Permit i ITY OF TIGAR.D MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2005 -00137
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/29/2005
PARCEL: 2S104BD -06400
SITE ADDRESS: 12701 SW 138TH AVE ZONING: R -7
SUBDIVISION: ROSE MEADOWS LOT: 023 JURISDICTION: TIG
Project Description: 45 ft. of gas piping to range.
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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 0
Owner: FEES
MONTGOMERY, KERRY Description Date Amount
12701 SW 138TH
TIGARD, OR 97223 [TAX] 8% State Surcha 3/29/200E. $5.80
[MECH] Permit Fee 31291200E $72.50
Total $78.30
Phone: 503 -590 -2314
Contractor:
KOEHLER CONCEPTS LLC
10772 SE HWY 212
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Phone: 503- 650 -9550
Reg #: LIC 120277
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
03/28/2005 23:30 FAX 5036501220 KOEHLER CONCEPTS I'j 002 /003
•
Mecha�cal Permit Applic io l nit OP l'it l'. !Isl.: ONE N
City of Tigard Hrt nl - D a t e By: ? - q U .i i. UC �� Date/By: , 9 !� Permit No..‘
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13125 SW Hall Blvd., Tigard. OR 97223 Plan Ravlaw
Phone: 503.639.4171 Fax: 503.598.1960 na p p c) t_ Z n' A' u ; . i • I\ Date/By: Other permit:
Inspection Line: 503.639,417$ l °IP . 1 L1 •I Dino Randy /By: INN 0 gap Pgae 2 far
Internet: www,ci.tigard.or.us Notified/Method: Supplemental information
CITY OF TIGARD
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Mechanical permit Poes° are based on the value of the work
❑ New construction ® Addition /alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other: mechaniool materials, equipment. labor. overhead, and profit.
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® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building v �)' i t,
For special luformarion use checklist.
[] Multi - family ❑ Master builder ❑ Other: Description I Qty. J Ea. I Total
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Job site address: 12701 SW 138TH
Air conditioning
ire to plan ngr heat pump
(requires Bite ph showing pldcemen9 14.00
City /State/Z1P: TIGARD OR 97223 Furnace 100,000 BTU (duets/vows) 14.00
Furnace 100,000+ BTU (dacts/vents) 17.90
Suito/bldg. /apt, no.: Project name: MONTGOMERY Gas heat pump 14.00
• Cross street/directions to job site: Ductwork _ 14.00 _
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronie) 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 a liances
l 7 ,, r ,r _n a� :nnrzT : lrs : , :,� ^' a utr• .'ri i ^ '� 10.00
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�1 G E l.9'r,�'r.I ll. .I.r.11,.....l..l { Water heater Gas fireplace 10.00
RUNNING APPROX 45 FEET OF GAS FUEL PIPING TO RANGE Flue vent for water heater or as
fireplace 10.00 _
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10,00
rzrnrn.- cr. :.n!rlrt'v 'el nryt I , :r "'� l,, f" �' �7sr.prisr.� src�;•r'.•• :',rq'u�p : fir Chimney/liner /flue/vent 10.00
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11J{ l{ i�m '•;Yl�aY ` -. �i;f49N.7n.r •��� 1'_ �LlClli��d� '.ItJ�.�,llyll_k u�t9_ �.,; I��lisr�� :u :.+�LrI,II ,IV�_.,1t_�._,1.1:}i Other: 10.00
Name: KERRY MONTGOMERY Environmental exhaust and ventilation
Address: 12701 SW 138TH Ro hood/other kitchen
equipment 10.00
City /State /ZIP: TIGARD OR 97223 Clothes dryer exhaust 10,00 _
Single -duct exhaust (bathrooms,
Phone: (503)590 -2314 Fax: ( ) toilet compartments, utility roomy _ 6.80
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PEER r. �{ , ^l � j' � , ,�y I ��r g `r 4 j, � , 7 � ■ �y � ^� I y T � I y , .[I V l l Attic/crawl ace fans l0 00
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Other: 10.00 _
Business name: KOEHLER CONCEPTS, LLC Fuel piping
Contact name: TODD . $5.40 for first four; 51.00 for each additional
Address: 10772 SE HIGHWAY 212 Furnace, etc.
Gas heat pump
City/State/ZIP: CLACKAMAS OR 97015 • Wall/suspended/unit heater
Phone; (503) 650 -9550 Fax; : (503) 650 -1220 Water heater .
Fireplace
E -mail: KOEHLERCONCEPTS @QWEST.NET Range I 5.+C) 5 -10
x T, :1 iI .ham ; a, , ..r T Per•
Ent y , ` y 5 n :fi t' I ` rl 1 �` CA t fi i 7` �,jl ' I t 'I t (n�; s 7 : ;
l s 't l a t. Barbecue
� l il h r1� � +j Pti�.� tl��f ,�' ,1A `llft;i ��i. �l•� LI�t� i L�lll4li,lui
Business name: KOEHLER CONCEPTS, LLC Clothes dryer (gas)
Other:
" S. f .� i , "r? r , ..` ry { zi pl l� t ' na; u:rxrn h is 9 t , ,
Address: 10772 SE HIGHWAY 212 ° ,. %, �?s {� " i l+ '�.i l : i i >a . a `' e 1r1� e,i W ' >} 1 i' c t: ,1 .. w : :r;.r . � , 1C 111 } :Fi n :l 1 1 r ,i .
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City /State/ZIP: CLACKAMAS OR 97015 Subtotal 5.1-Q
Minimum permit fee ($72.50) 7 1_ . SD
Phone: (503) 650-9550 Fax: (503) 650 -1220 - Plan review (25% of permit fee)
CCB lie,: 120277 State surcharge (8% of permit fee) 5 . $o
TOTAL PERMIT FEE 7 `fir . 50
Authorized signature: This permit application expires if a permit is net ebratned within 180
6n dim agar both ar It bold bh accepted as complete.
Print name: TODD KOEHLER I Date: 03 - - • Fee methodology aet by Tri- County Building Industry Service Board
i;' 9uitding1Permtta \NEiC- P4rmitApp,doc 12/03 440.45liT(II/O2/COM/WEB)
CITY OF TIGARD 5:
BUILDING DIVISION PERMIT #: MEC2005 -00137
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2005
Phone: (503) 639-4171 _ 14111;1II
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/30/2005 TIME: 7:11AM PAGE: 46
1.3
SITE ADDRESS: 12701 SW 138TH AVE CLASS OF WORK:
SUBDIVISION: ROSE MEADOWS LOT #: 023 TYPE OF USE:
PROJECT NAME: MONTGOMERY
DESCRIPTION: 45 ft. of gas piping to range.
OWNER: MONTGOMERY, KERRY, PHONE #: 603 - 590 -2314
CONTRACTOR: KOEHLER CONCEPTS LLC PHONE #: 503-650-9550
Inspection Request Scheduled For: Date: 3/3012005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 003207 -01 503 - 590 -2314 Y
Corrections /Comments /Instructions:
C A'S L i // 6 16 -6 • .Z
•
i ' a
A/ . \ fp
i C c - i 6 I C'.4 r c >�re-- t-- / A//4 -7 aG :ter
l e PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL IN ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 3 `10 ^ ° &hone#: (503) 718 -