Permit 1
CITY OF TIGARD
MECHANICAL PERMIT
' ° COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00014
TIGARD 13125 SW Hall_Blvd.,_Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/10/2008
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- PARCEL: 1 S134CB =04400
SITE ADDRESS: 12280 SW NORTH DAKOTA ST ZONING: R -7
SUBDIVISION: ANTON PARK LOT: 006 JURISDICTION: TIG
PROJECT: JACKSON
Project Description: Gas furnace install.
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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
•
> 10000 cfm:
Owner: FEES
NANCY JACKSON Description Date Amount
12280 SW NORTH DAKOTA ST
TIGARD, OR 97223 [MECH] Permit Fee 1/10/200E $72.50
[TAX] 12% State Surch 1/10/200E $8.70
Total $81.20
Phone: 503- 639 -2877
Contractor:
ALL TEMP PROFESSIONAL
8230 SE 72ND ST
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 236 -2263
FAX 503- 777 -9766
Reg #: LIC 58513
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: ± 116/ . A Permittee Signature: 6,77 e6,0/21-41-7----
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.
" . ,' 01- 09 -'08 09:23 FRO + 037779766 T -518 P002/002 F -699
)I4echanical Permit Appl I FOl: O F F I L E 1'.51:. ON i . V
City of Tigard Date/By i / i . PeImitN• • _ v/ • , Sr i
:N i l 13125 SW Hall Blvd„ Tigard, OR 97223 ' a , n 2008 Pan R= - =w
1 Phone: 503.639.4171 Pax: 503.598.1960°'• 0 J e7 Other Permit:
Inspection Line: 303.639.4175 DatetBy:
• • i ( ti Li vi Darn Ready/By: Jvac/ RI See Page 2 for
Int ernet: www.tigar or.gov Of I i�jf� ' N ot iTi odtMnthod; .1 Supplemental Information
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0 New construction 1WAddition/alterationfreplacement Mechanical permit fees* are based on the value of the wort
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials,
equipment, labor, overhead, and profit,
<8y4. j::rii �f¢ ?i:A'%i:> >. h :' Vahle:
4).: r,'�ii3;ii °.ti.ii >.'fL , y ..m �•'•: 'i"
....,...lif• ... ... , .'< �:. fa.• R.>, o. a ..,:.,•..,,..,.�.^.3�:::':'P.. .. f;£. .3: oo-s:.:�io� - �»�: >�, r'�.
1- and 2-family .:` dwelling 0 Commercial/industrial El Access building s l R�s`t .r
For special information use Checklist.
❑ Multi - family 0 Master builder ❑ Other:
Description I Qty. I I
Total
s,s Ea.
° . >j'I,• 7 ? �i : S 's''f =•f? ��'(�{S .. •' Y . :. c::v ,£.sa'.va,t.doi R:a.': q .°,£.$:tom ?<s%, ni' :l: x n C.'r<<•,
< •: ,.a <i <£: ` ;G 0:1 0.04:11 'Y,ly ". .:, .f rfS' : ...t ` g .:?''7 ..:. Heat41 mn
i!s'^ >. ,k . <�`: °.0ia: E.:a.:� � k1 �k
Job site address:
4:2,2,6,-.. ~ Air conditioning or hest pump
8Q r O 'T . 27,e (requires site plan showing placement) 1 14.00
City / State/ZIP: f . j 9 . 3. 3 . (u) / 14.00 -
IG' t F urnace Furnace 100 000 BT U (dncts/v 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: ,ar.,c44rsts‘..Due 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
Plue/vent for any of above 10.00
Subdivision: I Lot no.: '
Other: , 10.00
Tax map /parcel no.: Other feel appliances
• «n > "<'a . s F :(: ; > . � .£ ' :> .`.'Y" " s < s: s > '` s i.4 • • , ;g .;.: sx,.. . to Water heater 10.00
... >£• ;?.,: :kt- a::rs::.4.,..•.. ..,..,,,•.,....£: -. : :!:.•: ?:..:?.8 [�y,`'F' .:see:.*:, «�, G 6 Gas fireplace 10.00
'
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��ee r 3' zd.. 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
• .1 } "}�{yy{ 5: � :See.: >:P so . ,:P -,s, -: '!'J`�I -:Y•T b:NC"n .:4..i •,��)) / 4e':O:•:ux s .,..� L. Chimney /lime /fluelvent 10.00
...:.. v.n.e:i:S. '. )� e t,1:.' - >/ •'�a- et, Y 'iv •'• -'': I 1 :4 ; ..£<
. <t �,•w�' •r' �t�:'� �+f:f;�rtH'�:f . , , gl:+lo < other, 1�.��
Name: ti g 0tvirotetmtatal exhaust and ventilation Address: Range hood/other kitchen ,,
equipment 10.00
City /State/ZIP: Clothes dryer exhaust 10.00
- Single -duct exhaust (bathrooms,
Phone: ( , • .4110 7 Fax: ( ) toilet compartments, utilu ,rooms) 6.80
' l: ?£l is : :� > • - . ; ^' : £: 'i :;.i: ?t;> f: �1i•:; "• 4- . � '.s.c = , . .: a
' i %:ii:'<:Y<� w..4 : a + ` : : , . ; '1 '� ' i .t e:§y;: f ...:: � g ; - : •, : s 4., AttirhaawlspacePans 10.00 -
., �. �. E, � .- ...,,.., < .�£e<s e ..'.ea..w<it: . JSi :]£'�•�:Y # <.
Other: 10.00
Business name:
Fuel piping
Contact name: �, 4� i_el 4 . ( . i � a 0A./4,-- S5.40 for first roar; 51.00 for each additional
Address: ''{ Pumaeee etc.
Gas heat pump
-
City/ State/Z1P: Wall/suspended/unit heater
Phone: 3) /i/i I Fax 77 l' �. 7 ( Firaeplaceater
E -mail: Ave e, 4 r-
Ai ' 1M - r ,I L . IA% Range
^ft <' ffi'3:;i i :x:;;> e' • :adEeo ::i :;;::::¢ . "1<0: < yr . - .,: ; .�:ha: .
; P:_ •'£" ;',f,':4 r '•:, ':' : f:. 1 M y':: : i...1..w
:: “ :a3: >£"` ti i'`i:f'. s !: r :a�: tesb. :£. &Mi f i ,.• >:sq< .. Barbecue
<.... c...::,;... ��.: �..:. •::.:..:..<.,... ?.. +. � a.' >:�... ... • Q : c � �>c 7��,t.. , .•r.• s'�r�, ,
All Temp Professional Clothes dryer (gas) _
$230 SE 72nd Ave
sic.: of permit fee) O11ir=
; . ° ' : . ' xn c,c o, T � <. 9 f a:: wf" ":6: .'w:4-:;Wit:. .r,.v r
Portland, Or 97206 £.£. :< x; yfrr f �ry�`? :, . s
: YR S .. RE de3•y7f r; ;l :£•o,a ....: f -
1 3r : .
503- 236 -2263 a\ ` Minimum armit fee 50 /P .
533) -d 777 -9766 P ( ) -- 72
�/ Plan review (25 °k
e:cli State surcharge (12 %of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit epplieadon empires lfa permit is not obtained within 180
days alter it bas been accepted as complete,
Print « -T -•M' . 6 QNe t�
I -,. . � Tr n m
/ C . _. I • Fee Service set by Tri.County Buildiee Industry Board
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2008 -00014
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/10/20109
Phone: (503) 639 -4171 :1Iit?
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' F_ I.E.
INSPECTION WORKSHEET FOR DATE: 2/15/2008 TIME: 7:00AM PAGE: 49
SITE ADDRESS: 12280 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: AN TON PARK LOT #: 006 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Gas furnace install.
OWNER: JACKSON, NANCY PHONE #: 503-639-2877
CONTRACTOR: ALL. TEMP PROFESSIONAL PHONE #: 503-236-2263
Inspection Request Scheduled For: Date: 2/15/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 00991 -01 503 - 579 -2877 Y
Corrections/Comments/Instructions: }� L �- / �7 q
al •ri a fAt— i.t , H 4,t 6t' . r/ l 4-7 ¢'S &241 -26LEf L-L/vW =' ie-ALI.Cs
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: A Date: 2 --/S - --a '6 Phone #: (503) 718 - .2----