Permit C ITY OF TIGARD MECHANICAL PERMIT
i` DEVELOPMENT SERVICES PERMIT #: MEC2005 -00054
'4 II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/7/2005
PARCEL: 2S103BA -00128
SITE ADDRESS: 12045 SW 116TH AVE
SUBDIVISION: LERON HEIGHTS NO. 2 ZONING: R -4.5
BLOCK: LOT: 042 JURISDICTION: TIG
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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: 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:
Remarks: Replace furnace.
Owner: FEES
BROWN, STEPHEN P + JULENE M Description Date Amount
12045 SW 116TH [MECH] Permit Fee 2/7/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 2/7/2005 $5.80
Phone: 503 - 590 - 7909 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Phone: 503 Mechanical rough -in
Mechanical final
Reg #: L I C 72623
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.
Issued By: .G��L� S p Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Feb 06 05 07:39a TriCountj Temp Cntrol 5035570919 p.1
Mechanical Permit Application FOR OFFICE USE ONLY
City of EL Tigard DECE Received
g V C • Date/By: 7-0 PermitNa.:�6 , r l�, ` �
��
13125 SW Hall Blvd., Tigard, OR 97 Plan Review J
Phone: 503.639.4171 Fax: 503.598.1960 7 , �; Date/By:
Other Permit:
Inspection Line: 503.639.4175 `L
Internet: www.ci.ti ard.or.us 0 7 2 005 r a I Date Ready /By: Iur s: See Page :for
g FEB - Notified/Method: 1'1 (1' Supplemental Information
- •.... T 111 s al. s s, , CUIyIIYIERC II. .;EvEE SCHEDULE L'SE- CHECKLIST
o Mechanical permit fees* are based on the value of the work
❑Iew construction 1_I A.ditiofl/aIteration / replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
1 CATEGORY QF CONS TION
� ..:. ... �.. .._ ._._�..- ... :.;:.. = ?;- Value: $
} RESIDENTIAL EQUIPMENT: /:SYSTEMS FEES°
l- and 2- family dwelling
'El Commercial/industrial El Accessory building
❑ Multi - family El Master builder ❑ Other: For special information use checklist.
Description 1 Qty. I Ea. I Total
1 'JOB•.SITE l l(� f i, F ORMATION - AND LOCATION-„- Heatin
Job site address: i 1( . l 1/ V Lv v Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/ State/ZIP: l «7 Furnace 100.000 BTU (duets/vents) I 14.00
Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg.apt_ no.: I 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
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
; z r
' :`. s ... ' Water heater 10.00
. DESCRIPTIQN OE. WOR ': t „ � •:
1 .
Gas fireplace 10.00
It91. Itinlar Flue vent for water heater or gas firevlace 10.00
Log lighter (gas) I 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
, Chimney /liner /flue/vent 10.00
RRQRERTV OWNER' ❑ ,T ,t, .
. .. _ _. Other: 70.00
Name: V1CNVn Environmental exhaust and ventilation
^�� f� Range hood /other kitchen I
Address: �.A.✓t I 10.00
equipment
City / State/ZIP: Clothes dryer exhaust 10.00
Single-duct exhaust A (
Phone: 6b3) Sq6= lqO Fax: ( ) toilet compartments, utility rooms) 6.80
1 ❑
� . EPLi2.NT, r. n
C CONr c'r PERSON = Attic /crawlspace fans 10.00 I
/ jj Other: 10.00
Business name: Tr: Catit y Ter Ce f - t )
Fuel piping
Contact name: Mat On S5.40 for first four; 51.00 for each additional I
Address: 0 i 00 6 . Cia(kam�. N JUCl Furnace, etc. J
Gas heat pump 1
City /State/ZIP: Cirrgcfl 0 "N 0 q 7045 Wall/suspended /unit heater ,
Phone: ( ) 557••- '2 I Fax:: (5) 5 5 7--r t q . Water heater I
Fireplace I
E-mail:
Range I
'' 04. CONT.RA.CTOR':, t Y ,:,,r I. h Barbecue
Business name: Tri Cp r C fro Clothes dryer (gas)
� /) licKamctS '' 1y�y Other I
Address: �` 11' JU G Ri �-f n �� - J13 PER RS *-
City/State/ZIP: �Jri' 0i,-) C _ CI7 I Subtotal
Phone: ( SS S) 55 ' -222.0 Fax: (�Q1 657 •- l q i Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 72- 23 / State surcharge (8% of permit fee) ~ r
/� C ^ TOTAL PERMIT FEE �� • •
Authorized signature: t , o �)�� This permit application expires if a permit is not obtain : within i
( /7� (�� days after it has been accepted as complete.
Print name: D�ar,.e j Date: (4 7 I'jv) ' Fee methodology set by Tri -County Building Industry Service Board
is\ Building \PermitslbOC- PcrmitApp.doc 12/03 440 - -46 in (I 1 /02/COM /WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: • p > ! -4175
INSPECTION DIVISION Business Line: 0 17 -4171 MST
/ , BUP
Received Date Requested /D v PM / BUP
Location /? y //6 Suite ME 6G o 15 9
Contact Person 6 Ph ( ) — PLM
Contractor _ Ph ( ) SWR
BUILDING Tenant/Owner ELC C 4 '
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection N. - SIT
Post & Beam
Shear Anchors / 3
Ext Sheath/Shear
Int Sheath/Shear ;` � , VL * - - 5 3 7
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole •
Storm Drain
Shower Pan
Other:
Final
PAS - FAIL
fri 14.•3r► ' t
- ost & Beam, r 111 If/ r*
Rough -In ✓
Gas Line
Smoke Dampers
m
PART FAIL
TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 1=1 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
O
ADA Date / / Inspector it l/ `' Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL