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CITY F TIGARD � MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00330
A `� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/10/2005
PARCEL: 2S103DA - 06400
SITE ADDRESS: 13300 SW 110TH AVE ZONING: R -4.5
SUBDIVISION: MIRA PARK LOT: 002 JURISDICTION: TIG
Project Description: Installation of heat pump, furnance & electronic air cleaner.
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: 1 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
PERRAULT, STEPHEN & KIM Description Date Amount
13300 SW 110TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 6/10/200f. $72.50
[TAX] 8% State Surcha 6/10/200f $5.80
Total $78.30
Phone: 503- 639 -5726
Contractor:
OREGON HEATING + A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS
Phone: 503 -538 -2953
Reg #: LIC 125815
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: '0 rs Permittee Signature: n
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.
Jun 10 05 11:16a 503 - 537 -2172 p. 2
Mechanical Permit Ap ]['11��r r �- r'-' " FOR OFFICE USE ONLY
City of Tigard 1 t 11 • f 1 Reci d K —. .711 --- 6.0 ---
/' o / Permit No. 5 P � lie)
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13125 SW Hall Blvd., Tigard, OR 97223 eY n /� � , `1N\ ���
Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 , 1 (tA Date/By:
Inspection Line: 503.639.4175 1 JUN 10 , ,. - r� I Date Ready/ By: /mss: 10 Sec Page 2 for
Internet: www.ci.tigard.or.us I Notified/Method: Supplemental Information
.... CITY OF . T; . ' . . KLI
�j t e X :. : .,.' • : ;" . , . -' ,' .; COMNERCIAL : FE * - :U CH
• Dt S J OJNJ ... Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alteranon/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
-' _. -- : '•:: :CATEGORY OF •CONSTRUCTION.:';, :`` • t:'' ,' -
,�, J RESIDENTIAL EQUIPMENT %SXSTENIS I''EES* • ' .:` ; ::
II J and 2- family dwelling ❑ Commercial/industrial El Accessory building ' ' • '
For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
.. _. +: JOB SITE;IlVFORI�IATION'`:AVD . LO C ' PION: " ;,. . °: :- [:. :-:''
. ,..•'..]'
!;.:::.;',..:;:,:••,:••••••;:
.. . Heating/cooling
`�: 9,..\-.) '` A ir conditionin or heat pump
Job site address: t . in ) V 6 — €.-- (requires site plaa show n placem 1 14.00
City/State /ZIP: ' / �! G Z`f< Furnace 100,000 BTU (ductslvenrs) { 14.00
` Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: 1 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
hy(ronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: I 10.00
Tax map /parcel no.: Other fuel appliances
, ., ; :. ',; :;..: rl ,:. ::; ; , heater 10.00
' . I 1000
: DESCRLPTXON:: OF ':WdRR :.::...:.::..'i�:�' :�'::i;.,;; • _ .:;::., Water e
r� -c & Gas fireplace
/�'� S�
l '\ J) C t. [r et _ Flue vent for water heater or gas
V � ct � �j � � fireplace 10.00
Q tl �- CU t Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
10.00
•: _ ...........
ROPERTY 2' ER:: : `❑ NT
;;TENA:: ` : " • :7 •' ::
::..... :. . . ......: ... • • ,:.... ....._ Other
Name: j I�r1 4t (( S } -e \- . j ✓ Environmental exhaust and ventilation
t Range hood/other kitchen
Address: 13 C C,i t) J I) LY t r equipment 10.00
City /State /ZIP: /' / •I 1 � !7 7 �' Clothes dryer exhaust 10.00
L. ( i Single -duct exhaust (bathrooms,
Phone \i'•._
` t , ),(v Fax: ( ) toilet compartments, utility rooms) 6.80
;.. �',. - craw p e fans
10.00
"c/ Is ac
,.; : • APPLIC;AIVT;', y' `; '. .; ;': �. : �:: ®�'CONTACT;•PERSON i 'i:.:.;;t : :' ;,;,.
Attl
Oth I 00
er
Business name /r ` yI , . y1 r 4.. � 6-y....,4_., Fuel piping
Contact name: •" } 1 - • $5.40 for first four; $1.00 for each additional _
• Furnace, etc. I
Address: ` ' 34y) Gas heat pump
City /State /ZIP: L! _ 4 n IL s Wauisuspended /unit heater
Phone )3) S�� aC Fax: &3) `/ 3-j z1 -'2,. Water heater
✓✓ - Fireplace •
E -mail: Range •
c
‘.- ' Clothes dryer (gas)
Business name: / /� ! h &YLd , Other. •
Address : 9' U` ` / : MEC'HANICAL; PERNIEI"k"EES *:..:.•
�
( r L
City /StateiZlP: J ( � Subtotal � � r-
O
� / - ',� Minimumperulit fee ($72.50)
Phone:- �':'] 13 - a (. Fax6) ` ,3 247 Z Plan review (25% of permit fee)
CCB lie.: t . State surcharge (8% of permit fee) >
TOTAL PERMIT FEE g
�/�� � (` This permit application expires if a permit is not obtained within I80
Authorized satuie: M K n (] ,t f ll� �,lr // .�, r / v days after it has been accepted as complete_
Print name: L.: :n �l i+ P) r �����1 i , Date: r :Ma71� * Fee methodology set byTri - County Building Industry Service Board
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i:\BuildwewPamLtsts' C- PcmitAnn.doc 12/03 440.4617T (1l /02 /COM'WEB)
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CITY OF TIGARD 40
:sio BUILDING DIVISION PERMIT #: MEC2005- 00330
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/10/2005
Phone: (503) 639-4171 • ���ugpuloe, ,11�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/25/'105 TIME: 7 :12AM PAGE: 69
6pMtD es
SITE ADDRESS: 13300 SW 110TH AVE CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: PERRAULT
DESCRIPTION: Installation of heat pump, furnance & electronic air cleaner.
OWNER: pE* , - :� .._‘ PHONE #: 503. 639.5726
CONTRACTOR: • 'EGON H -ATING + A/C IN _ PHONE #: 503.538 -:'953
Inspection Request Scheduled For: Date: 7/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 011994-01 503 - 538 -2953 Y 4t Z:u. pm
Corrections/Comments/Instructions:
MIN/6I Li{ - 6F7 SS' ®zz - l6 d.14,
•
\PASS U PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL r/ • L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` _ —�_ Date: 1 7 6 \, Phone #: (503) 718-