Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005-00831
I
' I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/20/2005
PARCEL: 1 S 134AD -01900
SITE ADDRESS: 11369 SW LAKEWOOD CT ZONING: R -4.5
SUBDIVISION: ENGLEWOOD LOT: 059 JURISDICTION: TIG
Project Description: Gas furnace & venting.
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:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
DAN & TONY MEYERS Description Date Amount
1025 KALANA PLACE
HONOLULU, HA 96825 [MECH] Permit Fee 12/20/20C $72.50
[TAX] 8% State Surcha 12/20120C $5.80
Total $78.30
Phone:
Contractor:
AAA HEATING & COOLING
2915 NE MLK JR BLVD
PORTLAND, OR 97212 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 284 -2173
FAX 503- 284 -1552
Reg #: LIC 222
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: ej Permittee Signature: ...yjp Ptv
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business aa j
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.
. ,' ;Iii EGO ED
City of Tigard Da e,ve '0')V190 Permit No. e
/� �0 �6G,2UO
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Pernmic
Phone: 503.639.4171 Fax: 503.598.1960.EC 2005 n Date/By:
Inspection Line: 503.639.4175 www.ci.tigard.or.us r 61 - " Da Ready /By: 1,1 supp Sec age z for
Internet: ww.ci.tigard.or.us CITY of TIGA ^^"r ° Notified/Medmod:
�tll_DI DI`JtSIGI`3 /
TYPE OF WORK . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Xekddition/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," O CONSTRUCTION
' RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
g- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description ( Qty. I Ea. I Total
JOB SITE ' INFORMATION AND LOCATION Heating/cooling
/3 , 9 ) G 0 Air u res sit plan n showing i ng placement) ent) 14.00
Job site address: , plan showin lacenm
(requires site g p
City/State/ZIP: T ,. ' , Q 7 2 . .7 Furnace 100,000 BTU (ducts /vents) ) 14.00 IL/
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: /ley 0�5 Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
e Hydronic hot water system 14.00
S / 4 Q) / if '.r t+- w.C-it/Zt7-44,0-4 Residential boiler (radiator or i
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
...... • -, _; ,: .�;;:. DESGRIPTI_QN`WOR
Water heater r
Alm, "�j _ ' / � t Gas fireplace I
V�� ..�rti Flue vent for water heater or gas
UU fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
• ROPERTY' OWNEW - - 12 TENANT • Other: 10.00
Name: 0.4 773"/ y - /- FereeS Environmental exhaust and ventilation .
Range hood/other kitchen
Address: / d 2. 5 '4-4. A- isievst A...At-e. equipment 10.00
City/State/ZIP: /1p 'f t)LLL L 14, A.,‘ 94 S- Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
•s ° . = „ ®.- .- 'AP,PLICANT.. -:` 0 CONTACT PERSON
Attic /crawlspace fans 10.00
Other: 10.00 _
Business name: ClD Fuel pi ping
Contact name• $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
G- CONTRACTORp':c:: Barbecue
f� J 1
Business n ame: 4 jt � M Y2 t 0 /Crz(f Clothes dryer (gas)
name: 14,-,,Tie � ,/ Other:
Address: 0 2 q ,� n E nil aJ�/ I/d • MECHANICAL PERMIT FEES*
City/State/ZIP: I� ie q 7 2 Subtotal
Minimum permit fee ($72.50) 712 55
Phone: ( 3)_ t � Fax. �� 2 ire./.1 _ P_lan_review_(25% of permit fee)_ _ _ C�
CCB lie.: a ��'� Q e- f0 G i / State surcharge (8% of permit fee) -5 O 0
r
'�'" -- C TOTAL PERMIT FEE 7' • :u
_-
a This perm app expires if a permit is not obtained within 180
Authorized signature:-., j days after it has been accepted as complete.
Print name:
7.4 #,V eZ2 xi. Date: J L// 5/ tlr . Fee methodology set by Tri -County Building Industry Service Board
mn.,;1A;.ntl4.,milaMPC.Pnmit Ann dm 12/03 440 -4617T (t 1/02/COM/WEB)
5 canvit 400,..4 C / , 4-i
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: Mi:tflC��� f�(i3i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1,Jn0l;�t� ;f J
Phone: (503) 639 -4171 N 4poy�qi � � � I t
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/22/2006 TIME: 7:02Alvi PAGE: 41
SITE ADDRESS: 11369 SW LAKEWOOD CT CLASS OF WORK:
SUBDIVISION: E.NG f FWOOD LOT #: 059 TYPE OF USE:
PROJECT NAME: MEYERS
DESCRIPTION: Gas furnace & venting.
OWNER: MEYERS, DAN & TONYA PHONE #:
CONTRACTOR: AAA HEATING & COOLING PHONE #: 603_ 2842 . 173
Inspection Request Scheduled For: Date: 2/22/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 027316 503 -2(4- 2173 Y 4i
Corrections /Comments /Instructions:
./9 /I 5 6 Q z
, /":7_
PASS n_PARTIAL_AP_P_ROVAL 0_ CANCEL n_ NO_ACCESS__
FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
2Z `"
Inspector: Date: 2 A-2d if Phone #: (503) 718