Permit A 1, CITY OF TIGARD MECHANICAL PERMIT
11 DEVELOPMENT SERVICES PERMIT #: MEC2005 -00479
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/4/2005 5
PARCEL: 1 S134AC -02647
SITE ADDRESS: 11050 SW COTTONWOOD LN ZONING: R -4.5
SUBDIVISION: ENGLEWOOD NO.3 LOT: 213 JURISDICTION: TIG
Project Description: Installation of A/C, replace furnace.
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
LUDDEN, CONSTANCE Description Date Amount
11050 SW COTTONWOOD LN
TIGARD, OR 97223 [MECH] Permit Fee 8/4/2005 $72.50
[TAX] 8% State Surcha 8/4/2005 $5.80
Total $78.30
Phone: 503 -521 -9931
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Phone: 503 -557 -2220
Reg #: LIC 72623
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: Permittee Signature: IN
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.
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Aug 01 05 11:09p Tri Count Temp 5035570919 p.1 .
Mechanical Permit Applica
1- M � ` - FOR OitIC)EusEomot - .�
City of 1 n It-
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I Permit No G -^ �`
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13125 S'1: Ea a Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 fax: 503.598.1960 AU G ( � 3 A40..--.,,s1:- -
1 i ' Da[e,3y: Other ?ettrut:
Inspection Line: 503.639.4175 t, , 1 1 '
: Date Readv'By: RIM. RIM. J E1 See Page Z far
Internet: www.ci.tigard.or.us C ard.ous V T Notified/Method: /,' 1
Supplemental Information
.. -.. ^.� •,.: ".'�- ��'� � •. .. %.. '.. -.:': . 71'1:1 -
- -�: - .T'. E "'OF:•i�`O . '• ;�:�� "` ..` � � :: ' ��:, '' I COMMERCIAL FEE* 'SCHEDUT:E' - 'USEiCrIECKLIST
❑ New construction X Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
1 : }• - 7 _ ""J'
C. ^T:i riI1R : _- . r' Value: S . i .
.. ; ; =:1 ESIDEN•TIAL: :EQUIPMENT', SYSTEMS'FEES*
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building '"
For special information use checklist. .
El Multi ❑ Master builder ❑ Other: •
Description .� Qty. I Ea. Total
• JOB SITES INFORM -TI0N AND L OCATION ...
Job site address LI C)50 V ( ` o ` IDri 60 L I Air conditioning or heat pump
re. wires site •.Ian showin. placement) 1 14.00
City/State/ZIP: + Furnace 100,000 BTU (ducts/vents) 14.00
1 Suite/bldg. /apt. no.: Project name: L Furnace 100,000+ BTU,(ducts /vents) 17.90 I q l :
,1--_ Gas heat pump 14.00 I ,
. I Cross street/directions to job site: Duct work . 14,00: I
i-I dronic het water sys tsm i 14 00 '
Residential boiler (radiator or "
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. . 10.00
— — Flue /vent for any of above • 10.00
Subdivision: ( Lot no.:
Other: 10.00 .
Tax map /parcel no.: Other fuel appliances
"" Water heater I 10.00
* DESCRIPTION. .O - - ;:,: �,�:� #�:.< - - . `,� ;.
Gas fireplace 10.00
1`��U1rn j , e ll,�,l,I -Aic Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
I Wood /pellet stove 10.00
Wood fireplace/insert 10.00
,... Chimney /lineriflue /vent I 10,00
,, ;❑:' EROPERTY: OWNER sir.",' - :' T '
Name: COW K/ Ir Gc , L ACtaen Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 10.00 I
City/State /ZIP: Clothes dryer exhaust i 10.00 I
1 Single - duct exhaust (bathrooms,
Phone: 60 52_1 4431 Fax: ( ) toilet compartments, utility rooms) 6.80
❑.= APPLICAI .:-. ' .. CONTACT: E EtRSO 1' Attic /crawlspace fans • 10.00
' Other: 10.00
Business name: in Ce Z'np C (DI f` c' 1 Fuel piping • •
Contact name: bi ant n � 55.40 for first Cour; 51.00 for each additional
Address: 0 I , (') 6 C I QI kl Ur( (l,C. J I I , f J/ 'j� I UC) Furnace, etc. I
V Jil Gas heat pump
1 Cit /State/ZIP: �` CC I1 0 / c ((7Q4 WalUsusoended /unit heater
Phone: (O3) 557- 2120 Fax: : (b0.3) 557—C61 L q Water heater ,
- Fireplace
E -mail: Range
, ..
ange
"' :�< , - S •
•CONR't�CTOR -:" :t-- �'al' - 4 '. Barbecue 1
Business name: I ni 1 ?n C - I Clothes dryer (gas) •
1 t t : `' ' i Other. 111
• Address: 17) ∎r'5(` P). ' . (1 ' ti � � l I -Zl 1 - ' �� MECHANICAL PERMIT FEES
City /State/ZIP: Oregon L C! CI��� Subtotal I
7 , i Minimum permit fee (572.50) i
Pbone: ( .�) J5 I L22� ' I Fax: ( j r ]LJ 7 •-�: I <•� p
1 Plan review (25% of permit fee) 1
CCB lit.: � /. State surcharge (8% of permit fee)) 6)
v ' r -0 TOTAL PERMIT FE
% �
.Authorized signature: "" 7�^ d C ` Mr This permit application expires if a permit is not obta d within 130
'
days after it has been accepted as complete.
Print name: big/-) ( 11)1 Q. i(l ,41 Date: qfplo • Fee methodology se: by Tri- Coucty Building Industry Service Beard
1.'.Bui !ding ?vrnits':AEC- PernitApp.doc 11'03 440 - 45177 (t 1!0?'CO:,IN"EB
Aug 01 05. 11:10p Tri Count Temp 5035570919 p.2
INSTALLATION ADDRESS!
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PROPERTY LINE '
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CITY `
BUILDING DI ISION PERMIT #: MEC20000a179
13125 SW Hall Blud., Tigard, OR 97223 DATE ISSUED: 8/4/2006
Phone: (503) 639 -4171 / I
Inspection Requests (24 Hrs.): (503) 639 -4175 -''' ..
INSPECTION WORKSHEET FOR DATE: 912/2005 TIME: 7:07AM PAGE: 76
SITE ADDRESS: 11050 SW COTTONWOOD LN CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO.3 LOT #: 213 TYPE OF USE:
PROJECT NAME: LUDDEN
DESCRIPTION: Installation of NC, replace furnace.
OWNER: LUDDEN, CONSTANCE, PHONE #: 503 - 521 -9931
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503557 -2220
Inspection Request Scheduled For: Date: 9912/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 01484001 503-750 -8491 Y
Corrections /Comments /Instructions:
0 adergie4& 6(x. i '/ 1/4 5 5 9dQ= 7- t_Gi.-,7—.
�� affillo // co' '� 66,--h-,-- 4...„,-/-t1 fir '? .t-
ASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL ( CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
4
1
Inspector: Date: g" Phone #: (503) 718-