Permit CITY TIGARD - MECHANICAL PERMIT
����.�6 DEVELOPMENT SERVICES PERMIT #: MEC2005 -00694
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/18/2005
PARCEL: 2S 114BD -03900
SITE ADDRESS: 16540 SW COPPER CREEK DR ZONING: R -7
SUBDIVISION: COPPER CREEK STAGE 3 LOT: 079 JURISDICTION: TIG
Project Description: Replace furnace, add A /C.
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: 1 DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
<= 10000 cfm: OTHER UNITS:
FURN > =100K BTU: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
RICHARD /DAR SAMUELSON Description Date Amount
16540 SW COPPER CREEK DR. [MECH] Permit Fee 10/18/20C $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 10/18/200 $5.80
Phone: Total $78.30
Contractor:
ANCTIL SHEET METAL CO.
4320 N WILLIAMS AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97217 -2952
Phone: 503 281 - 0752
Reg #: LIC 8897
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 `% Permittee Signature: d „ . � I V �iff_,`
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 Perm' tion 0 c , :• FOR OFFICE USE ON1I.X
Cie of Tigard D Received h remit No.: #16-c--149125 _ b
] / /
)3125 SW Hs1iE Tiygrr�t, OR 97233 Date/By: ' 2y� 5 -U�
Plan Review
Photre. 503.6: 9.4171 Fax. 503.$98.1960 4t>e � w Datclliy: Other Permi
Inspection Lino: 50 639.4175
OCT 7 2005 +�'�i'
Internet: www.ci.ti g =�ard.or.0 Noti fied/ " •.�.a Date icd/ ho Sec P for
CITY adtod See Intorniat
OF TIGAR I.
' 19SQ) COMME1tCfAL FEE* SCHEDULE .- USE CHECKLIST
El Mechanical perfniX tees* are based on the value of the work
New construCltUti ® Addition/alteration / replaeemeni performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other; mechanical matenals, cqupment labor. overhead, andproft.
CATEGORY OF CONSTRUCTION Value: S
• ® I- and 2•fulnily dwelling 0 Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT information a :ion / use checklist.
FEES*
For Special information use check /isr.
• : ❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
.1013 SITE INFORMATION AND LOCATION Heatin;/cooling,
Job site address. /Wf -�+ 5rj /� /` Air conditioning or heat pump
1/ ��� L�C O te t ,( 0 ( requires site plan showing placement) ! 14.00
11
City/State/ZIP QR ���"7 Furnace 100,000 BTU (duets/vents) 1 14,00
^- " f Tt Furnace 100,000+ B"1'U (ducwJvcnto 17,90 •
Suite /bldg. /apt no.; Project name: Gas hear pump 1.- 14 00
Cross streetidirections to job site: Duct work 14,00
--. „. - Hydronic hot water system 14.00
.— Residential boiler (radiator or
hydronic) 14.00
f Unit heaters (fuel -type, not electric),
in - wall, in suspended. etc. 10.00 _
Flue /vent for - any o f above n
5ubdiviston �� -- Lot no.- _ i _ 1000 f Q.O� r
-
- _ Other: 10.00
Tax map/p no.: Other fuel appliances
. DESCRIPTION Of WORK Water heater 10,00
(� `1(_\ I �` \c �(� r��+ Gas fireplace 10.00
`-'1 ` �v 1� `/ ` l�/� \� Flue vent for water heater or gas
f .. . 1 ! u 4• n _ • treplace 10.00
Lo lighter a s) 10,00
Wood/pellet stove 10,00
Wood fireplace /insert 10.00
OWNER
0 TENANT � Chimney/liner /flue /vent _
® PROPERTY OWNER 10,00
Other: 10.00
-
Name:
i ` it • ael� St,nu�, \te lrovtronrnental exhaust and ventilation
Address: ' Range hood/other kitchen
. *tit C ' >.
2. equipment i IU.IX)
Ciry /State /ZIP; • to
CIothe5 dryer exhaust
• ♦ltt� i rY 10.00
Phone: ( 62g '��` Single -duct exhaust (bathrooms,
Fax: ( ) toti c orn a_rtments, utility rooms) 6.80
❑ APPLICANT CONTACT PERSON Aaic /crawtspace fans 1 10.00
b
Business name; - 1 Other: 10.00 ,
• r i .. ♦ : 1a 1t F uel pipin
t � V
Contact name i t S �V nq�t' „�-
U 5 5.40 for first four; 51.00 fo r each additional
Address: Furnace, etc,
r —_ _
City /State/L1P; Gas heat pump
•
Wall /suspended/unit heater E
Phone: ( ) Fax: ; ( ) Water heater
E -mail' Fireplace - I
Ran
CONTRACTOR ~' 1
Barbecue _
Business name- 1
'/ s.e- ►j ` N.a n � „Clothes dryer (gas)
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Address. gb ` `( v v Other: • MECHANICAL PERMIT FEES*
r City /S tate /ZIP: _ • V `♦ • ■ `! /� t1 -t y '
47 tic /3 - Pax ( ) Minimum permu fee (S72S0)
CC Fi lie : Plan review (25 /, of permit fee) I
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CITY OF TIGARD � . . .
BUILDING DIVISION PERMIT #: MEC200S•00694
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/1812005
Phone: (503) 639 -4171 e llpoAll
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 105
SITE ADDRESS: 16540 SW COPPER CREEK DR CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 3 LOT #: 07 TYPE OF USE:
PROJECT NAME: SAMUELSON_
DESCRIPTION: Ft∎ropla ftarnace, ac ALC—D
OWNER: PHONE #:
CONTRACTOR: ANCTIL SHEET METAL CO. PHONE #: 503 -281 -0752
Inspection Request Scheduled For: Date: 11/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message _ /
695 Misc. inspection 021769 -01 503 -684 -1511 E rr�tr7a.�
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Corrections /Comments /Instr tions: t
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M PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
❑ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I ns ecto Da te: ((A , / P C Phone #: 503
p � ( ) 718 -