Permit i ,„ _ (p .
CITY TIGARD MECHANICAL PERMIT
Vl/ DEVELOPMENT SERVICES PERMIT #: MEC2005 -00140 -
° .° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/31/2005
PARCEL: 1 S134CC -04000
SITE ADDRESS: 12372 SW WINTER LAKE DR ZONING: R -4.5
SUBDIVISION: CAPSTONE LOT: 007 JURISDICTION: TIG
Project Description: Installation 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: 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:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
JOE CLARK Description Date Amount
12372 SW WINTERLAKE DR [MECH] Permit Fee 3/31/200f. $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 3/31/200f $5.80
Phone: 503 - 590 - 8835 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD REQUIRED ITEMS AND REPORTS
HILLSBORO, OR 97123
Phone: 503 640 - 3607
Reg #: LIC 66578
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
I • ,
Issued Permittee Si natur ,,t), � /
_ Call 503 - 639 -4175 by 7:00 a.m. for inspections that. •usines say.
is permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
12/15 5:30 FAX a 002/002
Mechanical PermiairligtigE FOR OFFICE USE ONLY
City of Tigard y ' 31 O5 M Peen tNo.: , •, 5- 0.0 / 0
13125 SW Hall Blvd., Tigard, OR 97223 1 2005 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 , , , Date/B Other Permit
Inspection Line: 503.639. CITY OFTIGARD "', \
Date Rnody/By: ® See Paga2for
Intemet: www.ei.tigard,ar.us BUILDING DIVISIO NotiGed/bfedwd: � Supplemental Information
;'' ': - " 1 .. 1 % .. . - 19: C ' ' "r . , '''' ,.,:: • ra•T]1 1':- ."a1'4 ; .,. y�( U' l i ,- . 11.l ,1 1 1 . 1 r•.r'��CNIF,R `, ; L• VSF'vellE IS
❑ New constriction ❑ Addition/alteration/replacement Y LL Mechanical permit fees' are based on the value of the work
❑ Demolition 0 Other: .. performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
..'lPl l�`4 ir: 4 4 . igl Ol j,>rC ,01 r , 'Bic$: Chid 04:j value: S
. J, hdi � 7
mo' 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building p''r'11 � f? Y 1 S3GSEylvLSFFJ;S*
❑ Multi- family ❑ Master builder ❑ Other For special information use checklist
- �. Y 1� y Description Qty. � Ea. I Total
' ', , , :$1 1.L45b .`,r� • � ,9_FMA9,P:,1..411 �� fq h ' ! ivd:tr a, i 1. J Heating/cooling
Job site address: 12-31 Z mp
St--) t � Air conditioning or heat pu
't- i GEC ga" . (requites aim pith ahowlogylecemend 1400
City / State/ZIP: 1 C i }• 2 i- Furnace 100,000 BTU (duets/vena) 1 14.00
Furnace 100,000+ BTU (duceoventa) 17.90
Suite/bldg. /apt. no.: J Project name: heat pump 14.00
Cms 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 (fltel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: I Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel ppllancee
,° '
, '�, °h • 7•
, + r ,:ki '• l .∎ � t
.50- .s:. NM-1.5t' '; .0)l l '� Y�'IM 1I�L; fi ', . t Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
4,......,,,,svi
fireplace 10.00
Q Log lighters) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
:r, „. + Chrome /liner / ue v
'' •, " .., ° EU ps' i i t • i :'FF 2,' v: ` 3. n y 1 ent 10.00
Other: 10.00
Name. O1.. C l �, Environmental exhaust and vondlaelon
�� l Range hood/other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
7 Fax: Single -duct exhaust (bathrooms,
Phone: ( )
c (0- ( )) toilet compartments, utility rooms) 6.80
w i t'; ' ., N X� t : ,'+�:��i�r gg �MIhu. �, lVp , SQ} f�f( d �rd I Attie /crnwlapace fans 10.00
Business name: _if a? t t e C.L. 'J J , Fuel piping
10.00
S 1Y t ^•L�� �'1 � Fuel
Corittict name: 6 ) ` �.l (f"L' Q,- $5.40 for first four, 51.00 for each additional
i 5
Address: F / � ` red-- tv) �., Gas h ea t ter
Gee heat purtrp
City/State/ZIP: H; , i c •b ..:e r-0 Lent j 3- / L.3 Wall/suspetlded/unit heater
Phone: (5 ) (a Chi -- 7 U d 4- J• Fax: : ( ?) (o 8 o7-/I Water heater
E -mail.
Range
Fireplace
)
i i. ;sal ,, i
w 1U` [ '. i.,l:i A •'earl;+ Mu1 �I� , �y : � 1, r 1 . F ��1V,' wi:�.t iaY . fr Barbecue
�c1/.Lti i��' , �° 0., .- .,sue.- ::32� .�]LQY^' 3 „'l�y r•',!A�i � � �:7� c
Business name: Clothes drier (pia)
Other.
Address: _ iii:t �j ?- •• I 'yW i .
F.� ; ,3 R „ley'$
City/ State/ZIP: Subtotal
Phone: ( ) I Fax. ( )
Minimum permit fee (872.50) /).
& Plan review (25% of permit fee)
CCs Ire.: & . " } e State surcharge (8%ofpermit fee)
C A..../-4- ) / TOTAL PERMIT FEE . 3.e Authorized sigzwture: l��'4k - -e-- 0 t - 4 -- ' T61r permit appllmde expired tf o permit la not Dawned within too
7 data after It boa been accepted tie complete.
Print name: p i--e Date: J • 0 • Fee methodology set by Tn- County Building Industry Service Board
is113uildine \PendcAdaC4mnttlbe,Eec 17/01 daflda77T /„m,lreMour.a,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEG2005 -00140
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/31/2005
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Phone: (503) 639 -4171 a ji i�l�
Inspection Requests (24 Hrs.): (503) 639 -4175 ..-�!+L "__..
INSPECTION WORKSHEET FOR DATE: 4/5/2005 TIME: 7:09AM PAGE: 49
SITE ADDRESS: 12372 SW WINTER LAKE DR CLASS OF WORK:
SUBDIVISION: CAPSTONE LOT #: 007 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: Installation of furnace.
OWNER: CLARK, JOE PHONE #: 503- 590.8835
CONTRACTOR: SPECIALTY HEATING & COOLING PHONE #: 503-640-3607
Inspection Request Scheduled For: Date: 4/512005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 003714 -01 503-640 -3607 Y
k/
Corrections /Comments /Instructions:
or n
Ye ALA., 4 trIMINIP
PIMPLY • • u
0
•
PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
❑ FAIL ❑ r' LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 4 ( Phone #: (503) 718-