Permit CITY TIGARD MECHANICAL PERMIT
p DEVELOPMENT SERVICES PERMIT #: MEC2005 -00067
jadk 61. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/2005
PARCEL: 1S133DD-05800
SITE ADDRESS: 12675 SW WINTER LAKE DR
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 ZONING: R -4.5
BLOCK: LOT: 097 JURISDICTION: TIG
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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
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:
Remarks: Installation of furnace.
Owner: FEES
FREDERICKSON, KAM Description Date Amount
12675 SW WINTER LAKE DR [MECH] Permit Fee 2/18/200f. $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 2/18/200E $5.80
Phone: 503 - 502 - 8426 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.
Issued By: "j;r�� �, Permittee Signature: -€
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
11/07/2000 14•33 FAX I- 001/002
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Mechanical Permit Application p FOR OFI'I(I•; USE ONLY
City W Tigard n EC E 1 VU E r Dyer - / �' d c / �f
$ ettaitNe.: L... X0 0 I
13125 Sw Linn Blvd., Tigard, OR 97223 Plan lnview
Phone: 503.639.4171 Fax: 503398 - L960 ,� :. Dare/Ply: Ot rpermit lino Inspection Line: 503.639.4175 FEB 1 8 t lti ; Jil
Internet: www.ci- tigard.or.us I EB 1 V 2.' .. _ Date Ready/Ely:
Notified/Meth El See Pees 2 XDf
tld Supplemental Caiotmatlee
;� , TY OF TIGARD
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❑ Now construction ❑ Addition/alteration/replacement Meciumical permit fees • are based an the value of the work
performed. Indicate the value (rounded di the nearest dollar) of all
❑ Demolition ❑ Other: - mechanical materials, equipment, labor, overhead, and profit,
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rig 2-family i J':7:15'ill1: °:�L': ' -'L i 1 17(41 -5'1 K, tr4ti1 ...1 I4 1 ,1 1 � ,AljI ' 2-fmr dwelling Commercial/industrial � c : . .:. +.. _4C:1 :77U-1,)11,21 i ,1 l l
1- and mv'vC•
ly d elling • ❑ Co 0 building " � • �Q "'_''+"
❑ Multi- family ❑ Master builder ❑ Other:
For special Information use checklLrt.
: : y �,�,. Description I Qty, I Ea. Total
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Job site address: I ( fi c 5 i W I l �� Au conditioning or heat pump ,
Nedra siie plan showizue placement) 14.00
City/State/MP: q4-2--? q4-2--? Furnace 100,000 BTU (duel s) I 14.00
v -
Suitc/bldg. /apt no.: I Project name: Furnace 100 BTU (duCWvent) 17.90
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
hydionie) 14.00 '
Unit heaters (fuel -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 Biel appliances
._,.: :! I � t . .4., -•" I1 '
, ; ol ti 1 „ -1_. ,1:;:. +7 r,,t -:1:. Water heater 10.00
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,
..,...., . _ _ _ ,111 .:; ,.. 1
: ... 1 11 1 ._ _ 1 111 . . . -• � . . .1...11'.'.1 :: _- 10.00
Gat fireplace
Flue vent for water heater or gas
ILI n�1r S fireplace _ 10.00
� Log lighter (Ras) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
4 r- ' ' 111. Chimney/liner/flue/vent
� ; . 1 .. (�. ; I - . ; -, - / F. :. 4.• -ri' - ? ' ♦i,. � ' ,,11 I• 10.00 lone
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Name: , / ' ' ! a e- c' f �h I M1 „ Environmental exhaust and ventilation '
Address: Range hood/other kitchen
equipment 10.00
City/State/ZIP: ! Clothes dryer exhaust • 10.00
Single-duct exhaust (bathrooms,
Phone
( ) SN.., 2 . g L(2-4/ Fax: ( ) toilet compartments, utility rooms 6.80
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,; 111 -- - -- _
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�� 4Tr1S 10.00 •
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Other. 10.00
Business name: _f iii ` -/eQ 1 nal pip15
Contact name: 14 6 ( Se P ,1 w4-- 12_,11. 55.40 for first four: 51.00 for each additional
Address: - ^ �.► -Q , - - • Furnace, ore -
Gas heat pump
City/State/ZIP: jl LS f� Lyr`b l . R 7J y3 Well/suspended/unitheater
P hone ` Water beater
• (S 33 ) �. C4 0 7 4t 6 3 [Fax: (su3) (0 8- i - 0 }• 17
Fireplace
E-mail: Range .
ONIIIIIIIIIIIMINEIVEIMMIENIBIEIM Barbecue
Business name:
Clothes dryer (gas)
Other.
Address: _ = '' _ -; = •W,. _ s_
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City/State/ZIP: Subtotal
Minimum Eennit fee (572.50) Z f f2
Phone: ( ) I Fax: ( )
C Pleb review (23% of permit fee)
11
GCB lic.: G r } e State surcharge (8% of permit fee) 'Sg0
-
TOTAI. PERMIT FEE .30
Th
Authorized signature: O -
is permit application expires it a permit le not obtained within 180
doge attar It hie been accepted at complete.
Print name: Q 1 42 ,, Date: .?"---/t t3 f V 5 • Fce set by Tri Building industry Service Board
ekBuildutgWm7mot6EC•PmmicApp.4 c 17/09 1 440 -461 Tr(I trovCOMrwpsl
CITY OF TIGARD
..
BUILDING DIVISION A - PERMIT # MEC2005 -00067
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/18/2005
Phone: (503) 639 -4171 PS Inspection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: 6/27 /2005 TIME: 7:09AM PAGE: 71
SITE ADDRESS: 12675 SW WINTER LAKE DR CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT #: 097 TYPE OF USE:
PROJECT NAME: FREDERICKSON
DESCRIPTION: Installation of furnace.
OWNER: FREDERICKSON, KAM, PHONE #: 503- 502 -8426
CONTRACTOR: SPECIALTY HEATING & COOLING PHONE #: 503 - G40 - 3607
Inspection Request Scheduled For: Date: 6/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # • Message
699 Mechanical final 010145 -01 503-640.3607 Y 1
Corrections /Comments /Instructions:
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•
0 PASS a PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL I/ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1....■_ Date: Z- #: (503) 718 -