Permit ...
a CITY OF TIGARD MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00478
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/25/2008
PARCEL: 1 S135DA -02602
SITE ADDRESS: 09025 SW NORTH DAKOTA ST ZONING: R-4.5
SUBDIVISION: GRAHAM ACRES LOT: 025 JURISDICTION: TIG
PROJECT: MELCHOR
Project Description: Replacing 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:
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
DION MELCHOR Description Date Amount
9025 SW NORTH DAKOTA
TIGARD, OR 97223 [MECH] Permit Fee 91251200E $72.50
[TAX] 12% State Surch 91251200E $8.70
Total $81.20
Phone: 503- 753 -8787
Contractor:
D & R HEATING & AIR CONDITIONING
PO BOX 1292
CANBY, OR 97013 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 678 -2517
FAX 503- 678 -2097
Reg #: LIC 84489
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: ,_��� - e • • .. Signature: /C��yv
�%J
Call 1 3.639.4175 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.
Sep 25 08 09:42a DR Heating 503 -678 -2097 p.1
, FOR OFFICE l SE q\ Ll
Mechanical Permit Application www.tigard-or.gov �►�
er � ° 10 Rescived l� . WSJ - • - te
City of Ti nate/ay:
Iii 13125 S W Hall Blvd., Tigard OR 9 C Plan Review p Permit:
I Phone: 503.639.4171 Face 503.5 ^ O
Internet edB
T i G :'. R D Inspection Line: 503.639.4175 �� it 1� Dmtc Re ,By: Internet Q N � Q� NotifiedlMdlmd: r tal Information
''; .' :.. Q►iv CHECKLIST •
_ - ._ .. -:• ''TYP � FEE* 1'
WO � COMMERCIAL SCHEDULE - 1;SE lv Sf
Mechanical permit based on the value of the work
New construction El Addition/alteralj� Ophlbement performed. Indicate the valnc (rounded to the nearest dollar) of all
V" mechanical materials, equipment, labor. overhead, and profit
❑ Demolition ❑ Other: Value: $ •
.' -• 1. ;'••' ., •CATEGQRY TiO , .. :. '.. . �
ESI EQU !SYSTE :. - ... .
® I -and 2- family dwelling ❑ Commercialindustriai ❑ Accessory building F or special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other Description I Qty. ll Ea- j Total
.; . JOB 'SITE_ INFORMATION AND''.LOCATION •
`' • :.: :•.:: i, .: :.,..; ," . Heating/cooling t
' Air conditioning or heat pump
Job site address: 9025 SW North Dakota Street (requires site plan showing placement) 14.00
City/State/ZIP: Tigard, OR 97223 Furnace 103.000 BTU (duets/vets) I 14.00 14.00
Furnace 100,000+ BM (ducts/vents) , 17.90
SuitelbldgJapt. no.: 1 Project name: �ot„76 Gas heat pump _ 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit beaters (fuel -type, not electric),
in -wall, in -duct, suspended. etc. 14.00
Flue/vent for any of above 6.80
Subdivision: Lot no.: Other 10.00 _
Tax map/parcel no.: Other fuel appliances
rDESt�RiPIIONOF,WORK `
100
Water healer
.. ..... _ . . . ............. ... _ - Gat ftrcplacc
Gas furnace to pas Enrollee changeout. Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove • 10.00
Wood fireplace/insert 10.00
er /flu Neat 10.00 • 0 PROPERTY OVVNEit'::...:... ,.;11: ...:....., >..... " �: T ho Other: 10.00
I Name: Dion Melchor Environmental exhaust and ventilation Range hood /other kitchen
Address: 9025 SW North Dakota Street equipment 10.00 _
City/State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (503)753 -8787 Fax ( ) toilet compartments, utility rooms) 6.80 _
...._., . :.,._.. _ t spaccfans
" � IVTAGT; Att'tJraawl 10_ 10.00
CANT: -�.
-
CO -:
Business name: D & R Heating & Air Conditioning Fuel pipit
Contact name: Lisa Delzer Cox $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: P. O. Box 1292 Gas heat pump _
City /State/ZIP: Canby, OR 97013 Wall/suspended/tmit heater _
Phone: (503) 678 -2517 i Fax: : (503) 676 -2097 Water ater
he Wat he
E -mail: drheataclisa@oeaturyteLfCt Range ��
_ - ' t: Barbecue
CO) l CT ? Clothes dryer (gas)
Business name: SAME Otter.
Address: - MECHANICAL FERMrl' FEES`: • • ;.. , •
City/State/ZIP: Subtotal 14.00
Minimum permit far: ($72.50) 72.50
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
-
CCB Zia: 84489 State surcharge (12% of permit fee) &70
n /� TOTAL PERMIT FEE 81.20
.1 4 1 LtinA r rl , l This permit appfi ation aspires if n permit is not obtained within 1[10
Authorized Signature: V(i 114 - ' days after it has been accepted as complete.
I - - - - .. t _ I • C..� �...L. A..I. �..r L.. T� !� -.. u.. T�:11:�- -� -u_. c... �.... 0_ -J
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CITY OF TIGARD ...
BUILDING DIVISION PERMIT #: MFG2008 00178
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9..125/2000
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .'!+� ^'I,1
INSPECTION WORKSHEET FOR DATE: 10/9/2008 TIME: 7 :01AM PAGE: 33
SITE ADDRESS: 09025 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: GRAHAM ACRES LOT #: 025 TYPE OF USE:
PROJECT NAME: MELCHOR
DESCRIPTION:. Replacing gas furnace.
OWNER: MELCHOR, DION PHONE #: 503- 753 -8707
CONTRACTOR 0 & R HEATING & AIR CONDITIONING PHONE #: 603 -678 -2517
Inspection Request Scheduled For: Date: 10/912008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 076451 -01 503-678-2517 N
Corrections /Comments/ Instructions:
4 4 `h t - 5 / 799,� "e
Aoc n �,e
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: = /O
Date: —r9- e Z../ Ga s
Phone #: (503) 718- /