Permit - •
C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2005 -00128
DEVELOPMENT SERVICES DATE ISSUED: 3/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S125DB-08600
SITE ADDRESS: 09496 SW SHADY PL ZONING: R -4.5
SUBDIVISION: THE RAZBERRY PATCH LOT: 006 JURISDICTION: TIG
Project Description: Replace furnace, install A/C.
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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
WORLEY, RONALD L + KATHERINE E Description Date Amount
9496 SW SHADY PL
TIGARD, OR 97223 [MECH] Permit Fee 3/23/200f. $72.50
[TAX] 8% State Surcha 3/23/200E $5.80
Total $78.30
Phone: 503- 452 -1890
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Phone: 503 -557 -2220
Reg #: LIC 72623
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: .s€.
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.
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Mar 22 05 04:50a TriCounty Temp Cntrol 5035570919 p.1
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Mechanical Permit '
'� :� ` � " FOR OFFICE USE ONLY
City of Tigard I y Received _ �p
13125 SW Hall Blvd., Tigard, OR 97223 Dale/By: 3 �� Q� �� Jam- Permit vo• ` )
Phone: 503.639.4171 Fax: 503.598.1960
Plan Review �� ���D / �al�
Inspection Line: 503.639.4175 3 j "t ' � 1 Date/13y: OcLer Permit:
1 MAR 2 2005 r'' D ate Ready/By: luris See Page 2 for
Internet www.ci.tigard.or.us
at e Read /By:
Supplemental Information
y�. ".0 :. :FED "SC - 'f3 + :'CFiECKL1ST •
❑ New construction :i Addition/alteration/replacement 1 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, o verhead. and profit.
1r f` : p
.. : : : .. LATE( ORY., 01! CON : : : : ",: Value:S
1 -and 2- family dwelling ❑ Commercial/industrial R.E /
❑ Accessor b uilding
❑ Multi ❑ Master builder For special information use checklist.
esc
,.. .a.
,., Qty. I Ea Total
:.., ;.. .:, . • !'. .. - _,
Description OB'.SITE:I . dRMil::ON .. . :AND . LOCATIOIVki :r _ . ", :..;. . -:•::1•`!.:::,•;:1,..
; : '
.. _ .... .. - . „ Heating cooling
Job site address: C1444 e V 8 p Air conditioning or heat pump
J q7223 r v (squires site clan showing placement) ' 14.00
•
City / State/ZIP: 9 Furnace 100,000 BTU (ducts/vents) I r 14.00 I
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 1 4.00 :
Residential boiler (radiator or
•
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, susvended, etc. 10.00
Subdivision: Lot no.: Flue/ vent for any of above 10.00 1
Other: i 10.00
Tax map /parcel no.: Other fuel appliances
.....:.:...` . > : %:
�;° :_DESCRIP'I•IO1c1 :OF VYORIGi � ,� ��4 .; : •
;:, ,: '' Water heater 10.00
I flSt 1 1. il Gas fireplace 10.00
� �) � �J(�•�/6 � sLtJ 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
, ': " R; . :
Chimney/liner/flue/vent / 10.00
.. ' .'I (;tiPR0PERTY_: r ` -- :.. : ;• tner /flut: vent 10.0
•, .,;: V :..,- ..,... '•4. . ., -�h : � .. :eft °�.- , .... . _. : (�:4TEi� A NT`' : . .. .. _
:•::: Other: 10.00
Name: Environmental exhaust and ventilation •
•
Address: edine) "7 Range hood /other kitchen
equipment J 10.00
City /State/ZIP: Clothes dryer exhaust 10.00
Phone: '}� 44192.-M0 Single -duct exhaust (bathrooms,
( �/ Fax: ( ) toilet compartments, utility rooms) 6.80
; p- APPLIC :' Y ;i : t ;fl . CONTAG"1(=` ERSOY ; Attic'crawlspace fans 10.00
Business name: Tr! Cau c ]
C,t l l.' ! Fuel Temp C 1.7 -11- 10.00
piping
Contact name: Fuel S5.40 for Grst four; 51.00 for each additional
Address: [MO O 6 . C I Q(. }1 I) G' Ql k •� l t P l I Furnace, etc.
t l t�l U I l l L J 1 v l` �i1 ! V �. Gas heat pump
City/State/ZIP: on C{ ( k _ c 7046. WalVsuspended /unit heater
Phone: ( 557.-2220 I Fax:: () 55-7_611q Water heater
E -mail:
Fireplace
F 1 .3.._,. Range
i:s -'f :�' ^e ',4.54 �' - :' :C�Lr�l:.7,4 3 . '-, : . :, , .K� I ,.. p
• .... : Pt t`i :: 1� ... v CT,t91r -.: �' :� �lEi� °���, :.4! :. . ' 4 ... .. : '�S' Barbecue
Business name: I ri � -ro 'r n C( rr tro J Clothes dryer (gas)
Address: 1C l," /3 � /r/� L M1t O t C.FS l t RI . � ' 4 �1 I br.1 �� �'' Other: UC.1�! � � - - tME.CHANIG`A'L'E 'L�1T'
REESt ' .
I I
City/State/ZIP: 0}• O1./'� ok_ C17 � _ Subtotal
Phone: (C3) 5S ' -2220 Fax: ( )Q S5.7 .../ l( Minimum permit fee (572.50)
ICJ Plan review (25% of permit fee)
CCB lie.: -7214 State surcharge (8% of permit fe ,j,„ _
}ti a /� � �_� ' TOTAL PERMIT F a �T;
Authorized signature: `+CL This permit application exp(res if a permit is not ob fined wlihin
days after it has been accepted as complete.
Print name: �r
•Dr'l�n.F Al1a,„50f1 Dace: 25/te, • Fee methodology se: by Tri- County Building Industry Service Board
i:\ Buildings ?ermitsWEC- Pernvt,pp.doe 12103 410461r: (II l /ObCOM /WEB)
Mac 22 05 04:50a TriCounty Temp Cntrol 5035570919 p.2
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INST ALLATION ADDRE;s, D/L\ lJDr7,U1' •
6 1 6 5114at a"
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PROPERTY LINE • I
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YROP1ii{TY LINE
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---- ---6=-' -QUELIE_UNIT
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____ ...._____ c54/A1
CITY OF TIGARD -
BUILDING DIVISION r PERMIT #: MEC200&00128
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/23/2005
Phone: (503) 639 -4171 A �� �II l
Inspection Requests (24 Hrs.): (503) 639 -4175 —..
INSPECTION WORKSHEET FOR DATE: 4/7/2005 TIME: 7:14AM PAGE: 97
SITE ADDRESS: 09496 SW SHADY PL CLASS OF WORK:
SUBDIVISION: THE RAZBERRY PATCH LOT #: 005 TYPE OF USE:
PROJECT NAME: WORLEY
DESCRIPTION: Replace furnace, install A/C.
OWNER: WORLEY, RONALD L + KATHERINE E, PHONE #: 503-452-1890
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503-557-2220
Inspection Request Scheduled For: Date: 4/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 003940-01 503-557-2220 . /h . Al
Corrections /Comments /Instructions:
I/
(
` PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
' FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: — 7' -6 5 Phone #: (503) 718-