Permit CITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2006 -00255
J l DEVELOPMENT SERVICES DATE ISSUED: 6/5/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 104AD -02601
SITE ADDRESS: 12921 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Replace furnace & add electronic air cleaner.
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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + . HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: 1 OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
THOMAS PETTERSON Description Date Amount
12921 SW WALNUT ST
TIGARD, OR 97223 [MECH] Permit Fee 6/5/2006 $72.50
[TAX] 8% State Surcha 6/5/2006 $5.80
Total $78.30
Phone: 503- 590 -1003
Contractor:
OREGON HEATING + A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -538 -2953
FAX 503 -537 -2172
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 ( ) Permittee Signature: �p P
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business Ay l
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 02 06 03:07p MS Rentals, Inc. 503-537-2172
p.2
Mechanical Permit A ' a VED . : . FOR OFFICE USE ONLY
City a Tigard
9 z006
Date/By.
--) 0
‘...._, L_ PermitNo.. e--
- ...... b
h ,
13125 SW Hall Blvd , Tigard, OR 97223 3U \\I •- -, Plan Revicw
Phone: 503.639.4171 Fax: 503.598.1960 0- DateiBy Other Pennite
I n s pection Line. 503.639 4175 CITY OF TIGr -S' 11 Date Reany/By. hair: ( s.... 0 See Page 2 for
Lm
nteet: www ctligard.or.us BUit-DIN Mil '-- Notified/Metbod: .-.01) Supplemental Information
r ' ' '• . ' ' : - .,-. - '.....--:', - . I ' .11 OF W ,.. -: i "-: .. _ : j ..„:-.; -f,-...' .'.' -.., .1, -:,. ., ; - _COMMERCIAL 'FEE ; SCEEED1.11:1-'"- USE CHECKLIST
Mechanical permit fees' are based on the value of the work
P New construction {2/Addition/alteration/replacement performed_ Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
. . . ,, • Value: 5
- ..,:- _ „,.. CATEGORy OF cciNsTRucricnc...:: ',.. . '•-. ;,.1 .. L, ..
., ,- .. RESIDENTIAitEli)UTPI■4iET /SYS T.EMS
., ..„..- ,
L'1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building ' . For special znformation use checklist.
0 Mult-fannly 0 Master builder 0 Other. -
Descnption I Qty. I Ea. 1 Total
: „ . - , . -, - ■ .
JOB, SITE INTokivrApiri. AND tOCATIO1Y "::"..." . ,---. 21: .."_, ,...:, Heating/cooling
-
Job site address 19 al tAi a
SAA) i Air conditioning or heat punip
, (requircs sat plan showing placement) I 1400
City/State/ZEP:
N) ' 7 p3-3 Furnace 100,000 BTU (ducts/vents) t -
14.00 1 L i -
Furnace 100,000+ BTU (ducts/ven•s) I 17.90
Suite/bldg./apt. n o.. 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 beaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above I 10.00
Subdivision: Lot no.: -
Other. I 10.00
Tax map/parcel no.: Other fuel appliances
12..i. :.
-',
- ' ''''' '' Water beater I 10.00
; I . ti, i, -- - . - - - ',-,irA c/L et cc Gas fireplace
' . CI_ Xj_ a.) " U.__
f
1 i 1
Ur 1 Flue vent for water heater or gas
fireplace I 10 00
10.00
1.-C-- 61,4t./Y J-1--44%-0.-- Log lighter (gas) 10.00
Wood/pellet stove _ 10.00
Wood fireplace/insert I 10.00 1
10.00
ji"t,;.:k;,i za . 12.9gE43,TY; - 9 SVP:,.:1 , ,=7 4 :;`:;::'?;+4'...."):::4''.:?(''. 1 :1,:rii-:.: 1 41.... 1 7;.';‘.; - .. - ...a.`; . " - ;:7 0 .:;t■
Other: t 10.00
‘,.......
Name: ryy- , t-tt g.4 ,-54 4 ", Environmental exhaust and ventilation
6 0 Led , equipment 10.00
Address
,.....4; Range hood/other kitchen
, 10.00
City/State/ZIP: ,,,z1 ,,I,...z,,t 1. /7 2 - 3 Single-duct cio thesdl.erexhexahainutst(bthroorns,
Phan) D) ,
- () /0113 Fax: ( ) toilet compartments, utilit2. moms) 6.80
10 00
W ::■' ', ..:• .:- ;C.; 1 ' . 1 ::"--' ''' " ' ',i,,S -J5 4 - 13.1*.:*•-1.1-{-';';':.'t-I''..3,;'s9:';-ir.:::f `! 51 ' ' `A ' - c - : RS 0- S Atticicrawis fl t Other. c
10 00 0
Business name a / 0A A lii , A- ' LOi
.4 t-- f-j
Fuel piping , 1
..._
Contact name: ii f ) }1-S‘-`93 55.40 for first four; 51.00 for each additional
Address: i (1)
I Furnace, etc.
g _ sa l 6 , F 1
Gas heat pump
1 ,
City/State/ZIP: di, As ' 4 V-- C' fl I s- Wall/suspended/unit heater
Phone.P -- 7211M1Vri Fax. : -- 1 ) 7 z_/ ---2- W Fireplace
E-mail:
_ Range
. , , . ,. I
' : - - t ,-- _-- -a. c IVI:RACTOR: -..,_ ,... 2 , . A- , ; j. , - ': ' -. 1 . „ -' . Barbecue
• -
Business name: (1 Clothes dryer (gas) Address .
Other. ,
A C City/State/ZIP: - i t/J . _ 0 - V_ (4 r) I Lc . Subtotal p_Li 63
' S - • e -
C 4It'
I Fax 693 63 17 z_ Minimum -
Phone: permit fee (572.50) t
Plan review (25% of pennit fee)
CCB lic.: I ..---'
• '()‘-.- 4-_,, State surcharge (8% of permit fee) 7. 0
TOTAL PERMIT FEE
- This permit application expires if a permit is not obtained within 180
k
Authorized s" attire: ' Ut • ) I- ./ ._ 11 '. , i , o6 days after it has been accepted as complete.
EMEMIMEWMA Elte , 1 Ali Date z_i .....4-//rie •
II 7i, - .
A * Fe: cictI3odoloo set by Tr-County Buildms bidustry Service Board
- -- -- ...vi,gi-.-i- /11 1117,1-117471WFRI
CITY OF TIGARD _ _ MG- ` .
BUILDING DIVISION. PERMIT #: �e06 � ec�
Alk 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUE .
Phone: (503) 639 -4171 4
Inspection Requests (24 Hrs.): (503) 639-4175 " (—
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 9;- / 06?...-- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: `
DESCRIPTION: V•J oi2 OWNER: PHONE #:
CONTRACTOR: , a,(_ iJ H PHONE #:
Inspection Request Scheduled For: Date: 6 - D q 6 1 Pour Time:
Code # Inspection Description Confirm # Contact # Message
‘ ` CA4 S96- /vo3 TO
Corrections /Comments /Instructions: a,41.1 1 ik_eter_tgA.4-81
/
Al i II A
'_( _ i _.. 4 1."... Fil 0 .. -
4 0 - egFGrgiOt -- tu. tA4a,-- 44-1L- 2e S 6 8 9 68 67214,<.•G/II0i Cc-teT /—Ci� 11&
14 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Date: - 2 -f -, Phone #: (503) 718-