171 lrpn9�
Inspection Requests (24 Hrs.): (503) 639 - 4175 -�±i
INSPECTION WORKSHEET FOR DATE: 6/19/2008 TIME: 7:00AM PAGE: 31
SITE ADDRESS: 15515 SW 109TH AVE CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.14 LOT #: 706 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Install gas line.
OWNER: SMITH, WILLIAM PHONE #: 503 - 6246321
CONTRACTOR: A 1 INSTALLATIONS PHONE #: 503
Inspection Request Scheduled For: Date: 5/19/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 070057 -01 503- 6246321 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL (l CANCEL ❑ NO ACCESS
FAIL H CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: A Date: 3 ^ � � j Phone #: (503) 718 -Z—