Permit e Y!h
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T TY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00403
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/9/2007
PARCEL: 2S102BB -00805
SITE ADDRESS: 12460 SW BROOKSIDE AVE ZONING: R -4.5
SUBDIVISION: BROOKSIDE PARK LOT: 005 JURISDICTION: TIG
PROJECT: HOLLAND •
Project Description: Replace furnace and vent.
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: 1
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: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
HOLLAND, CARL B + SUSAN D Description Date Amount
12460 SW BROOKSIDE AVE
TIGARD, OR 97223 [MECH] Permit Fee 7/9/2007 $72.50
[TAX] 8% State Surcha 7/9/2007 $5.80
Total $78.30
Phone: ,
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 453 -4822
FAX 503- 968 -7224
Reg #: LIC 62196
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 d/ 1/1 ‘ /// ` � Permittee Signature: 7)
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.
Jul ` 09•t2007 11:31RM CLIMATE CONTROL INC. 5039687224 p.2 • Mecha 1; Pe rm_ it: F USE OFFICE SE ONI.1•
•
. - .City-of Tigard . � Received • : • .
13125 SW Hall Tigard, OR .97223 t f � • Date/By: • P muit No. /4 6 `„ : ^ noq63
• Phone: 503.b39.417 Pak: 503.59B, 1960 I' -" Plan Review
.. Other Permit:
Inspection Line: • 503.639:4125 { la Ready/By: ®Se Pa a
1�
JU 1 :
Internet: www.ci.tigard.or.us Page 2- for
• • Notified/Method: Ti� Supplemental lefotmatton ,
_ : COA4IMTERCIAI: FEE * aJSE CHECKL7S'
❑ New construction m • dition/alterationfreplaceent Mechanicalpennit fees* are bused on the value of the work performed. Indicate the value (rounded to the nearest dollar) of
Q Demolition Other. ' • ' mechanical materials, equipment, abor, overhead. and profit, .
,.. _ ...:.. CATEGORY. OF CONSTRUCTION' " :: s,`; ::.:...' ;: .. Value: S . l .
and.2- family dwelling .CommerciaUindustrial RESIDENTIAL EQUI / FEES' .
Q Accessory building - • • 'DI multi-famil Q Master builder . For. special information use checklist; - , • [] Other Description Ea: Total
. JOB_.SITE INFORMATION.,, AND` LO CA T I O N . ': :', `:,'. •: :'_
QtY-
. ... ,._ _ • Heating /cooling • •
Job site address: �F, r con o fi u
/ yb 510 U+ l5D/e si/JL / tr ( Ai n g tiires site nditio plan in r stow neat g.p l ac emertq m 1 -00. • _
Gity /State(LIP: 6R 72a . . • Furnace 100.000 BTU, (ducts/vents) . / , 14.00 . Pr
Suiielbld JI t. no.: Furnace•100.000+BTU (ducts/vents). 17:90
gi p ' : :Pr(aject.name: $"6 '7 / / • Gas heat
pump 14.00. '
Cross. strcet/directions tp job. site: , •
Ductwork .: ... ..:. ,
J4.00
. . . . . kydronic hat 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 10.0D j fl • . ,
' • Oilier: • .1 6.00
. Tax map /parcel no.: • : " ,. Oilier fuel. appliances • -
DFSCRIPTiO1V. OF,'WORK" Waicr heater •
fee y .: Gas fireplace :0.00 - • 4
Flue vent water heater or gas - .
,. .:: :' fireplace•:::• ,. °.:
I:ogIr hur(�asj ::70d0:••• .
Wooiifpehet stove: , - I O;f10. .
• :: ... .. ... .. ... ... Wood freplat:elinsett ;10160: :I:
P R O PERT Y OWNER.. _. .;.., ..,:,. ., .. mneylhnerlfluc/venC : •::..r.:..., .:. .::::1=0:00...', r - .
Gli',
�! , . •.:, .0 'TENANT �. ' �..:... .
Nam . .•;
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: , t�`� .i._.:. �- :U.'�?�s:'.': .. ..1:!!�!"�.1�:. _, ..__. _ . ........ EnvironiaentalrxhRpstand YCrrtilatluA . .: . '::.�' : 1 l ` . ':' ,., :.,.: •_. :
Address:
f e' / ' Range ter.7 it .: .,
`�-:' �� ,: sUIJ'. � F�. /GS�I� —'. ,�fLL ' - equipmo -': :1 , :00
t
C it /Sate /ZIP / � 9,-:-/ .
3' �l�� -s�A �� 'ClottiES'dr � I O.DO ;
.. . . . S ipgle- duct:ezltaust (bathrooms;;.',
Phone; ( I.
- y' rl/ 1?ax: ( ).: toilet'aompartmerrts, utility . rooms) . 6:80 : • . APPLI CANT
:.. , . - ,... ERSO .. tax o
�': . �:: CONTACT P Atiicic dspac fans. 10:(7D_ ' . . ;
Business name: . . . . .
.. t • 1 Mather
,
i k r _
(. 6 _,, j : , Fuel i pin^ • Confact.name:} " • S i. 40. for: first tour ;•S1.00 for'each•additional •
Address: t I - Furnace .etc.
r as G heat pump
; ity /State/ZIP : P •
o + W a0 /suspended/unit heater .
°h one: _ • ! . •Waterheater
Fireplace
'Ranee
CON'RtACT o R .. . . • Barbecue'.
3usiness name i t Clothes dryer faas) ii r Other: k
kddress:: .. _A) s 1. ,
—�a 'MECHANICAL PERM 1TFE£S�'
t:} /Stale /ZIP: .
6� .1 d , ' a a . • 5ubiota] , - 1
: i i
hone: ) + 'ti ` . Fay:,( . T •) . •Minimum permit fee :30) ) 7,2 -5 '
• . - •A - - - Plan review (25% of permit fee) . • CB tic:: . • :State surcharge (8% of perrnit•fee) • S. ® D.
/
tu TOTAL •PERi11IT - FEE 7 g' 3D
thori2ed signatu -' / This permit application expires ifa,permit.is not-obtained within 180
• - . • �• , - _ Date1� Y vs' after. it a
has been ccepted as.camptcie.. `
not name: S' Fee melhodolo set by Euildine lndustptService Board • BuildingtPermits \MEC- PermitApp.d • - . , ,. 440.46177 (I 1/02,COMJWEB(
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2007 -00403
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/9/2007
Phone: (503) 639 -4171 64 4 4 141111 -
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/13/2007 TIME: 7:00AM PAGE: 66
SITE ADDRESS: 12460 SW BROOKSIDE AVE CLASS OF WORK:
SUBDIVISION: BROOKSIDE PARK LOT #: 005 TYPE OF USE:
PROJECT NAME: HOLLAND
DESCRIPTION: Replace furnace and vent.
OWNER: HOLLAND, CARL B + SUSAN D, PHONE #:
CONTRACTOR: CLIMATE CONTROL INC PHONE #: 503.453
Inspection Request Scheduled For: Date: 7/13/2007 Pour Is -
Code # Inspection Description Confirm # ontact # M= sage
6 99 Mechanical final 051837-01 503. 453 - 4822 Y
Corrections /Comments /Instructions: ,.
1 PASS PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/I/ �j
Inspector: �" [ Date: 2 (7 l/ Phone #: (503) 718-