Permit r'
I.
- �1 CITY OF TIGARD MECHANICAL PERMIT
I N
°' COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00727
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/13/2007
PARCEL: 2S104BA - 00800
SITE ADDRESS: 12112 SW WESTBURY TERR ZONING: R - 25
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT: 089 JURISDICTION: TIG
PROJECT: NOWICKI
Project Description: Gas furnace replacement.
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: NIT
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: REP WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
TJ NOWICKI Description Date Amount
12112 SW WESTBURY TERR
TIGARD, OR 97223 [MECH] Permit Fee 12/13/20C $72.50
[TAX] 8% State Surcha 12/13/20C -$5.80
Phone: 503 -524 -5007
Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 453 -4822
FAX 503- 968 -7224
Reg #: LIC 62196
•
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: 02110:2____ A a r . # Permittee Signature: r — / ` / J C '-
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.
r Dec 12 2007 2:47PM CEllI �LINC 5039687224 p.
Mechanical Permit Applica o FOR OFT1CL USE ()NE1
City of Tigard DEC 1: u7 may: d 9 , P Permit No` dig - _ i, -O i /
13125 SW Hall Blvd., Tigard, OR 97223 P101Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY 1, r 4. . „.,,, Dat Other Permit:
Inspection Line: 503.639.4175 V v
a 4 . . " , l Dat Re edYBy. ®Sot P for
Internet: www ci.tigard.or.us BUIL ..� Ntui6etlMle
� Snpp kmead2 llaformaMm
TYPE OF WORK, - - .. - COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction P_._. edition /alteration/replacerrtent Mechanical permit fees* arc based on the value of the work
❑ Demolition • Other: performed. Indicate the value (rounded to the.nearest dollar) of all
mechanical materials, equipment, labor, overhead. and profit.
CATEGORY OF CONSTRUCTION - - Value: S .
_RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
r. m• and family dwelling ❑ Commercial/industrial ❑ Accessory building
II ❑ Master builder ❑ Other. For special information use checklist.
Description I Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION : Heating /cooling
Job site address: f f Z Air conditioning or heat pump
Sw / E'S r CJ� 7 Y�i (requires site plan slowing placement 14.00
City /StateJZIP: - /e7 _A 0 97z2:-3 1Project Furnace 100.000 BTU (ducts/vents) / 14.00 Jt�
Suite/bld Ja t no.: Furnace 100.000* BTU (duixs/vetus) 17.90
S P name: 3 S � 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
Subdivision: Lot no.: Flue/vent for any of above , 10.00
Other 10.00 _
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK : Water heater 10.00
Gas fireplace - .10.00
Flue vent for water heater or gas
wr fireplace 10.00
Log lighter (gas) 10.00
- Wood /pellet stove 10,00
Wood fireplace/insert 10.00 '
fir PROPERTY OWNER I • 0 TENANT Chimney/liner/flue/vent 10.00 .
l i l' Other: - 10.00
Name: �c. 1 kblAJ ICS 1 Environmental exhaust and ventilation _
Address: 1 a / / 2.- S of I, 4..) C/ � r Range hood/other kitchen
equipment 10.00
City /State /ZIP: ^n CI-K, , a3 clothes dryer exhaust 10.00
Phone:{ ) ! �� Fax: ( ) Single -duct exhaust (bathrooms, -
SP- y - S'7 toilet con rt) moms) pantments. util' rooms 6.80
APPLICANT 4 CONTACT PERSON Attic/crawlspace fans 10.00
Business name: �w>, Other: 10.00
' 111110m • Fuel piping
:ontact name: I ry ` M SS.dO for first four; 51.00 for each additional
address: r Furnace. etc. I
Gas heat pump
:iry /State/ZIP: i i i ` � D Wall/suspended/unit heater
'hone: _ r P / _ . Water heater
-mail; Fireplace i
Range
CONTRACT t R Barbecue
lusiness name /
a Clothes dner
r � l ■ • )
Other. I -
iddress: r . 6 04 41 a . r .-
.) ;,,•_.
MECHANICAL PERMIT FEES*
'ity /State2lP: Oy - -.�... 1 V 1 I ca a Subtotal f y
hone: )4 c , �.. ) Fax: 1 , q co ffF Cr t ^ 7 ry' Minimum permit fee ($72-50) ` "'7�. w
'CB lie.: (2 ` � - � Plan review (25% of permit fee)
State surcharge (8% of permit fee) S- QJU
TOTAL PERMIT FEE Zg. 30
uthori .: signatur This
p er mit application expires if a permit is not obtained within 1110 • /,2 davit 2111, It hos been accepted as complete.
rim name: r ► Date: 22 d? ' Fee methodolov eel by Tn- County Budding Industry Service Board
lu Id; nee .Pe mutsWIEC
_ I _ n110∎1 + �
IArWr.IN I1 Im1lr(Nrnlrcn.
CITY Of TIGARD . ..;�_
BUILDING DIVISION PERMIT #: MEC2007 - 00727
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/1317.007
Phone: (503) 639 -4171 �n
Inspection Requests (24 Hrs.): (503) 639 -4175 Atli I:.
INSPECTION WORKSHEET FOR DATE: 1/7/20013 TIME: 7 :00AM PAGE: 57
SITE ADDRESS: 12112 SW WESTr3URY TERR CLASS OF WORK:
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT #: 0gg TYPE OF USE:
PROJECT NAME: NOWICKI
DESCRIPTION: Gas furnace replacement,
OWNER: NOWICKI, T.I PHONE #: 503 -x;24 -5007
CONTRACTOR: CLIMATE CONTROL INC PHONE #: 503 - 4822
Inspection Request Scheduled For: Date: 1/7/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Gr.39 Mechanical final 062632 -01 503 - 4534822 N
Corrections/Comments/Instructions:
- -- • .. V ' - 4 X 8 4 c/ssl Ge 2l.,h7 -'
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 -7 - 0 0 Phone #: (503) 718- -2/