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Permit n CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00109 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/3/2008 PARCEL: 2S 111 AB -07700 SITE ADDRESS: 09425 SW INEZ ST ZONING: R -4.5 SUBDIVISION: PENROSE TERRACE LOT: 022 JURISDICTION: TIG PROJECT: NILSEN Project Description: Replace gas 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: NAT 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: 1 AIR HANDLING UNITS FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Owner: FEES JEFF NILSEN Description Date Amount 9425 SW INEZ ST TIGARD, OR 97223 [MECH] Permit Fee 3/3/2008 $72.50 [TAX] 12% State Surchai 3/3/2008 $8.70 Total $81.20 Phone: 503 684 - 2656 Contractor: COLUMBIA HEATING & COOLING INC P.O. BOX 7 TIGARD, OR R 97 97281 REQUIRED ITEMS AND REPORTS Contact #: PRI 503- 624 -2704 FAX 503 -598 -0270 Reg #: LIC 76359 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OU NC by calling 503.246.6699 or 1.800.332.2344. • Issued B ` 1 �, I Ji . - 4 ,t , Permittee Signature v_ Call 503.639.4175 by 7:00 a.m. for inspections that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OITI i i :O\ i DairJB Permit No.: � City of Tigard RECE1VE >� ed r ��D. ,� C'p�0 ©e- CY�/O Da[cJB 111 I • 13125 SW Hall Blvd. Tigard, OR 97 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ,� N R 3 z008 Dale/By; Other Permit: t ci.x Il i� luspecUOn Line: 503.639.4195 t ,� 3 Date Ready /$• ® See Page 2 for Internet: www.tigard or.gov CITY O { GARD Notified/Method: `�/ Supplemental Information a TYPE OF W t V.. " ` • .. COMMERCIAL 'FEE* SCHEDULE -- USE CHECKL Sf ❑ New construction ❑ 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. - CATEGORY OF CONSTRUCTION - Value: 5 RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling ❑ Commercial/industrial Q Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: - _ _ ___, Description Qty. 1 Ea. Total - - .IQB SITE INFORMATION AND LOCATION Heating/cooling Job site address' 9V,7 5' 5 k) - Z Air conditioning or heat pump /// r (regimes site plan showing placement) 14.00 City /State/ZIP: Purnnen 100,000 BTU (duets/vents) i f 14,00 Suite/bldg./apt. no.: Project name: N) , L(�' Furnace 100,000+ B U (,ductsive-eta) 17.90 ''" VVVv Gas heat pump 14.00 Cross street/directions 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 ' Subdivision: Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 . � z �_ �+ ft lJ l a . . Flue vent for water heater or gas f� . / 1 l fireplace 10 00 Log lighter (gas) 10.00 . Wood/pellet stove 10.00 Wood fireplace/insert 10.00 ROPERTY OWNER El - TENANT • . Chimney/liner/flue/vent 10.00 ' iP Other: 10.00 Name: .- J�.-� /7075 C4J Environmental exhaust and ventilation Address: Range hood/other kitchen e.,.Gv ry-u. equipment 10.00 City /State/ZIP: Clothes dryer exhaust 10.00 // Single -duct exhaust (bathrooms, Phone:5 3) (.4 A� 4 Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT [] CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact names' 7) it 1 b I 55.40 for first four; 51.00 for each additional Address: Furnace, etc. Gas heat pump City/State/ZIP: W'alllsuspended/unit heater Phone: 7 3 )4,)- t( ). I Fax: .(93)S 76 Water heater Fireplace &mail; Range • _ /r CONTRACTOR - _ Barbecue n Business name: C CJ l (Ayr? / C,..,J i yt y '&1'041 � Clothes dryer (gas) ( � J } T Other. Address: qQ 13 0 x .2 0 3 9 -? MECHANICAL PERMIT FEES* • CityiState2ZlP: G ,Q 2,0 ,) 2 97 yfii Subtotal Phone: (S ) --- ii) (eZ) i Minimum permit fee ($72.50) 7A{ . J � 0 , y 7d Plan review (25% of permit fee) -cim CUB lie.: 74 3 S' 9 r State surcharge (12% of permit fee) g .?a ��y TOTAL PERMIT FEE S i . go Authorized signature: C_ _d This permit application expires if a permit is not obtained within 180 /} days after it has been accepted as complete. Print name: /J �2 /) y Date: j7/ ,/ 2 2.C , ' Fee methodology set by Tri -County Building Industry Service Board I: V3uildinalPera •.its\MSC- Permit 04/06/06 440-46 (I 1 /02/COWWE B) Z. OLZO ONILV H b18Wf1 n01 :60 80 CO aelJ CITY OF TIGARD BUILDING-DIVISION PERMIT #: ME C2008-00109 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/3/2008 Phone: (503) 639 -4171 � kn�fn�� 1 4 1i Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 3/7/2008 TIME: 7:00AM PAGE: 73 SITE ADDRESS: 0425 SW INEZ ST CLASS OF WORK: SUBDIVISION: PENROSE TERRACE LOT #: 022 TYPE OF USE: PROJECT NAME: NILSEN DESCRIPTION: Replace gas furnace. • OWNER: NILSEN, JEFF PHONE #: 503 -681-2656 CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503 - 6242704 Inspection Request Scheduled For: Date: 3/7/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 603 Mechanical final 066154-01 503624-2704 Y Corrections /Comments /Instructions: AO il_ . 1.4..? #. c-on- .!r G,,h /L, .Y. S — 1 .S 4 7 U 4 7 e - 75A-At 4C ' r PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS Li FAIL CALL FOR INSPECTION ❑ADDITIONAL FEES ASSESSED /5 „,..\ Inspector: Date: - -7-® $- Phone #: (503) 718 -