Permit i
CITY TIGARD MECHANICAL PERMIT
Yr�* DEVELOPMENT SERVICES PERMIT #: MEC2005 -00290
�' , °�� II DATE ISSUED: 6/1/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S133DA -07600
SITE ADDRESS: 12612 SW SNOW BRUSH CT ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE NO. 2 LOT: 136 JURISDICTION: TIG
Project Description: Installation of heat pump, replacement of furnace.
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:
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
KRUGER, DENNIS A + WENDY L Description Date Amount
12612 SW SNOW BRUSH CT
TIGARD, OR 97223 [MECH] Permit Fee 6/1/2005 $72.50
[TAX] 8% State Surcha 6/1/2005 $5.80
Total $78.30
Phone: 503 - 524 -9029
Contractor:
OREGON HEATING + NC INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS
Phone: 503 -538 -2953
Reg #: LIC 125815
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: I� ,'- 17,.427:AL Permittee Signature: e, A y
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.
Jun O 1 05 08:46a 503 - 537 -2172 p.2
Mechanical Permit Application) FOR OFFICE USE ONLY
City of Tigard DateiBy: i / _ai.- .7��, Penn`tNolv‘� , J v 0q
13125 SW Hall Blvd., Tigard, OR 97223 . . Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 ke . s .a�. DateiBy.
Inspection Line: 503.639.4175 � J,J L L Date Ready /By: tuns: 0 See Page 2 for
L/
Internet: www.ci.tigard.or.us ITY OF 1 I''' Notitied/Method: " llr Supplemental Information
BUILDING DIVISION /
.: , • PE OF WORK • : . .. . _. C OMMERCIAL �'.EE* SCHEDULE •.: USE CHECKLIST:
Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
• CATEGORY 'OF CONSTRUCTION '
�/ , : RESIDENTIAL` EQUIPMENT /SYSTEMS, FEES* :"
U1 1- and 2- family dwelling El Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
- :..JOB SITE INFORMATION AND : LOCATION Heatin cooling
1 j� \ `� v Air conditioning or heat pump
Job site address:
J 7 6 (z '4ter s( ,,) �,L- (requires site plan showing placement) j 14.00
City /State/ZIP: ` �"c14 r " I 1 Furnace 100,000 BTU ( ducts/vents) j �•(
14.00 '
, � ' p fl y ( Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: 1 Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct 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
Flue/vent for any of above 10.00
Subdivision: Lot no.: Other: 10.00
Tax map /parcel no.: Other fuel appliances ••
. . ..
. .. :
.
:.:........ _,:..:::.:::;,' . D
ES CRIpTION: OE ■�• �' VORR:; :.��:.:;::: :::s :.
, ::.r,:..� . �i. :
c ... Water eater
J I , 1 t Gas fireplace 10.00
Lip p-0 J ✓ 1 n . it 1 ✓ �`1 +� I; I t . '. - Flue vent for water heater or gas
� / 6.- /` f I fireplace 10.00
7' .- t t ` Log lighter (gas) 10.00
( Wood /pellet stove 10.00
Wood fireplace/insert 10.00
.: ..::.::.. tner'flue/vent 10.00
:..s:• :. li!ERTY •OWNE ❑ 'TENANT .:•.:. !:: : other
.
10.00
Name: I ) P .. .1;•1 �) 1 `� �� � - n Environmental exhaust and ventilation
‘ 1 � Range hood /other kitchen
Address: / to / L / 6 : Il i.; 0 vvt-c ^- �' equipment 10.00
City/State/ZIP' 11 , ( CI R-7 ,.G _ , Clothes dryer exhaust 10.00
r ' » Single -duct exhaust (bathrooms,
Phone: j3) 5L ✓
t' 7 . Fax: ( toilet compartments, utility moms) 6.80
::..'...,.�, .: . APPI.J.CANT.. . •,..:::::...' ` ❑. CONTACT PERSON: Attic/ crawlspace fans
10.00
D ir Other. Business namee ( Q 11 / 4_ � � � � Fuel pip)ng 10.00
Contact name: •
,n I '• ri .� $5.40 for first four; $1.00 for each additional
Address: e, Y S(\ g_ a Furnace, etc.
;,,...11lttt i�` sail Gas heat pump
City /State/ZIP: 1J ' G� n. 1. S _ WalL/suspended/unit heater
Phone. 4 ) SP.
Phone. ) "7 Zi "q-2- Water heater
• Fireplace
E -mail: Range
C
Business TRfACTOR r_U1' Barbecue
m e: //N/ 1/ 4 �/fM � f Clothes dryer (gas)
vvr u r r.
Address: .��, y-a- � � •.:,..:,-,;..,...:.-..... . .. . _
*
MECHANICAL.PER14'QTTEES ' � .
City /State /ZIP: 0V- OP ( Subtotal :
t
Phone: 1, I Fax )3 f3 7 Z) 7 Z an review (25% of ($72.50)
permit fee) ��" CC.�� ✓✓ 1 Plan review (2> /o of permit fee) . t
CCB lie.:
S R ..' .,a (8% of permit fee) ':� y`
'!T AL PERMIT FEE - 7 , 6, - 5-6
Authorized S lure: �
(/� ., 1 ki , U ' I n I � ! . + J'\ •� This permit application expires if a permit is not obtained within 180
^ � � CJ 0 `Y + f 1 d tt r It has been accepted as complete -
I Print name_L '�, .e i J. UV1(3 Y1./ j/1 - Date: J JUN. , UU by Tri- Cuunty Building Industry Service Board
CITY OF TIGARD
BUILDING DIVISION
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CITY OF TIGARD
1 BUILDING DIVISION PERMIT #: MEC2005.00290
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1/2005
Phone: (503) 639 -4171 li 41' i` � iil�
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 7/11/2005 TIME: 7:07AM PAGE: 88
SITE ADDRESS: 12612 SW SNOW BRUSH CT CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE NO. 2 LOT #: 136 TYPE OF USE:
PROJECT NAME: KRUGER
DESCRIPTION: Installation of heat pump, replacement of furnace.
OWNER: KRUGER, DENNIS A + WENDY L, PHONE #: 503 -524 -9029
CONTRACTOR: OREGON HEATING + NC INC PHONE #: 503 - 538 -2953
Inspection Request Scheduled For: / Date: 7/11/2005 Pour Time:
Code # Inspection Description \ / Confirm # Contact # Message
699 Mechanical final V 011070 -01 503 -538 -2953 Y
Corrections/Comments/Instructions:
,
Igi PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ..---
r l r-" Phone #: (503) 718-