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Permit ti CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2006 -10007 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/1/2006 PARCEL: 2S114AB -06000 SITE ADDRESS: 09315 SW MILLEN DR ZONING: R -4.5 SUBDIVISION: KNEELAND ESTATES LOT: 047 JURISDICTION: TIG Project Description: Replace gas 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: DOMES. INCIN: NAT 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: GAS OUTLETS: > 10000 cfm: Owner: FEES ROBERT GRACELY Description Date Amount 9315 SW MILLEN DR TIGARD, OR 97224 [MECH] Permit Fee 3/31/200E $72.50 [TAX] 8% State Surcha 3/31/200E $5.80 Total $78.30 Phone: 503- 443 -6130 Contractor: A -TEMP HEATING & COOLING 16000 SE EVELYN ST CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS Contact #: PRI 503 -650 -9602 FAX 503 -557 -2990 Reg #: LIC 71878 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: ,� 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. FROM :A -TEMP FAX NO. :5035572990 Feb. 28 2006 10:57AM P2 /2 ' Mechanical Permit Application r(1'R Uhrlc IiSE ()Nix City o Tigard w ,� Dat ` - 5 -/ -0 A Permit No. ‘v ,�.24.� 4 —' J a 13125 SW Hall Blvd., Tigard. OR 972 4' °: Plan Review Phone: 503,639,4171 Fax: 503.598.1961 p tr, „ . J r l , r ,"�, I . " { D /B Other Permit. Inspection I,lne: 503.639.4175 2, U 20U t ., i {,�,. - . ! - Date Ready /By; Luria; l ® Sec Page 2 for Internet www.ci.tigard.nr,us L Notified /Method: - ) - I Supplements( Information _ - x l4 r„ „, r!r ,:,.n:n 1 � rvr, ,rr. ,Fa v!ro u4„ - n ,: ^. n ' + . ,. � rrr s.e °r °r �; �.'; ,`t f .. r r � a>T l i v OJr •y 1 ,Ilr ;rgrr a 0�, 5.. V7 .I,th E , r ,• r , t S t ru ,. , » \.�.x ,>i ,wt , w Sr •,G.., �. � r T T fr rJ ua � > 1 tIStMJ.rrt , tn,e,.•(a!,Y,,a'p,AJ.AY � To..., kr, : .: n, •.r: i'}. ,.� Jr. j K lnrr r r fr+ :Y9y� lt1 / +t,,. l. it ..{ , t i 41, n r !i\r r ¢I lj r(U rNa� .i itlfy ,l 1fio4�!a �! /; ,, • {'ti / '. 1'b rri” r t r h. s f l��.j, ,a .� I� , t l " ` i / �rx ! :go r r ;4�.) 4 '' l, ,., vl 1r 1 Y '')''''''''r'''''''').(‘ l ' +•, .' 1"0 it " ,{9i�,rie I 11 ' r.r, To I Ii', 'v 1 6. N4,'t 4,> A 6V.•. i l..t L''''4 , 4T J4 ,gg. n j § {� r,h.. nr l'�l� �y ,Y A. 1 1•f, A /,+ .v.I ,"]j 'Av.,. �•l. J 1 t r t+ {Y! " 1r Y r li q6 } I,f �. : ,. d , ,!..h l � ir vit 1J', v. . (11 !o �(j o. 1 1• ,..4 t '1 , ae �% 1 ��4`, (� r /xl y�.! ��,!'{ �k rxJr�. ?, v. f 1F; 1( � ! ay.ka. 4CPA,.,. tlX, rlh1. 1}r...,:Jlun,•N:l�,A-h,, ',Yoe lYI{7. {Ir�'rY �� { {�,1` 71•:.r tlY,,,ti.:IM,tx }:. N r�af .••.rjl,rraJldLr4'lJt.. � tti ,u,rfr4� ?sr,r r. ,;�a��Y'81 f •4? ,YM r. l�ua � Yi' r ��4Y(Yi { v F;' k�7. nlAtd .,un }(S,�k/„I�.r�.x�:A;f'.:1/; Lr�2f'lurt'�8L3��fx��.,, ..iN,x1.., •S {. ,V ,. 6 ...V ? , T � 1 ri .Sa. 4� I..r {J.1� £4. INJl•..... � 17 New construction 0 Adc'tt� n alteration /replacement Mechanical permit fees* are based on the value of the work performed. Indicate tho value (rounded to the nearest dollar) of all ❑ Demolition El Other: mechanical materials, equipment, labor IG( A o � v p e y rhead, and profit. 1 .) . r1 lL i bt h rrlgtrix , i 114 } /�i Y Y l/ I: a,)�. A,z x: r 4 r i ".: v4 rlM1 " . Td xrl.(S ` i,t v G( 4'FIl N•;,s f l ,tn rgi t l l,qi Value: $ ea ( ioM 1.' :, . Uc ! a� a^I., I. Il 4. r f 65 .1 : & 1 : 1' fA d' s r MY;?i∎;1: r •! :' 1 Y,,' V h rt : i 4 ,r :v /r $n. r1•., . { r � � it 1.. , .r, nl { , .:�: i'�13 r . r .Y r. { / },,. rv .s , xw„ r , ��Gz�b" t' ��r• d��aYk�w�xa; 6.' 1�r,>. r>}/ �la,: ipJ., 4�, s nl., on,r, sian�ecax+}, �n�varnlml4 ,k,a r 4•alkanx( .4:�ktL�.t•lr „nl•r.,f�'r�.r Pfak.�4!dV.aa. I,i�rl f,- ;(� °3frkrrat l,f�..raglarvrmt3 �6,ra�lcnl :n . a�. t{� , , J4r lt rrrx suFrp r �z . acar . t�Jae {� :• 7 . :4 0k . ,! ,..A a A . ,1 r u n ;;..774.,,,,,k� Clu . , " ', ,af. PT :T.404 r sR sPi ,,, � i, : l ik , , a ■ - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building , ,. kor special information use checklist. El Multi - family Master builder ❑Other: Description Qty_ I 2 . ° Total � y J� ff jr{ ril,,k) ` ,irl 4 I3f I;lrvraveYr>wrrr r ;: 1 ""'! 4{1(29,,,, BY. /i(i i { p •,,, 11'.,, ",l11I I IPp ti 14f "t`�I'it{lliavp hySl,7i • - `� 1 0 rt 111 1 {� �r { { 4, r,,, �}� ? t1, J i9t ;, � ( rr1 1 } 11 11 /J 71,M;IIA'rtl' 1! 9 el 1 } A�Oi S. M ,i1∎ } irld � f }rr'14'rr'i!ig79 IIealIln ce0lln pN�{ ( J .4!v •. ru aldhrlh, ala ve .fu M 8 } t „u + ,,:: u J. uS /..h �litllJ�v /l � ... - ._..,...., ... a� . A' 'l1i:r�gl x u u.a�.w„ oz ,rf �.LRn nleafN ! P�At4H` lr F !I�,'Sr ac •rnmYru job site address: �,3 I S — 5 14U1 D21 (Er- Air conditioning or heat pump (noires site plan showing placement) 14.00 City /State /ZIP: 4 a7, oi. 7 ?--3- it Furnace 100,000 BTU (ducts/vents) i 14.00 f Pomace 100,000^ BTU (suede /vents) 17.90 Suitc/bidg, /apt.no.: Project name: _.- ....._-_ - -_ _^ Qes !teat pump 14,00 Cross street /directions to job site: Duct work 14.00 - Ilydronie hot water system •. 14.00 _ _- Residential boiler (radiator or hydmnio) 14,00 -- Unit•heaters (iltel -type, not electric), in - wall, in - duct, suspended, etc. 10.00 - "1 Lot - Flue/vent for any of above t 0,00 Subdivision: no,: - I — .......,.. Other: _ 10.00 Tax map /parcel no.: Other fuel appliances. I U.OU 1 11' r " ' il. u)+ � Y��7'n 4 ; "t ; 4 Mif'41419 t/ r` ) Y�i / 1,,1 it"l i t . l?irk ; v iti'F „.', , lWhin,o, 1 ,f }.ili} rt4 111 (! ti ,(4 /4 144 Water heater -- -- 10,00 F S r 'ti l {fA�. n j , UbAT.,, t i 'S:J{ � I 4, f "7 hG. , 5 a 401 )n tt0; 1'! ; rl ).r1i l i �� t +j,a r,t, l }kt� w {lS r J, nrt", n k dr1,,.e',.,r t,n.Mr,ynrn dr na Mm ... --� +, ul tci,a n >1N r, iarU9 i ? , t' d ,,. rhl.. w }rS11�,tSiu !� / �,.,,. _ • • �� g TLS ��_ _ 5 -1 n el (ce -. Flue vent for water heater or gas fireplace 10,00 • � — .' ALL l — T - 4._111(,. Log lighter (gas)_ ._ 10.00 Wood /pellet stove 10.00 - - - Wood fireplace/insert 10.00,,,, r. bl r u l•/r ra> -:;q 1A yi"Y14"1'S '(l,Y$' l ?AYt<l�,ri 6 iipvqq`rl rl �'11 +t } ;t�y�W � }��t1 n}y9nt {4YjJ•',Yyi,1{rki W i ii!r�, �q�p rt , rll r jGa r l r r ��i Chimney/liner /flue/vent , 1000 _... � � du ,117i t r r , i f e vtr} . 1,,,, I J i {� i, ; ; bd / IT °�tx 1 r. vJ2 �� .: +a,1.1..tv.tY.rEnT ' ;!0'4(t9'4',..')'1;% 10.00 IP,1 .i!,r r1 , r "�rnrrrnrrnu,f X111 iY. slN nr.J. i�6 }7aS ,�Aa Other: , - __.,. Name — i14 '.t (rar (-'( t { Environmental exhanat and ventilation r _ Ci 5 5 Range hood/other kitchen — Address �'�! ��. �( rV` e 10.00 City /State/Z11':' —TI(L,• A t (.: ".2 , ,- -2,"'"2._S-- - Clothes dryer exhaust 10.00 single -duet exhaust (bathrooms, Phone: ( tit -- 3 Fax ( ) q {p toilet compartments, utility rooms) 6.80 ) r(Jf ;, Tt ~Demos �il lJuA t( imy^ h +:4 r �ll +a Y+�O4.ill t..li x vy i t'l t ,f19' �, 50 ,, te[rR? r h:t,1d ,:r u l i 11 .., 1!1.1)0 ^..�..^ � i',iV �? "444.4 fir ( „i �f/ a l j /41,mat ��1� � , ! rk� 1 , ,.., ( � , f .6� 3 , Ai'). O t h e r : wispacc fans yy r , ,45FrR,tn}' Vr 11 r, w, il.r �ri4 ,rr C%M b, ,,."`✓h•v IR+M+ 4 x•.rtr c, %i Nr ' , Yn{, YX i10r,. v� n t1„ v Y:.'rk, u . •,1f0Yr99,1e ., t,Ar<`cicrtYt .!A1 the - �- 10.00 r � ,. Other: Business name: ,e,(j�_ il , 1 -J-- Ly Fuel piping _ — Contact name: . $5.40 for first four; $1.00 for each additional ,,, y _, r ' `� Furnace, etc. Address: — / AA v __ Gas heat pump City /Statc /7iP: `'i '' 1 M � Wall/suspended/unit heater Water heater Phone; ( ) i Fax: : ( ) —^ . Fireplace - .. F- mail: ) t Range _ T �J, rr � n' r r ( ':r;ti R w 1, r 4 rl' ll r{ iN alliriF�G ri l7jrlAll;lilr A� 1FrlF { I, p 91!T{ t . r ttfl iih{i } li� Barbecue ` t ) i, ,it,Ao41z 4,,o, 0 ::∎Utto` f to: APO $ d,wr f . 1 }i ' o!r '41IM ' .4 :o 1 r ttoo , SPI4 �1(4 , {1 !; Ala 02... sl })Il 1, ?n2 i !}�i1,..117(ui. r r . 11'1n intj , r,t I,,t,l�a �'Y . \ a . l f ,) - `� Other' d er as Rosiness name: 1 * Other - G: c - l L ?} r l {l p' ” +st S )tN r fY Pnr ,1 1r ArS(v 1 Wtx�j ll inlT ) ✓A Jf4 i Tit +:IWIr( Address: t " 1. i 1 i:/iSkt.,0 1�' t ' I� /r ,, °di , 4 d 2xP r,. t,,s it'(J1;tw r ;a, ,, ,,,,. r, „„.,,,A, j + Jti) ' - • , Subtotal ' • j M C I, ty/statca1P(A^ c, . w_�40 e O Q—. Cl `� -10 L5 '7z Mi p ermit fee ($72 4 Phone: ('jf )) (.05-0C1.‘ (Q C.Y.- Pax: E03 r(, .0 -19, 0 Plan review (25% of permit fee) ___ CCB lic.: . State surcharge (8% of permit fee) f .. 0 ' ' _ 1 e, -• TAL PERMIT FEE This permit application caplets if a permit Is not obtained within 1 tin Authorized signature: / . 411 11111 -. \:--- ... days after it has been accepted as comptota. ��� ` area methodology sat by Tri•COunty Building industry Service hoard tn Printnae: �, : �y� / L)nte: ' „, r)nild,nu\t'crndtiamEc-rvrrrrdl App.doc 12/0? 440.4017T(I I/O OM/WF? ©) 1'\ CITY OF TIGARD 3/31/2006 u 13125 SW Hall Blvd. 1:01:20PM Tigard, Oregon 97223 TIGARD (503) 639 -4171 Receipt #: 27200600000000001025 Date: 03/31/2006 Line Items: Case No Tran Code Description Revenue Account No Amount Paid MEC2006 -10007 [MECH] Permit Fee 245- 0000 - 431010 72.50 MEC2006 -10007 [TAX] 8% State Surcharge 100- 0000 - 207020 5.80 Line Item Total: $78.30 Payments: Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid CreditCard A TEMP HEATING & COOLING DER/DLH 114098 In Person 78.30 Payment Total: $78.30 cReceipt.rpt Page 1 of 1 CITY ®F TI G AR D __m� .:__�__ q MECHANICAL PERMIT . „� m BUILDING SERVICES DIVISION p'n' ° � i jl 13125 SW Hall Blvd., Tigard, OR 97223 - 503- 639 -4171 www.ci.tigard.or.us PERMIT #• DATE ISSUED: 3_ - .0 6 SITE ADDRESS: '93 /5 s ■„....),` \. � _ � r PARCEL #: BLDG /STE #: ___--37\__,y- /_Z y - ZONING: SUBDIVISION: LOT: JURISDICTION: I This is an interim permit issued during computer system maintenance. Construction work and inspections may proceed under this permit number. • The actual permit will be issued and mailed to the applicant within one week of the date issued above. PROJECT_DESCRIPTION `Zz O c,Z, TQs3 ` tf,.�■Fr c z- - CLASS OF WORK: Q \ _ _ FLOOR FURNACE: _ EVAP COOLERS: _ TYPE OF USE: S- UNIT HEATERS: _ VENT FANS: ______ _ __ OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS ■COMPRESSORS I HOODS: 0 - 3 HP: DOMES. INCIN: _�� - FUEL TYPES 1, 3 -15 HP: - COMML. INCIN: MAX INPUT BTU: 15 - 30 HP: - REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: ----- . GAS PRESSURE: 50+ HP: CLOTHES DRYERS: FURN < 100k BTU: 1 I AIR HANDLING UNITS 1 OTHER UNITS: FURN >= 100k BTU: <= 10000 cfm: GAS OUTLETS: z > 10000 cfm: ___.__ ---- - - -- -- - OWNER 1 r . - - - FEES. -) Name: ' 0),,,L,,r G c eAk, Permit Fee $ _7,Lj7 Address: ___g 3157 Sk,J \\- \p '1).>' Plan Review Fee $ City /State /Zip: _ -\ - . fie, q 1 2.Y State Surcharge (8 %) $ -- W._ Phone: ,5p H3- b1JO__ Other Fee: _ $ Other Fee: $ • Total Fees: $ --rj , 30 r v ' CONTRACTOR ! Name: ra_�. g., _ . \� e _ _? C - d \-a Address: \ 6 a a 0L .slc Vim _S City /State /Zip: _ c2 ,K5z,S„ z_G 3 - . Phone: 5 - 0 6,i0 - 9 6 C 2, -__ - - Fax: __S.� Q"S3"1 - a_9...9__65 __ _ __ -- CCB Lic #: 7 l' - A ___.__ -.___. This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -1987 or 1- 800 - 332 -2344. • Issued By: 12)... . r Permittee Signature: .S.t-.-e- @t 'C. Call 503 - 639 -4175 by 7:00 AM for an inspection that business day. Note: If you cannot schedule an inspection while the system is down, please call 503 - 718 -2433 for assistance. 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. I: \ Building\ Forms\ ManualPermitForms \ManualMECpermit.doc 12/05/05 CITY OF TIGARD RECEIPT RECEIPT DATE: -� DEVELOPMENT SERVICES ,5 = / — (,� �� " °'�1�li`�', 13125 SW Hall Blvd., Tigard, OR 97223 JURISDICTION.: - ' `` - 503- 639 -4171 www. and -or ov 9 9 CASHIER DATE: CASHIER RECEIPT #: LINE ITEMS: Case No. ; Fee Description 1 Revenue Acct, No. Amount Due v �` �„2 �' 6 _... . a y 7\ . . ..(, - . _ - _. d , 2 _._. . �..� .._. t'�.� �� � `�'�' bra 1 �� � ,5 .. _ `g 00 r .. _ 0 fi j ,? ? S O 1 Total Due: $ - 2 O ❑ SEE ATTACHED FEE SCHEDULE. PAYMENTS: Payer: Method 1 Initials ; Check No. Confirm No. ` Amount Paid Total Paid: $ , zo I: \ Building\ Forms\ ManualPermitForms \/vlanualReceipt.doe 03/01/063/1/2006 CITY OF TIGARD Ec BUILDING DIVISION = PERMIT #: 26X)6 ` leo 7 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 =�!� INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: 9 3 / v CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: 1 PHONE #: Inspection Request Scheduled For: Date: 3 e - c t Pour Time: / 4.-7-; ; Code # Inspection Description Confirm # Contact # Message Corrections /Comments /Instructions: � 3 D rYLL -vi . 3 1 ' (30 ( c"; f<E- 4110. PASS P 'TIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL A CA L FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: (503) Date: 3 Phone #: p 111% () 718 - CITY OF TIGARD 4'1 -6c. BUILDING DIVISION . PERMIT # : O 6 , — /;jth 7 • 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 A PI��oi�i�r Inspection Requests (24 Hrs.): (503) 639 =4175 -_ . J - - INSPECTION WORKSHEET FOR DATE: TIME: PAGE: ,. t. ti yZ:.a fin,, SITE ADDRESS: 9'j 3/5- CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 3 3 0 c Pour Time: i. 4qi ode Inspection Description Confirm # Contact # Message 67 3— (130 Corrections /Comments /Instructions: T M DIV --- iTr i 1 1 � - Pik . No P c� K. C/4--- - C_____ PASS © / PARTIAL APPROVAL ❑ CANCEL I NO ACCESS IL Al 0 FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: , �---... Date: c. (96 Phone #: (503) 718 -