Permit C ITY OF TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00633
e ' - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/6/2005
PARCEL: 1S134CC-03200
SITE ADDRESS: 12000 SW 122ND CT ZONING: R -4.5
SUBDIVISION: YE OLDE WINDMILL LOT: 018 JURISDICTION: TIG
Project Description: Furnace replacement.
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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
• > 10000 cfm:
Owner: FEES
OSBO, JAN D Description Date Amount
12000 SW 122ND CT [MECI - I] Permit Fee 10/6/200E $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/6/200E $5.80
Total $78.30
Phone: 503 - 524 - 3505
Contractor:
SUNSET HEATING & COOLING
0607 SW IDAHO REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97239
Phone: 503 234 - 0611
Reg #: LIC 161085
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: j ' j J r . ,4/ Permittee Signature: r> - ;t , AA._
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.
Oct 05 05 01:36p p . 2
' 1 , 4iii
Mechanical Permit Applic
ti'1714*'S) FOR OFFICE FSF OM.%
eceived
City of Tigard R i n - firir 0.5 t , =m / . . '0 6 _ - 4
13125 SW Hall Blvd., Tigard, OR 97223 Plan ReviVik . ' 10 Datell3Y: 1 - LW
r „ 3 L. ,. , , ew
Phone: 503 \) \ Date/By: .639.4171 Fax: 503.598.1960 Other Permit:
44* '*
Inspection Line: 503.639.4175 ZC./.\ 2 A 'a 1 . Date Ready/By: UM El Scc Page 2 for
Internet: www.ci.tigard.or_us \SV1/4) Notified/Method: m
fieethod: Suppleental Information
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Mechanical permit fees* are based on the value of thc work
0 New construction El Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition D Other: mechanical materials, equipment. labor, overhead, and profit.
eididotiv)diaisigitiiictioierA:ii, • value: s
. . .
,,,:.•4,4_RI.11414,14M.i0dyftA,,STE/vis FEES,.•..c . ..
Oil I- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi 0 Master builder 0 Other:
Description I Qty. Ea. I Total
400.: Heating/cooling
Job site address: 12_0 0 D 2 i - 27,, t. 0-- Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: -r E .?„ A 1 - :)..- . Furnace 100.000 BTU (ducts/vents) 1 14.00 tu ---
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: 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
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
''-:,:1' ' ',A' : DESCRIPTION :***ORilOp...-"aW:,-:OW..:p52::4,3•4"y,r, Water heater 10.00
Gas fireplace 10.00
p t 4 +1 Fltic vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
. . .4';'."'.; ,',::, •: .:
10.00
Name: 0-4-24,-30 Environmental exhaust and ventilation _
Range hood/other kitchen
Address: 1 2 ou . c., - i 6 .,.. , ,,:1±.:• \,-_-,3- - equipment 10.00
City/State/ZIP: - I C. 0IC---- 4:0,9"-j).3 Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( 9.:6) SD (4 2, SI - Fax: ( ) toilet compartments, utility rooms) 6.80
• 0 Attielerawlspace fans 10.00
Other: 10.00
Business name:
. Fuel piping
Contact name: S5.40 for first four; S1.00 for each additional
Address: • Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail:
Range
<X::;_PrOCltilst.'*TigMik.v:ogAwoW'4.6oa Barbecue
Business name: Sunset Heating and Cooling . Clothes dryer (gas)
Other: .
Address: 0607 SW Idaho Street :0
City /State/Z1P : Portland, OR 97239 Subtotal t -4 ---
Phone: (503) 234-0611 Fax: (503) 234-0439 Minimum permit fee (572.50) 170)
Plan review (25% of permit fee)
CCB lie.: 161085 '" State surcharge (8% of permit fee) r)..icr
•
4 • TOTAL PERMIT FEE 7
c „
. x ,!"
Authorized signature: 1 c 0 . i — ' -- ----......,
-. This permit application expires if a permit is not obtained within 1St)
days after it has been accepted as complete.
Print name: Shauna D'Ambrosia Date: I - rckoS • Fee methodology set by Tri-County Building Industry Service Board
iltHuilding1P6rmits\MEC-PermitApp.doc 12/03 440-4617T (1 1/02/COMAVEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC200600633
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/6/2005
Phone: (503) 639-4171 hakbh
Inspection Requests (24 Hrs.): (503) 639-4175 J.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 86
SITE ADDRESS: 12000 SW 122ND a CLASS OF WORK:
SUBDIVISION: YE OLDE WINDMILL LOT #: 018 TYPE OF USE:
PROJECT NAME: OSBO
DESCRIPTION: Furnace replacement.
•
OWNER: OSBO, JAN di, PHONE #: 603-524-3506
CONTRACTOR: SUNSET HEATING at COOLING PHONE #: 503-234-0611
•
•Inspection Request Scheduled For: Date: 10/31/2006 Pour Time:
Code # Inspection Description Confirm # • Contact # Message
1399 Mechanical final - 019603-01 503-524-3505
Corrections omments/Instructions:
6 T2 z (Aq L
•
PASS 7 PARTIAL APPROVAL fl CANCEL I NO ACCESS
I FAIL ,. CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
4
( -3(
Inspecto Date: Phone #: (503) 718-