Permit •
,r.
CITY TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2005-00230
!J ' 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 DATE ISSUED: 5/11/2005
a v
PARCEL: 1 S134CA -05900
SITE ADDRESS: 12045 SW BURLHEIGHTS ST ZONING: R -4.5
SUBDIVISION: BURLWOOD NO.2 LOT: 032 JURISDICTION: TIG
Project Description: Installation of A/C unit.
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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
MATHIS, MICHAEL & OLIVIA Description Date Amount
12045 SW BURLHEIGHTS ST
TIGARD, OR 97223 [MECH] Permit Fee 5/11/200E $72.50
[TAX] 8% State Surcha 5/11/2004 $5.80
. Total $78.30
Phone: 503 -524 -7891
Contractor:
ADVANCED HEATING & AIR COND
5825 SE FOSTER
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Phone: 503- 774 -0161
Reg #: LIC 98573
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: 72 5r� Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business ay.
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.
•
Mechanical Permit Appi� �®
toI.ornr.. i' E ()NIA City of Tigard '1 G Ducar p..nitKo � . S-00,_ l
13125 SW Hall Blvd., Tigard, OR 97223 n Plus Review Other Permit:
Phone: 503.639.4171 Fax; 503.598.1960 " 20.•, 1 ,, 1 i N Date/By;
Inspection Line: 503_630A175 �t(p
39A175 3 ' .. I 1- Nos gaady, � 0 See Pace 2 for
:�.k'
Imam= vww.el.ttgtrd.oT.u■ ! �s �B N rrode.dmd,Iethed: �i� A Suppkeneatelinrarmatiao
.I.:s� CwIt:.c 'm 1tl .d� :`., _ :a ��: "im!; _•x'1.1 ,. .' al dip' 1 ' 4 M � .. I • I. - - f -
.r..1 � h • C r "i. -:: *_! :Sr r'., •,. • .'� h. • l� T,
,. k a
• Mechanism permit Cm' arc based on a value of the work
Et A_
' New construction maid. . tetation/replaccmcnt poribrmed, indicate the value- (rounded to the nearest dollar) of all
❑ Demolition ❑ Otber: mcehanical matcrids, equipment. labor. overhead, and pro5t
.: y j� y m value: S
;+6 .1;17- I; {'' ) ;. Vii i ' "•` ll6itlifee 4:i ii I' "" • W; •
st 1. and 2.fmmily dwelling ❑ ('ommerciaifindustrial El Accessory building • For spcc&l informalion we. °Aeoktler.
❑ Multi- family ❑ Master builder ❑ Other: Description ty. Ea. Total
`, ,, I . - � _
y ;4 .:.., ;.<:�.:"- -� -: �' 1(( �:,y,;l';;'�0yi lieatiuricouling
Air conditioning or heal pump •
Sob site address: ) LI,' . _ � 1 e J 4 ?: + (nQu[tsr clue Plan aho■rn,lt pltccrltent) 14,00
(l- ty/State/Z1P: � 4 . , 7 ja 2 -5 Fumapt: 100,000 BTU ( d4udvenal 14.00 _
Furnace 100,0001 BTU taut vent,) 17.90
Sttittt/bldgdapi, no--: P roject name: 14,00
Gal hratpump
Cross street/directions to job site: Duet work 14.00
Hydronic hot wi to stem 14.00
Residential (radiator or
______ hydronie) 14.00
Unit heaters (fuel -type, no; electric),
jn,woll, in -duct, atopended, etc. 10.00
Fluefventtee miy of above 10.00
Subdivision: ` Lot m.: Utller: 141001
Tax map/pasad no.; Other fud appliances j
(7' ..af•.i'i: �, i a1:5. -'I `1': n.,.,., r , c. ! T t ''R; j Ir; ; '1 l,j'' :
; Veil anc�atcr J . J 10,00
; 4 , -� �.. mC' .w • � �.... - 1 . . . �11 C ' ( t!i ply Ltl bl r 1,
"'IP - iL'_I: .• _��Qt.-lJ�i �,., y -. .. �� n5fa�llai. , :if�!ILfT'F" '1 [l�'i ^.T N ° , 16q � S+rC clef �' ���a�tld �� 19.09
.11! ii.., m Cras t
-
Flue vent for water heater or gad
fireplace _ - 10.00 ,
er 1t r gas t 0,0
Wood/pellet stove 1 0.00
Wood fireplace/insert 10.00
11 g Chimrtvllinerglueivent 10.00
'. S ' ,; lg l ! li; 1�l 1'
d M . iti; :. - 51: :PSrl 1 1 , :l il:i' 1 41' : 1.4 - 1 7 o i ;' N'llii 10,00 ,
t,,usaw �/l /A.
1 , r r 0 V v \ ta. Rnvironlern ioit _,. aatlt d vcnGi __- _
Ali , Range hood/other kitchen
Address; ot 5, f . 4 1 1M& it • - `u 10.00
Clityl$tstclz12 j r"' 0 r q'Z� s �j Clothes drier exhaust -. 10.00
F Single-duct exhoust (bathrooms,
+
phone: (S2) 1 ,.
• A Fax: ( ) _toftae •uti rooms) , BO
I : ... .. , ;m Ill.'. w t °Mai 1 Er[e7Fitc§Ik( _ ti, _� „ :Ai III,,;; - Anicicrawlspaca fang 1 0.00
c -: : . i : il. .
Other: 10.00
.`.
Hustrless name: f Feel plptaz
Contact name: 35.40 for Greg four; 51.00 for teach additdOiul
Address: Furnace. etc.
A •
.47 + � �� Gas teat pump _.
Cliyaceac/ZIP; [ a _ rd. (1 ► • _ s (p wiWsuavcndcdlunithomer
Water heater
Phone: _ Pax; : ( �� Fireplaro
Kam
p, =1,∎(h ') :.,1', mil!.', 4 , : I VW' i . ;'r4 , :t ., I E p I • d .
7!'..•. I A U > �� ii1 il' t ', I .',. . 14.xTn i _ ,
.�• �, t',--','•,', , 114,i aT Pt'. ' „ ,..! t- -. .. 1 il'l!' • . I. �i : 1tr ell C•;� BaYlk,L11 _
nCfll ' /
Cloth
Huila= oama: J _ t es dryer (8ssL
at 01 . '�Jt = ice` Other.
Address: ..$17 .. Fa5r X • '�'.e�'i'l'r. , , ,,p..
caylytataZiy: , 70G� ( 9y6 / Subtotal
Minimum -
/// mitfee M2,50) 7.2",-d
Phone; ta2j zzyr epY Fax' s p3) ' ', f ,/31/ - Plun review (25% of perrnit fe4) y
GCB lie.: / �7.5 vtaec awcharg, (gt'. of permit fcc) 0: Fri
•+
TOTA P E13.MMT FEE , 10
This permit aaplr
pplo if permit it act ot c
rtalad within 1 tO
Authorized signature: T vppl once It but ce Deed if a permit is wut itatu
Print name: 5 /4 /4 1'1are t--.^ , - Fee methodology lei byTri-Counry 0 diltiug led usay Service Board
1+e... .1 � L. . ",.. „m. eeOJOlrs' -/Yr)
ZO 39Vd cJNII H IrlONVACIV TEEbbLLEOS 55 :9Z SOO
SITE PLAN
NC UNITS,'GENERATORS, SPA/HOT TUBS OR
ANY NOISE PRODUCING EQUIPMENT
I
REAR PROPILRTY UNE
L
ADDRESS:
E0 3917d
.. r
9NIlt73H Q3DNtAato
4 INDICATION OF STREET LOCATIONS AND FRONT OF HOUSE •
PLEA ANCL.UDE;
1
LOCATION OP UNIT
2
LOCATION OF PRO T, SIDE & REAR PROPERTY ICES
3 DISTANCE FROM AGE OF UNIT TO FRONT, REAR & SIDE PROPERTY LINES, NOT
mom DOUSE
T6EbbLLE05 55:9T 500Z10T,'50
I V
CITY OF TIGARD . rt
BUILDING DIVISION PERMIT #: MEC20 r 00
O.r 230
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/11/2005
Phone: (503) 639 -4171 At 11,1\
Inspection Requests (24 Hrs.): (503) 639 -4175 ..: =.,
INSPECTION WORKSHEET FOR DATE: 5/31/2005 TIME: 7 :11AM PAGE: 4.1
SITE ADDRESS: 12045 SW BURLHEIGHTS ST CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.2 LOT #: 032 TYPE OF USE:
PROJECT NAME: MATHIS
DESCRIPTION: Installation of NC unit.
OWNER: MATHIS, MICHAEL & OLIVIA, PHONE #: 503. 524 -7891
CONTRACTOR: ADVANCED HEATING & AIR GOND PHONE #: 503 -774 -0161
Inspection Request Scheduled For: Date: 5/31/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 007938 -01 503-774-0161 Y
Corrections /Comments /Instructions:
c c ∎ .. _ := Gt , - S' 3 7 9 7—C 4 -:cz j
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL z CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
_ ,i
Inspector: Date: 5 1 -0 J Phone #: (503) 718-