Permit CITY TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00308
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/29/2007
PARCEL: 25111 CD -05100
SITE ADDRESS: 15975 SW BRENTWOOD CT ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.9 LOT: 510 JURISDICTION: TIG
PROJECT: SEITZINGER
Project Description: Gas furnace change out.
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:
NAT 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
PEGGY SEITZINGER Description Date Amount
15975 SW BRENTWOOD COURT
TIGARD, OR 97224 [MECH] Permit Fee 5/29/2007 $72.50
[TAX] 8% State Surcha 5/29/2007 $5.80
Total $78.30
Phone: 503 -624 -1925
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 266 -1249
FAX 503- 266 -3478
Reg #: LIC 14008
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: i , A L W // 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.
May 29 07 12:02p p.2
# 12 - 7 Co z .. K.M
MFC �rnical Permit Application FOR OFFICE USE ONLY
C, of `t'i and N � ' a �� - Y e Receive 5 Z9 • 51� .. ` &Y - Lb
g'..le .�.m df 3 ' %� Date/By: Permit No.: ► `�
13125 SW Hall Blvd., Tigard ,01}A7223
t rr• � L Plan RCN' law
Phone: 503.639.4171 Fax: 503x.5981960 ¥ • -. ( Other Permit:
v 0 x «.a' �t(li.�� Date/By:
Inspection Line: 503.639.4175 _ J. I Date Ready/By: Ju s ® See Page 2 for
Internet: www.ci.tlgard.or.us 2007 6 7 Av v ii Not /Met od: '1 & S upplemental Information •
: • ;; - • T YPE..OF A /ORK ,,. : COMMERCIAL; .FEE* SCHEDULE ` USE CHECKLIST •
Ti �l J 7 13 , - Mechanical emtit fees'" are based on the value of the work
❑ New construction � ' � (�� Addition /alterattoris t t p
.eo:• '''� ••' v a r:rm. - r e f, r - � x E performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, labor, overhead, profit
J and
:CATEGORY: OF CONSTR - [a: l
Z( -O
s egvpmenl a a d
Value:
H gj ; .'RESIDENTJAL EQUIPMENTSTEMSFEE *':' :
1 - and 2- family dwelling ❑ Commercial/industrial 1=I Accessory budding
For special information ttse checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
" JOB SITE INFORM AND L OCATION
Heating/cooling
•
Job site address: q 1 j -e, nn Air conditioning or heat pump
;,4� \ t�•� 1. (requires site plan showing placement) 14.00
CityiState /ZIP: L 1 (in r d 1 C q72-2-4 Furnace 100,000 BTU (ducts /vents) 1 _ 14.00 14 • L i
', 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 j 14.00
Residential boiler (radiator or
hvdronic) 14.00
Unit heaters (fuel -type, not electric), .
in- wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flueivent for any of above 10.00
Other, 10.00
Tax map /parcel no.: Other fuel appliances
- - DESCRIPTION OF WORK Water heater I0.00
Gas fireplace 10.00
al f 1 fl Cl ( 0.-h ( -nC G7 •Lt Flue vent for water heater or gas
J fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert _ 10.00
Chimney /liner /flue /vent 10.00
..:. • PROPERTY O `. • :: :: o TEN :
' Other. I ow
Name: PC C r l � C �' r Environmental exhaust and ventilation
d �l
Range hood/other kitchen
Address: ! S ;S�t) IJti 1"1)10(; fd l 0 f- • equipment 10.00
City/State/ZIP: i (Ia r (91 1 C Clothes dryer exhaust 10.00
" r 7
G Single -duct exhaust (bathrooms, Phone: 15o,3) L0Z_ �( - I t 2.5 Fax: ( ) toilet compartments, utility looms) 6.80 _
A PPLICA NT : ::::.:, '❑ - CONTACT PERSON'.: crawlspace
... :::: . fans
Attic 10.00
Other. _ 10.00
• Business name: Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional .
Address: Furnace, etc.
Gas heat pump
City/ State /ZIP: _ Wallisuspended/unitbeater
Phone:( ) Fax::( )
\L Water heater
Fireplace
E -mail:
Range
_ .. ......:.. :::. _ :.:C
-
_ ... .. .. .. RAC'1j'OR? . ? : Barbecue
name: a/? f -/� 11,3 •
Clothes dryer (gas)
//�� � � O t h er.
Address: .Y - / 2 i ' " :_ `: .. : * .:..
!! t - 1 �1EC 41∎ApA , : PE'RMIT: 0: .I
City/State /ZIP: C VA U 4 ., 9 704 Subtotal t - Up
�t / 6 _! - 7 /q i Minimum permit fee ($72.50) - 72 -SC)
Phone: (5 7 , 1 - 1 Z l ; Fax: (55) 22 - � ' 7/) ' ! Plan review (25% of permit fee)
CCB lic.: / `' Odd' State surcharge (8% of permit fee) I r.i. RI-_) ' TOTAL PERMIT FEE j 1 � • 30
Authorized signature:
�a C -_,z4.-c\ This permit application expires if a permit is not obtained within I8D
/ ! � days after it has been accepted as complete.
Print name: 1 Gt L( , L Date: 5 /' - /67 . Fee methodology set by Tri- County Building Industry Service Board
i:ukLilding Penuiu\MEC : -I'mn itApmedoc I2/OJ - I4U• -16I7T (m I /ULCOM'WEBI
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Pv1EC2007 -00308
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/2992007
Phone: (503) 639 -4171 l eemovi'( i
Inspection Requests (24 Hrs.): (503) 639 -4175 :_..
INSPECTION WORKSHEET FOR DATE: 5/31/2007 TIME: 7:00AM PAGE: 52
SITE ADDRESS: 15975 SW BRENTWOOD CT CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.9 LOT #: 510 TYPE OF USE:
PROJECT NAME: SEITZINGER
DESCRIPTION: Gas furnace change out.
OWNER: SEITZINGER, PEGGY PHONE #: 503- 6241925
CONTRACTOR: ROTH HEATING & COOLING PHONE #: 603-266 -1249
i
Inspection Request Scheduled For: Date: 5/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 049320 -01 503 - 266 -1249 Y
Corrections /Comments /Instructions:
nil _ _ cnz 14.,,. /,..oX' ' �- / t z g45 9 v s9wS G.%eec -41, ae�,
P ASS PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 2J 17 Phone #: (503) 718- �X