Permit •
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CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00630
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/5/2005
PARCEL: 1S134CD-04100
SITE ADDRESS: 11740 SW 121ST AVE ZONING: R - 4.5
SUBDIVISION: BURLWOOD LOT: 001 JURISDICTION: TIG
Project Description: Furnace replace.
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:
GAS 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
TAN, SUOR/SUNDARA Description Date Amount
11740 SW 121 ST AVE [MECH] Permit Fee 10/5/200f $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/5/200: $5.80
Phone: 503- 740 -1996 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045
Phone: 503 - 557 - 2220
Reg #: LIC 72623
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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: It
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business d :y.
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.
. Oct;'"02 05 08: 53p Tr i Count. Temp 5035570919 p.1
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Niechanieal Permit ApplicatiQot,, .z''s
City of
13 Tigard . P IS e a c , ei i B v c y d : 10I 06 8.0 Pemut No.: IV\ 6-0,90G_...
125 SW Hall Blvd., Tigard, OR 972 c
C . ‘ Plan Reviv.v
Phone; 503.639.4171 Fax: 503.598.1
i s t. V ' ',Al Date:By! Other Permit:
Inspection Line: 503.639.4175 , -... AI,. ,..•4 r -: • •. Date Ready/By: Juris: ' 0 See Page 2 for 1
Internet: www.eitigard.or.us \ ' Notified/Method: 7741
Supplemental Information
'' ' ' - ? 7 : : . - .._ - ? .: .t : :;.,:: - 7 .:! :. .. ;'"1.1 „ :: '.1 - : •' . " - '. : : ' ::: :: ..:::: ':( 1 7 1 . 4*;fOit_ t . . '':..'f.:7.'•:':!: : :::,.CellOigRCW.;,7:BpSCHEDUILE"="IISECRECI<LIST
0 New construction XAdditionplacement Mechanical permit fees" are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: icVV' mechanical materials, equipment, labor, overhead, and profit.
.9 O CT OI Value: S •
:-/-**Ii I '7..,... .l:- ;:-,'•':.t..7A rgGF.-1/:F-..CN- : .. ..::,:..,-,.:,-...,:•-, ,.. --.:...,.. - , ...,. ,, . - -
'''''''..."'":-. I '''''''''' ' - '...- . - ' '''''''...--" . - . - - - . --- . ' . - - ' • . --I .... I - . .. . - I. I I • • ' ',.: ..F- iPITt**4.;:i1S5eS:** FEES*
_ and 2 dwelling 0 Commercial/industrial 0 Accessory building ;
i, i...: . .4 special infor 4 t 0.1.6i mation use checklist.
0 Multi 0 Master builder 0 Other: Description 1 Qty. 1 Ea. Total
... .... ..... . .. , .
fl . ..;II . .-.I : :.I.:'-':' : I .!: - .., Heating/cooling _
. Job site address: Inko v Zn
si r
io Air conditioning or heat pump
(requires site plan showing _, • ._ 14.00
C,,..Stutz/Z. rn,
.? • Fue 100,0/...0 BTU (ducts/e...,• .-.; 1 4.00
.
Furnace 100,000+ BTU (ducts/vents) I 17.90
Suite/bldg./apt. no.: Project name: •
Gas heat purno 14.00
Cross street/directions to job site: Duct work . 14.00
. •
. , It•ronic hot water system :
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
_
Flue/vent for any of above • I 10.00
Subdivision: Lot no.:
Other: I 10.00 .
Tax map/parcel no.: Other fuel appliances
-.:/-'; ' ;.,v1:-.s ..,,,T.:::::7' Water heater 10.00
....-:-.,:•;--;., t.i;;;',......;... .-;-....,, , ... -- .• , ..,A1;44i..:L.. ••: '.''''''.:',-,- '
• . . ........,. 1 I
I' Prin.a& Gas fireplace 10.00
Flue vent for water heater or gas ,
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
. Wood fireplace/insert 10.00
.. .' I Chimney/liner/flue/vent . 10.00
i
ii I'III."1:::;.i.=‘'-l::;I:.-.,t''SI .. Other
'.:0 .:I:::.CJ:lII'
,,, -,.- . : I 10.00
Name: e Tap Environmental exhaust and ventilation
Range hood/other kitchen
Address: eal equipment I 10.00
City:State/ZIP: Clothes dryer exhaust I 10.00
Phone: (s -140-1416[1 Fax: ( ) Single-duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80
- Attic/crawl ace fans
a: i - ,Isrr:*r4:06 - %§ . br4.'' . ;':':' '=.':'.-.' 'O ther: sP 10.00 I •
1 10.00 I
Business name: Tr) CC(..0 Tory Corrfro I Fuel piping
Contact name: Ili a 55.40 for first four; S1.00 for each additional
Address: I I 00 6. C_LaCkai(na5 Ri lirt (PP UC) Fumace, etc.
Gas heat pump
City/State/ZIP: CreCpn 0 - eR .. q7045 Wall/suspended/unit heater
Phone: (52) s57-- 9790 Fax:: ( 5 ( :B ) 557--CA1q Water heater
- Fireplace
E -mail:
.. Range .
.'t." I:Ii Barbecue
Business name: To cowry Temp Coi / Clothes dryer (gas)
Other: .
Address: ?) ( t ,- . (F Ri kfcr l)r) \It !:::.,---, .:. • - ••
Cit Dram n ok_ q 4
. LA. 1
Mini Subtotal murn permit fee (S72.50)
i Phone: (6.3) 537- 22201 F (I'Dc6 .i -61,1 Plan review (25% of permit fee) ' ---.....,1_
CCB lic.: 721 23 State surcharge (8% of permit fee
,- TOTAL PERMIT FE 1
.,,,%.. f? 71 17 This permit application expires if a permit is not °Mai within III/
Authorized signature: 4( - 1 -...- - - .' ( cloys after lc has been accepted as complete.
. Print name: bign_c m I Date: 1 Fee methodology set by Tri-County Building Industry Service Board
i:..Building\Perrnitst.NIEC-PerrnirApp doc 12(113 440-4617/ (11102/COMPATinl
CITY OF TlGARD
BUILDING DIVISION PERMIT #: MEC2005 -00630
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/5/2005
Phone: (503) 639 -4171 v %� +II
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/7/20055 TIME: 7:05AM PAGE: 50
SITE ADDRESS: 11740 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: SURLWOOD LOT #: 001 TYPE OF USE:
PROJECT NAME: TAN
DESCRIPTION: Furnace replace.
OWNER: TAN, SUOR /SUNDARA, PHONE #: 503.740.1996
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503-557-2220
Inspection Request Scheduled For: Date: 10/7/2005 Pour Time:
Code # Inspection. Description Confirm # Contact # Message
699 Mechanical final 017732 -01 503. 557 -2220 Y
Corrections /Comments /Instructions:
c."16(472/414-6 4.4/46 -# 5 6376 2 - T
2 )?,ti
P ASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES
Inspector: Date: !0 7—O � Phone #: (503) 718-
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