Permit A , . OF TIGARD MECHANICAL PERMIT
1k DEVELOPMENT SERVICES DATE ISSUED: 3/9/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #: MEC2004 -00106
PARCEL: 1S136AD-01700
SITE ADDRESS: 06875 SW PINE ST
SUBDIVISION: VILLA RIDGE ZONING: R -4.5
BLOCK: LOT: 002 JURISDICTION: TIG
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: 1 DOMES. INCIN:
LPG 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
Remarks: Install new gas furnace, AC.
Owner: FEES
BLUME, HENDRIK 8 JULIE Description Date Amount
TIGARD, SW OR 97223 PINE
TIG [MECH] Permit Fee 3/9/04 $72.50
[TAX] 8% State 3/9/04 $5.80
Phone: 503 246 - 6120 Total $78.30
Contractor:
COMFORT MECHANICAL INC
17936 SE DIVISION STREET
PORTLAND, OR 97236 REQUIRED INSPECTIONS
Phone: 503 - 761 - 1500 Gas Line Insp
Heating Unt Insp
Reg #: LIC 79558 Cooling Unt Insp
Final Inspection
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 -6
Issued By (141,471,4 Permittee Signature: 7 7
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit FOR OFFICE USE ONLY ,, J / Mechanical
• DateB * ,fr. Permit No.• - y ✓ 00 /0:w
Planning p.roval Building
City of Tigard a 200 DateB : Permit No.:
13125 SW Hall Blvd. MAR Plan Review Other
Tigard, Oregon 97223 (�F It . RD Date/B : Permit No.:
Phone: 503 -639 -4171 Fax 503 -5 O:S1 1 ). Post - Review Land Use
tiN III ! isn, �.ro ( Date/B : Case No.:
Internet: www.ci.tigard.or.us BUI Ni i Contact ID See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ` " " " Name/Method: Su . • lemental Information.
:TYPE,OF WORK. :: •: 'i,COMMERCIALFEE*iSCHEDITLE IUSE CHECKLIST:
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
IS Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION ;_' mechanical materials, equipment, labor, overhead and profit.
® 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE•
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
: , . .. JOB SITE :INFORMATION and LOCATION .. -''' Furnace - add -on air conditioning ** I e4, 14.00 2$ .
Job site address: _ S� 'pi ne�l . Gas heat pump 14.00
Suite #: 1 Bldg. /Apt. #: Duct work 14.00
Project Name: 51uurn 0 _ Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
_ u Unit heaters (fuel, not electric)
I
IGJ55FI Z (in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: I Lot #: Repair units 12.15 _
Other Fuel Appliances .
Tax map /parcel #: Water heater 10.00
', :', '1,. ' DESCRIPTION OF i �" W Gas fireplace 10.00
7 - YUrnr Flue vent (water heater /gas fireplace) 10.00
1 � , S � / Log lighter (gas) 10.00
COY \(4 Wood/Pellet stove 10.00
' Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
ROPERTY OWNER '.'. •, • - I ❑ TENANT. ,: ' ; :. •" , ', Other: 10.00
Name: -kgr (I k 4-Julie Bt ()Mf21 • Environmental 'Exhaust'& Ventilation ,
Range hood/other kitchen equipment 10.00
Address: ( 0(.0-{t na ,S4 ,
Clothes dryer exhaust 10.00
City /State /Zip: Tjgax e l l 2. 2 3
l Single duct exhaust
Phone: 24( - (, ( c D Fax: (bathrooms, toilet compartments,
❑`:APPLICANT %.., ❑ CONTACT PERSON :. • utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: I Fax: Furnace, etc. I ** 5.40
Gas heat pump **
E -mail: Wall/suspe nit heater **
' . ,. : 'CONTRACTOR , . . ' Water heater **
Business Name: Cv y--tr INA<LiutfAi (,aQ Fireplace **
Address: 1'lg3ln SE ()ldisi a Si-. Range **
City /State /Zip: perena.uL e 87 2-01 Clothes dryer (gas) **
Phone: -- 1 wi • 150o I Fax: 10 2 - 539 4 + Other: **
CCB Lic. #: lei 55$ Total:
Authorize Mechanical Permit Fees* III■
� L f 6 7
Subtotal: $ 33.10
Signatur : A . ! J /� . /� a ate: Minimum Permit Fee $72.50 $ --7 SO
I -A = Mov I he . -11 C.t . / Plan Review Fee (25% of Permit Fee) $
(Please tnnt name) State Surcharge (8% of Permit Fee) $ � 5 _ So
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
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LOT LINE:
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INSTALLATION ADDRESS: ‘r 7— s 0, ,— CI
7: STATE: 0/2
PROPERTY LINE
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Comfort ile:thenkal, Inc.
179S6 SE Division St,
Porthind 91236
Alt: 003,761.159O
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION QIVISION Business Line: (503) 639 -4171
s // BUP
Receive / L` Date Requested 3 //Z /O AM PM BUP
Location d 7 5 J-2 Suite ME DL
Contact Person Ph 5) $ 9 / PLM
Contractor r /. �L y� . Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL •
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
os & eam
Gas n=
S.• • e Dampers
i al
SS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA y Pr/..;75
Approach/Sidewalk Date / O Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record -from the job site.
PASS PART FAIL