Permit CI TY OF TIGARD MECHANICAL PERMIT
a •' COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00639
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/1/2007
PARCEL: 1 S135DB -09300
SITE ADDRESS: 09375 SW NORTH DAKOTA ST ZONING: R-4.5
SUBDIVISION: ASHBROOK FARM LOT: 023 JURISDICTION: TIG
PROJECT: STONEKING
Project Description: Gas furnace replace.
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:
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: 1
Owner: FEES
STONEKING, RAYMOND D AND Description Date Amount
GERALDINE J
1040 CEDAR ST [MECH] Permit Fee 11/1/200? $72.50
LAKE OSWEGO, OR 97034 [TAX] 8% State Surcha 11/1/200? $5.80
Total $78.30
Phone: 503- 636 -6611
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR • 97013 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 266 -1249
FAX 503- 266 -3478
Reg #: LIC 14008
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: 6727 a p pe +(a -" TyL,.
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.
Nov 01 07 08:29a FIELfhiVrel*-1 p .2
Mechanical Permit ApplicatioNOV 0 2007 FOR OFFICE :USE ONLY
City of Tigard ,T ,k/ / . . 1111, • ecerved
13125 SW Hall Blvd., Tigard, OR 97223 �j .1 1 Ot Date/By �1 I Q Si Permit N° ' G _ /� i
Phone: 503.639.4171 Fax: 503.598.196 �Zj�f f ' ri Review ICJ
j� � �j jj�V1 � �" �' . 'I Other Permit:
Inspection Line: 503.639.4175 V j L n 1, �� I ■ te ' e y'
Internet: www.ci.tigard.or.us.. f 3 1 / ��' �' 1 Date Ready /By: hair: See Ie Page 2 for
/ Nertified/Metl:od: Supplemental information
......: T- YPE :!OF • WORK . ;
COMMERCL4 SCHEDULE = :USE:CRECKLIST
El New construction Addition /alterationireplacement Mecaanical pemut fees' ate based on the value of the work
❑ Demolition 0 Oth • performed. indicate the value (rounded to the nearest dollar) of all
l i
mechanca mater
.., .- .r. - - ..::.:. � labor, overhead. and profit.
=CATEGORIt,QF = COVSTRi1CTION :[' _
equiptrtertt la cad rid ro
Value: S
- and 2- family dwelling El Commercial /industrial ❑ Accessory building ;RESIDENTIAL :EQUIPMENT t:sYSTEMS:FEES"
s 0 Other:
For use checklist.
❑ Multi - family ❑ Master build
Description
;JOB SITE�1FORMATION AND .':`I:o_CATION. - :: `.: Heating/cooling
_ � Qty. i Ea. � Total
Job site address: –1 37 S so.) -1 1 't , a Air conditioning or heat Pump
��. (requires site plan showing placement) 14.00
City /State/ZIP: %-7 ‘ . 742_0),,._ ct i 2_7_3 Furnace 100.000 BTU (duets/vents) 1 14.00
Suite/bldg. /apt. no.: I Project name: Furnace 100 ,000+BT1.1(duetsevents) 17.90
Gas heat pump 14.00
r
Cross street/directions to job site: Duct work
14.00
Hydronic hot water system 1400
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended. etc. 10.00
Subdivision: I Lot no.: Flue/vent for any of above 10.00
Tax map/parcel no.: Other: 10.00
Other fuel appliances
:. ,; - SDESCRIPTION WORk
heater
• Water h _ 10.00
Gas fireplace 10-00
(�1r1. /� -.11f2 601,_031_ Flue vent for water heater or gas
; ' fireplace 10.00
G , Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood 5replacdtnsett a 10.00
PROPERTY {3VpNEiZ::. . = .t - Chimney/liner/flue/vent
I 10.00
Name: t! s/ ,[ Other: I 10.00 ,
v1 Environmental exhaust and ventilation
Address: • I
0 � �`° Range hood/other kitchen
ip 10.00
iStatdLIP: `�
Ci tr~
equipment
�' /L � - - l �(g 1 Clothes dryer exhaust 10.00
Phone: ( ) (03 b _ i _ (, Fax: ( ) o Luc[ exhaust (bathrooms,
t
:.....- oilets utility
PLICAIVT
1– . ::.: ..: 0. > p N
eras,
T:AGt` PERSON:: =.' T. : .
i : of icicrawlspaee fans
moms) 6 80
10.00
Business name: Other. 10.00
Contact name:
Fuel piping
55.40 for first four; $1.00 for each additional
Address: Furnace. etc.
City / State/ZIP: Gas heat pump
Wall/suspended/unit heater
Phone: ( ) I Fax:: ( ) Waxer heater
E -mail: Fireplace
Range
'COT... .
Barbecue
Business name: /� goi-t, /✓ �hz�a� na, Clothes dryer (gas) Address: .y� •J Other.
! r t . ::: MEC$/U� iCAI: PERMITiFEES* ., ` ...
City. / State/ZIP: �4,--1 '0,/,/ L// \ / ?D/ Subtotal
Phone: (5/6) �to —f -� , /o) ( ax: (.5z)5) 2Z — ,3‘,1:71 Minimum permit fee (S72.501 72
CCB lie.: / �otJ `T Plan review (25 °/> of permit fee)
• State surcharge (8% of permit fee) _L-',
` ; iLi'� TOTAL PERMIT FEE 713, 3 0
Authorised signature: This permit application e:plres If a permit is not obtained within 180
days after It has been accepted as complete.
Print name'
I /, f : et,1 17lLYL Date: (( it /O ' Fee methodology set by Tri- Couaiv Building industry Service Baud
1. 11 . PrrmilApp.doc 12/03 440- 4617T(II /02/COM'WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2007-00639
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/1/2007
Phone: (503) 639- 4171 ill
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/19/2007 TIME: 7 :01AM PAGE: 29
SITE ADDRESS: 09376 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: ASHBROOK FARM LOT #: 023 TYPE OF USE:
PROJECT NAME: STONEKING
DESCRIPTION: Gas furnace replace.
OWNER: STONEKING, RAYMOND D AND, PHONE #: 603-63G-661i
CONTRACTOR: ROTH HEATING & COOLING PHONE #: 503 - 266 -1249
Inspection Request Scheduled For: Date: 11/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 059895-01 603. 266.1249 Y
Corrections /Comments/ Instructions:
0 eterc Lel, _ --- S /4iX6 4'ell Ci 5
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION
/ El ADDITIONAL FEES ASSESSED
Inspector: Date: /! l 9. --o '2 Phone #: (503) 718-