Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00189
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/6/2007
PARCEL: 1 S 133DA -04800
SITE ADDRESS: 12630 SW GLACIER LILY CIR ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT: 070 JURISDICTION: TIG
PROJECT: KOEPKE
Project Description: Replace furnace and a /c.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF 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:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
BRUCE & JAN KOEPKE Description Date Amount
12630 SW GLACIER LILY CIR
TIGARD, OR 97223 [MECH] Permit Fee 4/6/2007 $72.50
[TAX] 8% State Surchaq 4/6/2007 $5.80
Total $78.30
Phone: 503 - 524 -7432
Contractor:
COMFORT MECHANICAL INC
17936 SE DIVISION STREET
PORTLAND, OR 97236 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 761 -1500
FAX 503- 762 -5394
Reg #: LIC 79558
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.
P Sig ature: _t/ �r , a t
k„... ` ( �
Is ed By: �L1 �� /J_ � i�i.�ag
Call 503.639.4175 by 7:00 a.m. for inspections h .usiness 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.
Apr 04 07 11:39a Comfort Mechanical RNC 503 761 1390 p.1
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INTechnic Permit pp
ral Pit Alication ,, ,
, : . '!_ - " • .' FOR OFFICE:USE ONLY . '
041
City of Tigard Received ,,
13125 SW 1.1 H. Blvd , Tigard, OR 97223 RECEIV:1114,
, , Datc/Ey: 'Y V D 7
Plan RcVLeve " Permn No. Hed _ jo iv ; 7
Phone 503 639 4171 Fax 503.598.1960 .- • ..,.
Ocher Permit:
h 03.6
ispectioit Line 539 4'175 lti 'pt.
APR - 4 21 ;; ..,-t.... 11 .-..
. I ..... 'w Date/Hy.
Date Ready/Hy: hr . 121 See Page 2 tar
Internet www ci.tigard or.us NotitiecLU anode Supplemental Iniormarlon
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.' : /' ' . ' .1' S.: : ':',''''' 1 :.' ' IL Lk '. .;' 1 '', ' !'l'i >,;-; .c:014XgA0 , VSEL CHECKLIST
Mechanical permit fees* are based on the value of the work
0 New construction .■t< Addition/alteration/replacement • performed Indicate the value (rounded to the nearest dollar) of all
El Demolition 0 Other: mechanical marenals, equipment, labor, overhead, and profit
'•., ' ,'' -• ''. -.' •,,, . • i'CATEGORY ■ OF:.'i3.ti•t" -*KA ; :., i , ;•,;;;.1;:,$„1, ,.•-' • . Value: S
4 , L : „: V, .AP k 0 4 a P 3Yg NW / 1$ rySTEMS FEES*
. ..K 1- and 2-farruly dwelling 0 Commercial/indusrrial E Accessory building
For special it:format:on use checklist
E IvIulu-family 0 Master builder 0 Other
Description I Qty. I Ea, I Total
- '...'...:ibli:ATPii*. 1 * - ...+ 4 *9.1 ` 1 ,. 9 c ,AT I Q.N.; = ' ;,' . .:.; :' : :-:..: '...' Heating/cooling
Job site address: j 2_(_ 5 ,, 6 1 a ex - L 1 ty C ( 1 e. Air cond or heat pump
(requires sue plan showing placement) 1 14.00 )24-
C2lry/StatelZIP Tigard O1 CI 1 223 Furnace 100,000 BTU (ducts/vents) I 14,00 )L4 — ,
1 Furnace 100,000+ BTU (ducts/vents) , 17.90
Suite/bldg./apt. no.. Project name: h pep M
Gas heat pump 14.00
Cross street/directions to job site Duct work 14.00
(- -133 Hydronic hot water system
14.00
Residential boiler (radiator or '
hydron ic) 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 00
-
Other. 10.00 1
Tax map/parcel no . Other fuel appliances
, : , ,, , , $ , ,o ,c r w: o c o i :m t, - . . 1 4 .1 ** 0 , ,, ::• , • ,,, ,,y r •:• ; ,,, , i 11 45 , ;• ,,, 1 1 : , , , , ii ,, . 1 ;■,•!t i :" : :14 . : Water heater _ 10 00
rf....pac IMV(r, 1 A )c..., ' F water heater or gas 10.00
fireplace 10.00
e Log lighter (gas) 10 00
inotea) 61 Wood/pellet stove [0.00
Wood fireplace/insert 10.00
- '• ' ' ' • • • ' ' • `' ,'• ' ',-,,, "i - • i -t..,r .4 - ,:.•:.,,• Chimney/liner/flue/vent 10 00
4 , .. •AKR,R :r45 'WeT t -.1.Ii4.; ;.:#':a-!, other. 10 00
Name. 7 13 nice, - KOCPC., Environmental exhaust and ventilation
Addiess i 2( 30 5kr 6 1(jc'itir o ii y C 1 laCle Range hood/other kitchen
equipment 10 00
Ciry/State/ZIPIT ard O q1zz5 clothes dryer exhaust 10 00
#
-
Fax: ( ) Single-duct exhaust (bathrooms,
Phone.505)5 14 - 714 52
toilet compartments, utility rooms)
I 6 80
, ,.- • ' ;',;." 0.•,0,ja,,bothf 4 , -- ‘ 1 4 ' ,.• . ..'• 1: :'.,',. , Ef; 6644 :,pgg,s oiti ','1;:!):. Attic/crawlspace fans
i 10 00
Other: 10.00
Business name:
Fuel piping
Contact name' $5.40 for first four; $1.00 for each additional
Address: ' Furnace, etc.
Gas heat pump
City/St ate/ZIP Wall/suspended/unit heater .
Phone' ( ) Fax : ( ) Water heater
Fireplace
E-mail
Range
',.,..,-....•.'; . 9 VW:T9W';';:': '2c:1, 04.: ;',..Igf;.., . Barbecue
Clothes dryer (gas)
Business name: czy r-y ni (70... ( nc , i
Address ' -6 ZSG f3e "Dtutsicry, _
Ctry/S tate/ZIP ,---pcy-±lar. cri 2-3 C, Subtotal
P" Zo5 - I (‘>( - 1 6 on Fax. (C )0 - 3 —74s1-190 Pl Minimum permit fee (S72.50) --/ 2 -50_
an review (25% of permit fee)
CCB lic. 1 C i 558 State surcharge (8% of pen fee) . gt)
TOTAL PERMIT FkE 78, :3?)
Authorized signatuL,a0 dli704=lie This permit application expires it a permit is not obtained within ISO
days atter it bas been accepted as complete.
Pnnt riame•g imc, 1..../ n (len 9_1?1?f Date' 4 4.1 _07 • Fee methodology sec by TO-County Building Industry Service Board
I ', 8 u 1 Id , /16■Pcirruc s ■M.B C - Penn] i App do c 15/03 440.4617T (11:02/COMiWEB)
Apr- 04 07 11:40a Comfort Mechanical RNC 503 761 1390 p.2
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CITY OFT3ARD t >�
BUILDING DIVISION -'' PERMIT #: MEC2007 QO183
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 416/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175 1 11-' �' L
INSPECTION WORKSHEET FOR DATE: 4/23/2007 TIME: 7:00AM PAGE: 69
SITE ADDRESS: 12630 SW GLACIER LILY CIR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 070 TYPE OF USE:
PROJECT NAME: KOEPKE
DESCRIPTION: Replace furnace and a/c.
OWNER: KOEPKE, BRUCE & JAN PHONE #: 603- 524 -7432
CONTRACTOR: COMFORT MECHANICAL INC PHONE #: 503 -761 -1500
Inspection Request Scheduled For: Date: 4/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 046786 -Q1 503-524-7432 Y
Corrections /Comments /Instructions:
ASS I I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718- "7