Permit C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2006 -00455
DEVELOPMENT SERVICES DATE ISSUED: 9/25/2006
✓' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S1 /200 06700
SITE ADDRESS: 12775 SW 111TH PL ZONING: R -4.5
SUBDIVISION: WILDERNESS LOT: 013 JURISDICTION: TIG
Project Description: Replace furnace.
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
DEREK LEMIEUX Description Date Amount
12775 SW 113TH PL
TIGARD, OR 97223 [MECH] Permit Fee 9/25/200€ $72.50
[TAX] 8% State Surcha 9/25/200€ $5.80
Total $78.30
Phone: 503- 913 -3163
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
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: D Xd �" Permittee Signature: ,c)1
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.
Sep 25 06 10:18a MS Rentals, Inc. 503-537-2172 P - 1
- (
- r,
- ii we. t !' n 11
Mechanical Permit .Application 0 rq _ . . . FOR OFFICE USE ONLY . .. .
, ,, -t.. ____ t ./.7 ,• — . ' ' - ' '
Ci of Tigard R Permit No \NIVS c„,? vOv5
33125 SW Hall Blvd., Tigard, OR 97223 I Plan. Review
Phone: 503.639.4171 Fax: 503.598.1960 SEp 0 t5 2006 4 .,,, it, Date/By: Other Permit
Inspection Line: 503.639.4175 . Date Ready/By: loris: i ei See Page 2 for
....n. ....at
Internet www.ci.tigard.or.us Notified/Method: 1 .-. I Supplemental Information i
Ut' ii ilkji
'. s. ::: : :::'. , ' ,...: '''.'' .'"Y - •. 1,1 - 11,1 11 ... .. '. -:1-00111 - '
Mechanical permit fees* are based on the value of the work
0 New construction 6 Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
D Demolition U Other: mechanical materials, equipment, labor. overhead, and profit
Value: $
.
gr 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special infortnation use check/oar.
0 Multi-family D Master builder 0 Other: Description Qty. Ea. 1 Total
...., .. - •....::.... ,
.Y26i.1.Sii".*:64164ti.C2.111:1;C:1?1:•9:411P.1-.1.1:S:.1:.l':1;.1-,•11,'....1..111,1,1:.='11,1 Heating/cooling
Air conditioning or heat pump
Job site address: i ail 5 .5 ,...) il 5 411 pl (requires site plan showing placemer.t) 14.00
City/State/ZIF': --i (IR qi).. a 3 Furnace 100,000 BTU (ducts/vents) j 14.00
Furnace 100,000+ BTU (ducts/vents) 1.7.90
Suite/bldg./apt. no Project name: .
Gas heat pump I 14.00
-- )
Cross street/directions to job site: Duct work I 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 1
Pluetvent for any of above 10.00
Subdivision: Lot no.:
• Other. 1 10.00
Tax map/parcel no.: Other fuel appliances
l:;:4.,,',:ilt.:24,,..'-:',4i§e013..iii6i{:6;ii-iiiiiiiiersiii:qiIhy::::Aigi•t.Ft5:; Water heater 1 10.00
11:1 ,:i:?... ...,:,:i=1;..:1:
Gas fireplace 10.00
'
t+ PC Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) I 10.00
Wood/pellet stove I 10.00
Wood fireplace/insert I 10.00 I
- . 1 Chint1/11111`rinueiveat I 10.00 1
1 :: , =.:; - :':1:.".,:,:', 5 ■ 1 ..;•-. 1 ...'::P:-....':--'-.1*..`L+. 1 ;-!'6 1 1- - "1.:: 1 871: - : - f . . 1 ::' 11 ,F•4i11 1 : 1 . 1.--11 1 1111 ::: 1 :, - 1. 11 . 1 : 11 :: - iti= 1 ....., ,:11ll..,.,.:...-..-:.
Other. I 10.00
Name: D ereK Lo-viiewc_ Environmental exhaust and ventilation
Range hood/other kitchen
Address: ia115 N_LD tisi%-1 Pi equipment 10.00
1
City/State/ZIP: - - r iaarr i o p , cil a I s , Clothes dryer exhaust 10.00
Siugie-duct exhaust (bathrooms,
Phone: (502,) q I - 3 I 6 Fax: ( ) toilet compartments, utility romps) 6.80 1
' .i1.:, AttinkrawisPann fans I 10.00 I
. Other. 1 10.00 I
Business name 1,. , I AA a .., tibl 4_ 01(u9, , Fuel piping
Contact name: ' ,1\ y —) $5.40 for first four; $1.00 for each additional
ri
Furnace, etc.
Address: fl ) - K r ,B4,y)
Gas heat pump
City/State/ZIP: J Alfils__
b V_ (4 fl IL s— Wall/suspended/unit beater
Water heater . 1
Fireplace 1
E-mail: Range
C - Barbecue
suam
Busines e: ' /IP i r 1) NI (liuli. CdtmAs Clothes dryer (gas)
Address
Other I
: ; cy. 7 ..,,X4 r- . ,...,..s:..."--.:., :„.„-..:..:
i.,_:: PAR-
City/State/ZIP: 11 Otte 0 Cl 11 I (,,. Subtotal I
6 t Minimum permit fee ($72.50) 12. 5 0
Phone: .. - 23 3 Laj_63; Fax-6 F-53 0172-, Plan review (25% of permit fee)
CCB lic.: ll
'(.._,
State surcharge (8% of permit fee) 5 . S.
TOTAL PERMIT FEE 7 ( 5 , go 1
This permit application expires if a permit is not obtained within 180
Authorized sWature: /, i OW ) LILL/nm ap.,./k„ Th days after it has been accepted as complete_
"
Print name C , it • I , ,..... A b-rt.,.(.4r1 , _. ,
Date: :, 6F/0 . 6, * Fee methodology set by Tr-County Building Industry Service Board
' CITY OF`TIGARD . " . ..
BUILDING DIVISION J PERMIT #: MEC2006.00455
-13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/25/2006
Phone: (503) 639 -4171 4ptyi lllli
Inspection Requests (24 Hrs.): (503) 639 -4175 =�.
INSPECTION WORKSHEET FOR DATE: 12/11/2006 TIME: 7:00AM PAGE: ?3
SITE ADDRESS: 12775 SW 111TH PL CLASS OF WORK:
SUBDIVISION: WILDERNESS LOT #: 013 TYPE OF USE: '
PROJECT NAME: LEMIEUX
DESCRIPTION: Replace furnace.
OWNER: LEMIEUX, DEREK PHONE #: 503 -913 -3163
CONTRACTOR: OREGON HEATING + NC INC PHONE #: 503.538.2953
' Inspection Request Scheduled For: Date: 12/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 04089B -01 503.53E -2053 Y
Corrections /Comments /Instructions:
Y' i✓ �/LGT/l.4 '44s bLt, tl.ia /,/✓1ift . - J arse , ..ri e,,,,eez„, f 'r,
PASS ❑ PARTIAL APPROVAL I CANCEL 1 I NO ACCESS
I I FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date:" / /.—.0e, Phone #: (503) 718- _..-4
L. -