Permit • a .
CITY TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00240
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/30/2007
PARCEL: 2S 109DA -08300
SITE ADDRESS: 15117 SW HAZELCREST WAY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 077 JURISDICTION: TIG
PROJECT: SHAW
Project Description: Installation of an 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
LOREN SHAW Description Date Amount
15117 SW HAZELCREST WAY
TIGARD, OR 97224 [MECH] Permit Fee 4/30/2007 $72.50
[TAX] 8% State Surcha 4/30/2007 $5.80
Total $78.30
Phone: 503- 734 -7116
Contractor:
OREGON HEATING & AC
PO BOX 397
DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -538 -2953
FAX 503 -537 -2172
Reg #: LIC 172126
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,; y: y4 / ✓ i Y - / Permittee Signature: 5 2 i..... jrp / /caj:
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.
Apr 27 07 01:33p Oregon Heating & AlC 503 - 537 -2172 p.1
Mechanical Permit Application F' , Foil OFFICE USE ONLY
City of Tigard t Received
® ®�� ciDy: ��
M ill
13125 SW Had Blvd., Tigard, OR 9722 01 Plan Review ENE
Phone: 503.639,4171 Fax: 503.598.1960 PpR / 1 2 DatDate;B Other Permit:
Y
Inspection Line: 503.639.4175 * �i
TIGARD se �S � 1� Date Ready.'y: Juris: See Page 2 for
Internet: www.tigard-or.gov g CAI ei0.`� Notitied'Mehthod: Supplemental Information
WO" ''� tJ
TYPE OF WORK • COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
Mechanical permit fees* are based on the value of the work
III New construction ® Addition /alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL; EQUIPMENT / SYSTEMS FEES*
® I - and 2- family dwelling [] Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Description I Qty. , Ea. Total
•
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: �'q Air conditioning or heat pump I (�
��� 1� C, �l,Lt HGZ�1� 1 r F�} I l^ll,` (requires site plan showing placement) 14.00 I `•oe
��rd
City/State /ZIP: J 1 Fumace 100,000 BTU (ducts :vents) 14.00
ic � �a�
Furnace 100,000+ BTU (ducts/vents) 17.90
�
Suite/bldg. /apt. no.: Project name:
Gas beat pump 14.00
Cross streetidirections to job site: Duct work 14.00
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. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.: Other: 10.00 _
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK • Water heater 10.00
H VAC- Gas fireplace 10.00
Flue vent for water heater or gas
� �0,11 NC. fireplace 10.00
•
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
® PROPERTY OWNER Clrimncy /liner,'tlue /vent 10.00
❑ TENANT Other. 10.00
Name: Loren 5 \n� Environmental exhaust and ventilation
� 17\
Range hood/other kitchen
Address: -tJ
`) l-7 ` l � J,.� (�7_.1 cre S-i- t kj0 () equipment 10.00
City /State /ZIP: 1 1 C card 91 (I Clothes dryer exhaust 10.00
" �'} ' Single -duct exhaust (bathrooms,
Phone: FiQ3 _ 1 1 r0 Fax: ( ) toilet compartments, utility rooms) 6.80
® APPLICANT . . . ' ❑ .CONTACT PERSON Atticicrawlspace fans 10.00 _
•
Other. 10.00
Business name: Oregon Heating & A/C Fuel t utg
P
Contact name: ��.. 'l� $5.40 for first four; $1.00 for each additional
Address: PO BOX 297 Fumace, etc.
Gas heat pump
City/State /ZIP: Dundee OR 97115 Wall /suspended/unit heater
Phone: (503) 538 -2953 Fax: : (503) 537 -2172 Water heater
Fireplace
E -mail:
Range
' CONTRACTOR. ... - Barbecue
Business name: Oregon Heating & A/C
Clothes dryer (gas)
Other:
Address: PO BOX 397 MECHANICAL PERMIT FEES*
City/State /ZIP: Dundee OR 97115 Subtotal
Phone: (503) 538 -2953 Fax: (503) 537 -2172 Minimum permit fee ($72.50) 1Q, C 6 - 0 —
Plan review (25% of pennit fee)
CCB lie.: 172126 State surcharge (8% of permit fee) 5. SC
TOTAL PERMIT FEE ' .,30 80
Authorized signature:
1S' Thi p ermit application expires if a permit is not obtained within 1
• , days after it has been accepted as complete.
Print name: FFC1S1nene, r , \i'. te: 4 - a_i 0-7 * Fee methodology set by Tri -County Building Industry Service Board
1:\ Buildinb ',rerm its`MIIC PermitApp.doc 0410 (1 1 410- 4617T(11102/COAIIWER)
Apr 27 07 01:33p Oregon Heating & A/C 503- 537 -2172 p.2
• d ...
I �
i
•
4
i'
U
�a
. ca
ti
c ��
' �, e \S
�1
a
• 1
CITY OF TIGARD
BUILDING DIVISION PERMIT #:'' M :G2007 -00240
13125 SW ,Mall Blvd., Tigard, OR 97223 DATE ISSUED: 4/30/2007
Phone: (503) 639 -4171 o Nl A h
Inspection Requests (24 Hrs.): (503) 639 -4175 , '� 'I_L.
INSPECTION WORKSHEET FOR DATE: 5/17/2007 TIME: 7:00AM PAGE: 43
SITE ADDRESS: 15117 SW HAZELCREST WAY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 077 TYPE OF USE:
PROJECT NAME: SHAW
DESCRIPTION: Installation of an a/c unit.
OWNER: SHAW, LOREN PHONE #: 503-734-7116
CONTRACTOR: OREGON HEATING & AC PHONE #: 503-538-2953
Inspection Request Scheduled For: Date: 5/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 048502 -01 503-538-2953 Y
Corrections /Comments /Instructions:
at• cLc 4 C _, .. 11.,44 At S - /'..M89 .1 cii Ga-z2,e3 t
r'
ASS ❑ PARTIAL APPROVAL ( I CANCEL n NO ACCESS
I I FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector - f/ 1 Date:-.S 7— 1 Phone #: (503) 718 - �4'�