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10920 SIN MIRA CT
CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2005-00780
13125 SW Hall Blvd..,Tigard,OR 97223 503-639-4171 DATE ISSUED: 11/23/2005
PARCEL: 2 S 103DA-07400
SITE ADDRESS: 10920 SW MIRA CT ZONING: R-4.5
SUBDIVISION: MIRA PARK LOT: 012 JURISDICTION: TIG
Project Description: Replace gas furnace,gas piping for water heater and range.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENI FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL- 1 VENT SYSTEMS:
STORIES: BOILERS/COMPREiSORS HOODS:
FUE!.TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 I:P: COMML. INCIN:
MAX INPUT: BTU 15-30 HP: REPAIR UNITS:
I':.^.E DAMPERS?: 30 -50 HP: WOODSTOVES:
GAS PRESSURE: 50+ HP: CLO DRYERS:
FURN < 100K BTU: 1 _ AIR HANDLINGUNITS OTIIER UNITS:
FURN -=100K BTU: <= 10000 cfm: GAS OUTLETS: 2
a 10000 cfm:
Owner: _ FEES
MICHELLE CROMBIE Description Date Amount
10920 SW MIRA COURT [MFCHI Pennit Fee 11/23/20( $72.50
TIGARD, OR 97223 [TAX] 8%State Surchaq 11/23/20( $5.80
Phone: 503-348-9540 Total $78.30
Contractor:
ROSE HEATING CO
9945 NE 6TH DR REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97211
Phone: 503-283-5183
Reg#: LIC 2084
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Gre. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expii o if work is not
a started within 180 days of issuance,or if work is suspended fcr more than 180 days. ATTENTION: Oregon law requires
L7 I you to follow rules adopted in the Oregon Utility Notification Center Those rules are set forth in OAR 95::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-
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Issu d By: Permittee Signature'_.--'�-
Call 503-6394175 try 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 Irspectlon.
Nov 22 05 05: 49p p. 2
Mcchanicr.: Permit A
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City of Tigard50
131253W hall Blvd-7Igatd,OR 97323 rl ij,
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Phone: 303.639.4171 1;—: 503.596 IMO D.K1Dy: n
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In■pectine Line: 301.6)1.4173 C1TY D..a .er
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❑New conllttsotiors [D Addition/slier■tion/replacement Mechanical ppe�rMt foes-am based on the Y+ Of Lw wort
perfotmat.Lndic■le Ore"I—(rounded to d s.e.1 dollar)of an
❑mmolilion ❑other: mecMnic■l materials,cquipriway kib9r,ovi ad L-4 fit
• I?t.+l.,.i C�'AEC6RY OM Cbl!1lrIRUCkIbN- ! valw5
' , ' _------` �1,- .' ItilS[11EiYi1. ,.'QiUii'>'I01:Nit/aw ►,,s'rtctttr-'�.
XI-attd2-family dwelling ❑Commercial/indushial ❑Aceesso y buildiDR fou ltlon rrtra !L1
Milli-family ElMasser buildu 0 Othcr: 'y�Y'Y Ra Teul
Joa.Sec INIFU�tM IRON'AND LOCAT HellltlVu11 _ — --
Job site addrta!' 1�� Air conditioning or heal pump
lnquha d lan skotrin�Pbe CM 1 •00 D
0ty/Stwoz P. Aarnow 100,000 6711�M.eM.rm� F 16.W
Suitrlbld`.lapt.oo.: U Prof.--et name: /�� ►/� Oa 0,1"100,E BTU(duelt✓•att! __ 17,90
11eK _ 10.00
Cross oft"t/dimViong to)ob sloe: Ducl work 14.00
11 drmic toot weer■sly_arw —� 14.00
_.-- --- Residcotisl la(nEM1.11 Or
oicL __— 14.00
Un hewten(fuel-rp+e,not eltz rk),
in+.■1L In-deet.1- 04 0.er- _ 10.00
La no.: tludvtu: nn of re 1•Q. 0
Seixlivision: —, OUter _ 10.00
Tu map/parcel m.: Otter hel��Ilancn -- —
�_.�! pcaCµlrlrilOt+ Ret IRK:' Waferheaur ._- _ 10.00
cos fireplace 10,00
Flue Dent for water hea.er or 6a+
l fire Wee 10.00 /01.iz
LO 1' kttt l _ _ 10.00
Wepg�pq�Ictslovt 10.00
- Weod Rtcplseelru; t__ 10.00
"0*BIR�1f�WNE�t j1, , . Chlma /qudveDt 10.00 —
Name: , MOD
nzu Y.2 Ewrirtoemtnlal exkarsl asd sKaISsUOn
Range hood/athn 1�l�ihm
Address; s u. t 10.00
City/StaletzlP: Clotilts Otter oncost 9111
Single dttct exhsuss(ballrootas,
Phone ( ) i na ( Wllst eom9 5 �mnenu�ud room 6.110 _
11frIJb"rktN'r' 1 .:'•i •• :� CON2'ACT!tHRSOW'. f,.;;.ir Aaldcnw rem 10.00
0 a: r� Other. _ 10.00
B:uinels Datnc: ria _ _
Contact none: Y 1 ��'-- 0 r r utl Man
Address: � r.'. Flrrleeee,mc. - _ rf
_ C1as he"a
City/9utftlw! Wallsusoc �vnitheater _
Water beew
Phone: t_ u::( )�-• �� _... ..
a fir- Fite�1100 ._._
a E-mail: Ino
- ® RatnRe_
�•• C OR yr Barbecue
U) Bwiness e■rwe: ss �% Clothes
Address: 7—_ AI!(4�A3;'M� 1 ''I 6•`
m CitylZsuldZtt: I t� 'rl.
Pisolle:( ) F■r 7 ?0 _-- Misiuru+n tennis let¢) `
W `__ flan rovtew(25%or pt stdi :)
J CCE lie. Stsw we6■tSt(0 4 of pwtw r)
TOTAL tEMM E
TUa rtrrwM agol{odut rr+lrar M■yrn■It M�
Aayt eA w h las been arrepted eat tMh.
Pit " err~NWolvp set by rrt ountr Ovildind In 7 Sw. 4rr 19e-d
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CITY OF TIGARD I I
BUILDING DIVISION PERMIT#: pLMI(1Cf,dK1t,',1
13125 SW Hall Blvd , Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639.4175
INSPECTION WORKSHEET FOR DATE. 1/23 006 TIME: T(VIAM PAGE: 21
SITE ADDRESS. 10911)SW MIRA CT CLASS OF WORK:
SUBDIVISION: MIPA PARK LOT#: p11 TYPE OF USE:
PROJECT NAME:
DESCRIPTION: 'nsiall gas water heater.
OWNER: CROME31C,MICHELLE PHONE #: 5()3.34&.Wf lD
CONTRACTOR: 114017k.'HEATING CO PHONE #: 5a32Et3 rj 183
Inspection Request Scheduled For: Date: 1I7 U?O(It; Pour Time:
X
Cod() # Inspection Description Confirm # Contact # M ge
I'lu+++l,m(lti++.il 02537 01 60.2.83-5183 Y
Gorrectioi+s/Comments/Instructions:
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( � I SS ❑ PARTIAL APPROVAL – ❑ CANCEL ❑ NO ACCESS��
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: _-- —_-- Date: ��_ Phone #: (503) 718 t ---
CITY OF TICARD -
BUILDING DIVISION PERMIT#:
13125 SW Hall Blvd., Tigard, Citi 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639•4175
INSPECTION WORKSHEET FOa' GATE: 1/23/2006 TIME: t (MAN PAGE: ))
J! 'E ;,DDRESS: 11)'.!.11)SW MIRA CT CLASS OF WORK:
SUFs.)IVI3I0N: MIRA PARK LOT#: 01.) TYPE OF USE:
PROJECT NAME: (',IZUMRI['
DESCRIPTION: Roplace gat.fumace, gas poi inq Coi water heatei anti range
OWNER: CROMENt". MICHELLE PHONE #: 503-34&95rt0
CONTRACTOR: RO`',L:HEATING CO PHONE #: xn20 403
Inspection Request Scheduled For: Date: 1/23Jm Pour Time:
Code # Inspection Description Confirm # Contact # Message
Mochanic;al final 143.283.6103 Y
Corrections/Comments/Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCFL ❑ NO ACCESS
[] FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL. FEES ASSESSED
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Inspector: �r ✓,�--�___- Date- .y Phone #: (503) 718- I
b CITY OF TIGARD PLUMBING PERMIT _
DEVELOPMENT SERVICES PERMIT#: PLM2005-00652
13125 SW Hall Blvd., Tigard,OR 97223 503-639-4171 DATE ISSUED: 11/23/2005
PARCEL: 2S103DA-07400
SITE ADDRESS: 10920 SW MIRA CT ZONING: R-4.5
SUBDIVISION: MIRA PARK LOT: 012 JURISDICTION: TIG
Project Description: Install gas water heater.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 11ACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: INATIF1 HEATERS: 1 CATCH BASINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: � URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES _
MICHELLE CROMBIE Description Data Amount
10920 SW MIRA COURT
TIGARD, OR 97223 [PLUMB] Permit free 11/23/200E $72.50
[TAX] 84%State Surcharl 11/23/200E $5.80
Phone: 593-348-9540 Total $78.30
Contractor:
ROSE HEATING CO
4045 NE 6TH DR REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97211 _
Phone: 503-283-5183
Reg#: LIC 2084
PLM 26-343PB
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This permit is issued subject to the regulations contained in the Tigara Municipal Code.. State of OR. Specialty Codes
m and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
5 not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
W requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
957.-0001 through OAR 952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by
calling 5 3-246-61 9 -332-2344.
Issued : Permittee
Call 503-639-4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job s!te until completion of the project.
Approved plass am reauired on the job site a< the time of each inspection.
r�
Nov 22 05 05: 490 P• 1
dumbing Per it Application ®■
City of Tigard RECEIV
r.rreif rye.: f
11123 SW!loll i31vd.,Tigard.OR 97223 Review R
Plan !`
Phone: '03.639.4171 Fax: 503.598.1960 PtPlan R OfAe3 pe'"
24-Noun L LtLine: 303.639.4173 Deft Reed)WH - r 1 .e Pane 2 ter f-
Inlemel: N"rovw.e.oi.tigard.or.uc � - NdiOtdlMahal: /(p t ,teairnrd rnt•rmerteei
_rnsramm� >Ree• acttto >t
❑New coni mction -Ali p� /rYr rrn�rJar r QhWMb;
❑AdditioWelteration/replacement ❑Olhtr. D�soription - I T U• To41
__ I
NOW 1-248m111y Jwedsp(itrcludes 100 for Gooch utility corubdion)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.2u
1-and 2-family dwelling ❑Commercielhndustrial SFR(2)ba!N 330.00
❑Accessory building ❑Multi-fanuly SFR(3)both 399.00
❑Master builderEtch sddniorul beth/kitchmt 45.00
❑G�tx: _-_- Fire eprink ler Csq.0.) -
JOB SITE INFORMATION AND LOCAnom S16e u1WtlGs -
lob site address: - -A- . Catch basin or erne dna. - 16.60
City/Statd7,IP: j' Drywall,leech line,or trench drain 16.60 - _^
Suite/bldg.Mpt.no--:tt _ Preject name: V I Footing tore (no.linear fl:_) Page 2
Cross stteet/directions to job site:
Manufactured home utilities 110.00
- -- -- Manholce 16.60
Rain d•ain rwmtaotor 16-60
-�, -
Sanitary sewer(no.linear ft.:o , Page 2
Storm oewar(no.linear R:�, Page 2 -
Subdivision: -- Lot no. ^ Water s.,A.(no.linear it:_, Page 21 - -
FlOwe or hens
Tax map/parcel no.: --_
Absorption valve 16.60
1 DHSCRIpi ION OF WORK - Backflow prevanter Page 2
Backwater valve 16.60
Clothes washer 16.60
p - -- - Dishwasher 16.60 -
PROPERTY OWNER -��- ❑'TENANT
Drinking fountain 16.60
rEjactaa/eump _ 16.6C
Name: �pF.xpensicm Iwrrh 16.60
Address: ` o q �O _ r'�W-a - - Fixtute/tewer enp - 16.60
City/Statemp. bf �! Floor drain/floor aink/hub 16.60
Phone:(LIA` UP16 � Fax:( ) -- tierrbagedisposal 16.60
APFLICANT ❑ CONTACT PERSON V.rxe bib _ 16.60
Ice raker 16.60
Business frame Int-oeptortgreave trap 1611
Contact name:
Medical Ips(value:3 ) Pa3e 2
Address: Primer 16.60
IL City/State/zip: - - Roofdmin(commeroiol) 16.60
Sinlaftsin/la-at 16.60
F- Phone:( ) Fax: :( ) aY - -
FQ - -- ubhhowa/shower pan _ 16.60 -
E-mail: TUrinal - 16.60
CONTRACTOR Water closet 16.60
m Business frame: f in-� Wetor heats 16.60
U Address: �/ - other:
LU
--I City/Stat"JZIP: ld Ca' Sahtotal
-+ Mlninrmt permit 372.30 C
1 �'hane:( ) ack
- - Ft. ( Reaiden"I bflow rninhnum permit $36.13 5
CCB Lic.: 7 R Plu, c.no.: tj h Plan review (2354•o Tmit foe) s
3tstc Lurch arp My,o rmit fie)
Authorized eignahtre: -- �?/�,4 �"`- TOTAL P1 AIT FEE
Pratt name: [tire: This PeMN spplksfkn explres If a pets s not sbtabr d
Uic
l"dsaye offer h has been aecep( as complete.
*Fee methodology sat by Tri-County Builds ndustry Servioe Bcard
i�Efu;�dM�1rn„+svtat-ttmtf�rp.doa rdID7 +10-+RfGr(foa�co�vwr!nt