Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00109
� � I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/15/2005
PARCEL: 2S111 BD -03200
SITE ADDRESS: 09790 SW PEMBROOK ST ZONING: R -3.5
SUBDIVISION: CLOUD CAP LOT: 014 JURISDICTION: TIG
Project Description: Installation of gas service to house, adding gas insert, gas range, venting for gas water heater, range hood,
gas outlets for water heater, insert & range.
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: 1
STORIES: BOILERS /COMPRESSORS HOODS: 1
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 2
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 3
> 10000 cfm:
Owner: FEES
KRANZ, NEAL Description Date Amount
9790 SW PEMBROOK [MECH] Permit Fee 3/15/200E $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 3/15/200: $5.80
Phone: 503 - 598 - 1150 Total $78.30
Contractor:
NATURAL GAS CUSTOM PIPING INC
4450 NE SUMNER REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97218
Phone: 503 335 - 9950
Reg #: LIC 125031
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-'3
Issued Permittee Signature:
503 - 639 -4175 by 7:00 a.m. for inspections tha burin s
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.
03/07/2005 14:39 FAX 5035981960 CITY OF TIGARD 0001
• rs , OFFICE Us e o
Mechanical Permit Application r ONLY
City of Tigard
bate/B. /I ®� i _ b � //, (OJ
13125 SW Halt Blvd., Tigard, OR 97223 p lan Review
Phone: 503.639.4171 Fax 503.598.1960 : .o,>ii i •i , Date/By: Othe Permit:
Inspection Line: 503.639.4175 `YI �' :', Date Beady/By: IIM Ed See Rage z for
Internet: www.ci.tigard - or.us - hl0titied/Methtxi: Supplemental tnformadon
L u d t ,711, fi 1 re. ' 0 1 I . J r-1 7 1 7 `nTr : i ,. r'• I .1 Y• r'. -
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t��_i,l . t•� , rAr� , uJL; I Z.il.'CT,,.,... y1 ,. r_..�.�t_.. _ .. :. v. .
0 New construction 13 Addition /alteration/replacement Mechanical permit fees' arc based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other, mechanical materials labor, overhead, and profit.
T _ ;7 "0.r -- r } '.64(,11 't k ,,�rl Value: $
$u� :' f, t'.•[•1.1 I;itit i�al'!�,�r:C( h�J` ..r a63'FJ"'"Ji ' . ; II ,, i ..
.,.i..., _r�J1. ,�, rr11�,6�,. ,. ,,G ;wl , 4. �1'�.i: ,flu -J .f ,. ,,7i.: " ,.. ! :�i�Bi Yt•A�L ..: .�'� + 7:�" �i!Y , ,,�„rr.�..
El 1 - and 2- family dwelling ❑ Commercial/industrial - El Accessory building ' �� i�'�`t�,Wat 1. 1 a :' $I S*
For special information use checklist.
❑ Multi-family ❑ Master builder 0 Other _ Description 1 Qty. 1 Ea. Total
. y ,,, ;,i , , r }JNr,���_ 1 , i-' ^. r , k IA
Y �;'I l I:AL,lk-,.1• �; d + : .J PA t r l . ,i { , � .;i \ IjS r A. , l e , A ., . l '. HCAi ltt�f0001[ n
t..... vet,. �� -� . I-•..��_ �� - �:�rr.s>~t.�L � �
Job site address: /� -; //_ ,t ,/ Air cauditionin8 or heat pump
�� 0 , . 6t .. e, 4 (9� v t6 5 I (requires site plan showing placement) 14.00
v Fur 10 0 ,00 0 BTU (ducts/venta) 14.00
City/StateiZEP: j 17Gr v G° �L q Z Z- .
•
Furnace 100.000+BTU (ductslvents) 17.90
Suits/bldg.apt_ no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: /VI ac Gotta la 4_ 9 f 4 ._ c Duct work 14.00
Hydronic hot water system 14.00 .
P '14 , 1 t'' YV' 0 I 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 aEptiances _
',r,7 {: `ri '_ . r .7. i I�.'} t ." J - .
rvTA 1 r9i y 1 , t t 1 rx ' , l ly Water heater 10.00
h r ,V ; M t - , , t 7 �a y, inn S aa t' t7 � '. . { 'h:vcf� .,
`.� ' i.' u J , il;_,..._.dh... *� } , �. L icrG..flt _ �...... fit✓
Gas fireplace i 10.00
A 4 . 1 A)ouo (90&5 5ervie -+0 VtoLt3 Flue vent for water heater or gas
L / fireplace 10.00
a c _ 1 ' 7 W - <7 C�' .� Log lighter (gas) 10.00
J 1 se✓'&' Wood/pellet above 10.00 ,
Wood fireplace/insert 10.00
t:i:t' .,terms -te rsir;i'i sl.:' F:rr.� -, - n. -�:,�: scr:. a'�; " r. Cbirttney/liner /flue/vent 10.00
t 1 : r �,�� 7> ,o,)k yt 1 ,y'b '' - "�11. l;:a'..IIr ci irr I €ix'. Other: -# 10.00
�1_d I WAS ,.1. 1 1.x_. ��,., . _ . i.a�, �;• a . _,...J. � t� i , . 'i. I. r•,1��. - .9' %__�' r..�. 6 .1u.:�_.ui�'
Name: j u N Environm exhaust and ventilation
Address: r Range hood/other kitchen
-7 Gf G 5 e v t i 0 k 5 equipment if 10.00
City /State/ZIP: -r- C 0 a • 7 ZZ Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (5 03) 5 7 z _ , c Fax: ( ) toilet compartments, utility rooms) 6.80
,: t t , -;: 7 -,:r;' , 1 Ik } r, ,- .7 F u'. ; rtr Attic/crawlspace fans • 10.00
ti , i P r , t "t i� 13 L:_? r 1 : -�1- , - 4? } I-J t�s+ I ^I a ' -x - rA, . ` l t 1 - 2� ,
-: ,� . . t a ••_. , o. . . .+ c rs ul , �- _� L 1
Other: 10.00
Business name:
Pue1 pipi g
Contact nano: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
•
Gas heat • u • •
City/StatefZIP: Wall/suspended/unit heater
Water heater 4.
Phone ( ) Fax:: ( ) 1
Fireplace
E -mail: Range
,7 -,7,7: 1 i �, I } a ` 1 '. , LG r llf :∎:; 41 j 1 r �I i r v ] !, , ; Barbecue
' ll , 1 " at '1 :, r } zr_ �u�_L.L ;, , ..• ..1 . -v �..:.,I.,..
� :c.. u a_ Clothes dryer (Ras)
Business names / pfk - v Gt 5 C c< 6 4 - t-2 vtt Pl,9 ►� i' C 1 0 _
Other:
Address: LI L/ 3�...../1)1- 5 , a`' ) *:'AiY:o?:l/_ a ot7 4.. • : i,:. -:•
l '1 i ^ i ` „4 1�1L'Y C a tl_•':W,r ., _mu:� i Md
City /State/ZIP: Po i . - 10 , v1 /� (9 �f Z l U Subtotal
Minimum permit fee (572.50) 71 ,60
Phone: 5 7 3 j _ _ ci oLg�j Fax: ( ) Plan review (25% of permit fee)
CCE hc.: t Z 50 3 1 _ State surcharge (8% of permit fee) • i 0
TOTAL PERMIT FEE , 36
/ � This permi application expires if a permit is not obtained within 10o
Authorized signature: �J/� �� days after It has been accepted as complete-
Print na ge: ��1 / 'rrr000 MZ ` Date: 3 _ 7 - • Fee methodology et by Tn-County Building Industry Service Board
et8uitdiogP rmiuMEC- Permit4DD.doe 1710.0 440.46171 (111ovcomrwBB)
CITY OF TIGARD - -- -- 4 I
BUILDING DIVISION PERMIT #: MEC2005-00109
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/16/2005
Phone: (503) 639 -4171 � �y0, g p � I �
Inspection Requests (24 Hrs.): (503) 639 -4175 1,1- I I..
INSPECTION WORKSHEET FOR DATE: 4/6/2005 TIME: 7:10AM PAGE: 9
SITE ADDRESS: 09790 SW PEMBROOK ST CLASS OF WORK:
SUBDIVISION: CLOUD CAP LOT #: 014 TYPE OF USE:
PROJECT NAME: KRANZ
DESCRIPTION: Installation of gas service to house, adding gas insert, gas range, venting for gas water heater, range
hood, gas outlets for water heater, insert & range.
OWNER: KRANZ, NEAL, PHONE #: 503 - 598-1150
CONTRACTOR: NATURAL GAS CUSTOM PIPING INC PHONE #: 503 - 335 -9950
Inspection Request Scheduled For: Date: 4/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 003869-02 503-598-1150 N
Corrections /Comments/ Instructions: LI( ;1 — cM--
Cocks Lo -‘-; - -hU l A aj 4- -4--r-v. �--
f Lk_ k,,,�4 , \i c/1 y cv_rL_. ki, 072_4_ __ 6 44
,.
4 1 (
�
15 ) PASS ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
\ a; \ Inspector: Date: H d 503 -
p
Ins Date. / Phone #. ( ) 718
CITY OF- IGARD s:
BUILDING DIVISION PERMIT #: MEC2006 00109
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/15/2006
Phone: (503) 639 -4171 g� i l l k
Inspection Requests (24 Hrs.): (503) 639 -4175 l `:_
INSPECTION WORKSHEET FOR DATE: 3/18/2005 TIME: 7 :24AM PAGE: 14
SITE ADDRESS: 09790 SW PEMBROOK ST CLASS OF WORK:
SUBDIVISION: CLOUD CAP LOT #: 0 TYPE OF USE:
PROJECT NAME: KRANZ
DESCRIPTION: Installation of gas service to house, adding gas insert, gas range, venting for gas water heater, range
hood, gas outlets for water heater, insert & range.
OWNER: KRANZ, NEAL, PHONE #: 603- 598 -1150
CONTRACTOR: NATURAL GAS CUSTOM PIPING INC PHONE #: 503 - 335-9950
Inspection Request Scheduled For: Date: 3/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 002218-01 503.598 -1150 N
Corrections /Comments /Instructions:
fid< -- err -, -m--5 = 2 9.5 tic. /5" /44/ -V s
) �/ L L hoc ,. - L- 1&GS�E 7A/
P ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: . 3—/g--6 , S Phone #: (503) 718-