Permit CITY TIGARD MECHANICAL PERMIT
g COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00071
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/12/2008
PARCEL: 2 S 102 D B - 03700
SITE ADDRESS: 13435 SW CHELSEA LP ZONING: R -
SUBDIVISION: CHELSEA HILL LOT: 014 JURISDICTION: TIG
PROJECT: POLIVKA
Project Description: replacing furnace
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:
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
JOHNNY POLIVKA Description Date Amount
13435 SW CHELSEA LOOP
TIGARD, OR 97223 [MECH] Permit Fee 21121200E $72.50
[TAX] 12% State Surch 2/12/200E $8.70
Total $81.20
Phone: 503- 372 -0724
Contractor:
SPECIALTY HEATING & COOLING
7500 SW TECH CENTER DR #130
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503 - 598 -0718
PRI 503- 620 -5643
Reg #: LIC 66578
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: "-'4"� Permittee Signature:
(�7 ,
Call 503.• 9.4175 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.
Mechanical Permit Appii . . filly ;
i f r FOR OFF I(. L USE ONI.1
7,1 :e City of Tigard '-:_ d ,L • ac :d �.
1
'� 131 SW Fiall)31vd Ti OR 97223 Date/By; U� ��� Permit No -: �i —t�C C)
2008 Plan Review
Phone: 503.639.4171 Fax: 503.598.196 i 7 Date/By: Dame
Inspection Line: 503.639.4175 y
T 1 G A R D r Date Ready/By: lurks: Ed see Pare 2 for
Internet: www.tigard or,gov CI ', i Plottiled lethod: Supplemental (nferoratioo
T1J NG DIVISION col► ItCIA>, $CF lEDi)E;v.='TiSEc ci ;isT
Mechanical
the value (rounded
❑ New construction Q Additiot )/alteration/replaccmont P oxidic value of the work
p ( nded to the nearest dollar) of all
0 Demolition Other: • mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: $
1- and 2- family dwelling El Commercial /industrial El Accessory building
a •1FSI1)E1!)T I E, UIPMENT / SYSTEM .F E *..
Multi - family El Master builder ❑ Other: •
Description For special fr:formation use checklist.
I Qty, I Ea. L Total
JOB SITE INFORMATION AND LOCATION ' Realty/cooling
Job site address: /3 (� C Ci Se Air conditioning or heat pump
rT rre '�' (requires site plan showins ,pIacemeat) 14.00
/ -77: City /State
: u,, 04, e3 7a2 t, 3 Furnace 100,000 BTU (ducts/vents) / 14,00 ��.
Suite/bldg./apt. no.; Project name: Furnace 100,000 +BTU(ducts /vents) 17.90
Gas heat pump _ 14.00
Cross street/directions to job site; Duct work 10.00
—
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. 14.00
Subdivision: Lot nn : Flue/vent for any of above 6,80
Other: 10.00
Tax map /parcel ro.: _Other fuel appliances
DESCRIPTION OF WORK Water beater 10,00
�/ Gas fireplace 10.00
O9pl/n�tei 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
[ PROPERTY OWNER Chimney /liner /flue/vent 10.00
� • ❑ TENANT Other: 10.00
Name: - jhn y �.p Ji 11 jam-' Environmental exhaust and ventilation
Address: /, , s S w c±ej Range hood/other kitchen
City/State/22: equipment w 10.00
City /StateJ2
-11441 ail„ e37,1,,,13 Clothes d cr exhaust 10.00
= (503) ) Fax: Single -duct exhaust (bathrooms,
Phone
t _ O7 ( ) toilet corn... errs, utili rooms . 6.80
❑ APPLICANT ❑ 'CONTACT PERSON Attic (crawlspace fans 10.00
Business name: „,,/M. t ._ .4. if. ,:
.�� d f rr Other: 10.00
�� Fuel piping
Contact name: / C�1 o n114.14/1e/-9 4 55.40 for first four; 51.00 for each additional
Address: ��Y Furnace, eta
City /State /ZIP: Gas heat pump
Wall/sus,ended/unit heater
Phone: ( ) Fax; : ( ) Water heater
E -mail; Fireplace •
Range
V C ANTR • Barbecue
Business name: Specialty Heating & Cooling Clothes dryer (gas)
Address: 7500 Tech Center Drive #130 QeC
DECIIANICAL rE;oviti;
City/State/ZU: Tigard, Oregon 97223 Subtotal I OC'
Phone; ( ) (503) 620 -5643 Minimum permit fee (S72.50) 7
�1 Plan review (25% of permit fee)
CCB lie -: S yE S tate surcharge (12% of permit foe) `'
C t TOTAL PERMIT FEE g7, „70
Authorized signa This permit application expires if a permit is not obtained within 180
days after it hat been accepted as complete.
Print name: r
,.� F.74i_ ,_ A Date: , • Fee methodology set by Tri- County Building Industry Service Board
I:\ Bui lding\Parmir6tMmEC- pamitApp.doc 01/19/07 440.tttI' (It/owKOM/WBn) ,
300 'd 'oN Xdd Ihld O3 :30 NON /8002 /T I /dHd
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2008 -00071
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: J12!2008
Phone: (503) 639 -4171 /i�N�j������'��
Inspection Requests (24 Hrs.): (503) 639 -4175 °I_..
INSPECTION WORKSHEET FOR DATE: 3/13/2008 TIME: 7:02AM PAGE: 43
SITE ADDRESS: 13436 SW CHELSEA LP CLASS OF WORK:
SUBDIVISION: (',HELSE-A HILL LOT #: 014 TYPE OF USE:
PROJECT NAME: POLIVKA
DESCRIPTION: replacing furnace
OWNER: POLIVKA, JOHNNY PHONE #: 603-372-0724
CONTRACTOR: SPECIALTY HEATING & COOLING PHONE #: 503- 620•b&43
Inspection Request Scheduled For: Date: 3/13/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 066626 -01 603-620-6643 t
Corrections/Comments/Instructions:
•
- / LLv< C-7 Lid L /4A. t iii 4.44 TsL. 4 - 3 i,S 2_9s - 41..4 -.-1,8441-
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 -/ 6 Phone #: (503) 718- �4-¢