Permit CITY OFTIGARD MECHANICAL PERMIT
•
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00137
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/12/2007
PARCEL: 2S 109DA -11600
SITE ADDRESS: 12989 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 105 JURISDICTION: TIG
PROJECT: WIZNEROWICZ
Project Description: Installation of heat pump.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF 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:
WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: 1 OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
MIKE WIZNEROWICZ Description Date Amount
12989 SW BLACK WALNUT ST
TIGARD, OR 97224 [MECH] Permit Fee 3/12/200 $72.50
[TAX] 8% State Surcha 3/12/200r $5.80
Total $78.30
Phone: 503 -598 -0958
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 234 -7331
FAX 503- 808 -9108
Reg #: LIC 1441
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: ' - t — Permittee Signature: _.-s - C._ '
Call 503.639.4175 by 7:00 a.m. for inspections that business day. V "
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.
.Mecianical Permit Application RE CEp'j FOR OFFICE USE ONLY
f . f
City of Tigard Dace/By: ; 1-' ` Permit N. 7 'd J
13125 SW Hall Blvd., Tigard, OR 97223 , h U
1 - ; Phone: 5 0 3 .639.4171 Fax: 503. 598.1960 1 . r ~11 2 �tj; Other Permit:
A
TIGARD I Line: 503.639 L 1 TY �FTI •.te Ready/ By: Juris: El See Page 2 for
• Internet: www.tigard- or.gov BUILDIN "Iled/Method: Supplemental Information
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❑ New construction Addition /alteration /replacement u Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
_° ,,a =.e- ar, ., ..,- . ;. ut Value: $
u - =r '$- A'FE 67 "UF0:1415 IJts",l�l l :.: l
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f R S IDE I V TTTTTTTU Qt7It'1LE 1 /SYSTEMSE ; ,'
[ 1 - and 2-family dwelling 12 Commercialindustrial ❑ Accessory building ' ""
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
N b ,_: �'t' s•: r ", ..,r;,.;a " ',6I? 14 s =. �.;:,r.. . »r,.s.. ; .�,.� -� :ter y ii';"5°4 "M' =x`9 `> `
': ,, =� t -, d ' B SIT .:. F I lY ATIO1S> AlV�1,� LO,CATTON ;r t =Ty„ ; : -�1,, e - Heating /coolin -
�"�s�::�,r�.,��?�:�.; ^� Q-:,�. - x.� <:- ��:> s., ,,,.„.,L, -. �>.,.,,.. n; w, e�;,- r�,.. , ,.< , .�,,,r,�-z:� , ,:...�.<,. , r'�=`� =`:ate „�c3:�,� > °a rl l; � 1�
Job site address: Air conditioning r heat pu
' 02 1 ! / , _ (requires site plan sho g p acement) / 14.00
City /State /ZIP: T , O, 9' /_ Furnace 100,000 BTU (ducts/vents) 14.00
JIJ�' '/' Fumace 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
� �` = j ,;;,» x .;� - eV , 3 ,I .S ;: „ g Water heater 10.00
3Z,i. '� ::•; �a % , s:DE... 1PT'ON`'QF'; 4F';QRI a ? Fmr 14
, 4til I
/- 1 ` P 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
" -'"' ..- • ,, T "-;�',,, ; > : , �z- -, „ ,„, Chimney /liner /flue /vent 10.00
r, �nPROEERF f�YGIWN'ER - °.� „ �: ;. _` :;;�ENATi , >i� > �''
... � "'�1f��:',�,, -E..., ` `�;t b:.....; '`�i'��_ .:s����: s�E.: :3c. Other: 10.00
Name: M l' ke 'n >' ('��)( 1i Environmental exhaust and ventilation
-' ` Range hood /other kitchen
Address:. n equipment 10.00
City /State /ZIP: �` �' Clothes dryer exhaust 10.00
- Single exhaust '' toilet compartments, y rooms
Phone: c..J� /� � � Fax: ( ) P utility rooms) 6.80
�:, .,- ;;max, ", :: ,... =TK t-
4 At gar ;; ,. _ ; ws .... s Attic /crawlspace fans 10.00
z i l � .,,.., � Iw ;GQI!,,' A g. ERS N ,,,,V
,cE • - ^' _.:,r". ? _..,,,�`�: �i;�".> = _� �s.,, - -�:ar :M - <+ ..>
Other: 10.00
Business name: ,
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: Gas heat pump
City /State /ZIP: WalUsuspended/unit heater
Water heater
Phone: ( ) I Fax: : ( ) Fireplace .
E -mail: Range
.. _ :., .; ,rrx, . =,> .'�i:T,r"� pRIM: g_',�`.;>ail'7ti;>, " v,i;;iR ' » :,n Barbecue
,., >� R em� r ,.; ; �
� ":e,e> . m moo__ �.,:�a� •�- - .. ..' � ..�... -ov � :a� ...., �-`�
Clothes dryer (gas)
Business name: i . ' dft / • . 1‘)/1 ' Other:
Address: „ 4. o f i J U' V{.zJV z *fir >., ^:
=.MEG>ETAN DIAL= I!E- IiMIT.>�EES„�
c - Subtotal
City /State /ZIP: ; '� �'4 C /Gq . r) /4 � � Minimum permit fee ($72.50) - 7
:
Phone ) - •7 Fax: - ce3O - 9 i 00 Plan review (25% of permit fee)
CCB lic.: ! j.., i State surcharge (8% of permit fee)
TOTAL PERMIT FEE 2
! '� = / ^ ^ This permit application expires it a permit is not obtained within 180
Authorized signature: r� S� f ` days after it has been accepted as complete.
'^ /� * Fee methodology set by Tri- County Build Industry Service Board
Print name: Y I LvA/n 1 0 Da te: /
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•
CITY OF TIGARD .. r •
BUILDING DIVISION PERMIT #: MEC2007- 00137
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/12/2007
Phone: (503) 639 -4171 A11�I +�
Inspection Requests (24 Hrs.): (503) 639 -4175 M ''IL.
INSPECTION WORKSHEET FOR DATE: 4/16/2007 TIME: 7:00AM PAGE: 55
SITE ADDRESS: 12989 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 105 TYPE OF USE:
PROJECT NAME: WMZNEROWCZ
DESCRIPTION: Installation of heat pump.
OWNER: WIZNEROWIGZ, MIKE PHONE #: 503.598 -0958
CONTRACTOR: JACOBS HEATING + NC PHONE #: 503 - 234.7331
Inspection Request Scheduled For: Date: 4/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 046486 -01 503 -234 -7331 Y
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
I FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: -- Phone #: (503) 718 �itAz?