Permit CITY OF TIGARD
BUILDING DIVISION PERMIT #: Mr_r2flrto0515
AR 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2009
Phone: (503) 639 -4171 Atti " „ i,�1G l i l i i i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/23/2008 TIME: 7:00AIM1 PAGE: 19
SITE ADDRESS: 16080 SW COPPER CREEK DR CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 4 LOT #: 1 TYPE OF USE:
PROJECT NAME: S'I'F.VENS
DESCRIPTION: Replacing gas furnace.
OWNER: SEVENS, MIKE & JEAN PHONE #: 6.03,660
CONTRACTOR: ROTH HEATING & COOLING PHONE #: 6032661249
Inspection Request Scheduled For: Date 10/2312008 Pour Time:
Code # Inspection Description Confirm # Contact # Message tel r11
699 Mechanical final 07708301 503 - 2661249 Y
Corrections /Comments /Instructions:
/VO One- 146- h G l4'7o
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
❑ FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ES Date: R 06 Phone #: (503) 71&2'/23
CITY TY O F TIGARD
G®® MECHANICAL PERMIT
r 4 ��!! 0A°1
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00515
TtGnRD` 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/20/2008
PARCEL: 2S114BA -15000
SITE ADDRESS: 16080 SW COPPER CREEK DR ZONING: R -7
SUBDIVISION: COPPER CREEK STAGE 4 LOT: 115 JURISDICTION: TIG
PROJECT: STEVENS
Project Description: Replacing gas furnace.
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:
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:
Owner: FEES
MIKE & JEAN STEVENS Description Date Amount -
6287•EVERGREEN DR
WEST LINN, OR 97068 [MECH] Permit Fee 10/20/20( $72.50
[TAX] 12% State Surch 10120/20( $8.70
Total $81.20
Phone: 503- 650 -8457
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 - 266 -1249
FAX 503 -266 -3478
Reg #: LIC 14008
•
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: j" % Permittee Signature: �/ �7
Call 50 .639.4175 by 7:00 a.m. for inspections that busirtgeday.
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.
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: -4- REQUIRED ON GREEN INSPECTION CARD.
Code I Inspection Description I PASS Date I B 1 Code Inspection Description I PASS Date I By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill • 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG - Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post /beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG - Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post /beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final • 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
• ( 699 _ Mechanical final
BUP - Fire Protection System Permit /�
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in
•
915 Fire alarm rough -in 305 Plumbing underslab
920 Suppression trip test 310 Crawl drain
995 Misc. inspection: 315 Post /beam plumbing
998 Alarm final 320 Plumbing rough -in
999 Sprinkler final 322 Shower pan
fi
330 Water service
335 Rain drain
340 Storm drain
• SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert /catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
, 205 Footing 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
.498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
I: \Building \Forms \InspCard- AOP- Blank.doc 02/02/07
III a MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00515
TIGARt DATE ISSUED: 10/20/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S114BA -15000
SITE ADDRESS: 16080 SW COPPER CREEK DR ZONING: R -7
SUBDIVISION: COPPER CREEK STAGE 4 LOT: 115 JURISDICTION: TIG
PROJECT: STEVENS
Project Description: Replacing gas furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WIO 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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
MIKE & JEAN STEVENS Description Date Amount
6287 EVERGREEN DR
WEST LINN, OR 97068 [MECH] Permit Fee 10/20/20C $72.50
[TAX] 12% State Surch 10/20/20C $8.70
Total $81.20
Phone: 503- 650 -8457
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 266 -1249
FAX 503- 266 -3478
Reg #: LIC 14008
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ,, «L.L % Permittee Si nature: g S/e Gf �rI/I 7
Call 50 .639.4175 by 7:00 a.m. for inspections that busi a day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Oct 17 2008 4:59PM ROTH HEAT 5032632513 p.2
. Mechanical Permit Applicatt !, , V
� Received
11 • City of Tigard • ti�\. Ducar Permit No..
13125 SW Hall Blvd., Tigard, OR '`:7 - c, % t -
(fitter Permit
Phone: 503.639.4171 Fax: 503.598.1960 Plan ate/BRevy: iew
Inspection Line: 503.639.4175 • O 1 ,, p
l' I G A R f) / / l✓♦. w • ale Ready/By: Juris: See Page 2 for i
Internet www.tigardor.gov . -y' f - Notified/Method: 71-,/o Supplemental Information
:TIiTE : 0 5. #0 NN . GO**C" I.AL F,EE .$ V fflJLIA.. ;T. CHEC7d:Is' :
❑New construction ddition/alterationlrepla .-� tr " r Mechanical permit fees• are based on the value of the work
❑ Dem olition Performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other: f A � G , mechanical materials, equipment, labor, overhead, and profit.
CATEGO�t.V.:b ONSTRUC i iI : 'si�{� " Value: $
,and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building �i4'I'M / : Sti'sTEM5 : FEES3
El Multi family ❑ Master builder ❑ Other: For special information use checklist
Description 1 Qty. I Ea. I Total
'`"JOB SITE: IVFO N A1vD LO(,ATION , Heatingfcooling
Job site address: ` 6 ell'
( l' 0 S ( n non �)� Air conditioning or heat pump
U ` -+'�_ (requires site plan showing placement) 14.00
�\
City /State /ZIP: - ���F-+�`- ��. Z 7 % Furnace 100,000 BTU (ducts/vents) / 14.00 / -
6L_
Suite/bldg./apt. no.: Gl Project name: Furnace 100,000+ BTU (ducts /veins) 17.90
Gas heat pump . 14.00
Cross street/directions _to job. sites - -- - r, Duct work 10.00
r
'•,--- Hydronic hot water system 14.00
!` Residential boiler (radiator or
1. . 1 a 1♦. , � • hydronic) 14.00
/� Ivry ; ' t �� : T - 4 Un heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
I Lot no.: Flue /vent for any of above 1 6.80
Other: 10.00
Tax map/parcel no.: Other fuel appliances
D ION:OF; WORI Water heater 10.00 1
Gas fireplace 10.00
Flue vent for water heater or gas
' CI61 V-V 1'
4 \Q0,_(_..1-- . _ fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove ' 10.00
Wood fireplace /insert 10.00
PROPERTY 0.1*.NEB : : I f], TENANT: ..
10.00
Chimney/liner /flue /vent 10.00
, ^ Other:
Name: l_ ]I .) lX-- Si- ,.� 1 I•Q iUl� Environmental exhaust and ventilation
Address:
2 - 8 • 0 1 • v ' ,,e_- Range hood/other kitchen
equipment 1 0.00
City(State/Z[P:
/e
4 ry4 -42/ 7 0 (0(f? Clothes dryer exhaust 10.00
) Single -duct exhaust (bathrooms,
Phone: ( ) 1Q Fax: ( ) toilet compartments, utility rooms) 6.80
LI A .KliCANT ", ®CONYFACT: PERSON Attic/crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: S5A0 for first four; 51.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspt nded/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
cONTIf4G'FOR ` ,J Barbecue 1
Business name: L CJ Clothes dryer (gas)
qq�� ��- � �- Other: �
Address: 1.1 1. ) .. J - ?MECIi41V ICAL= itliM1 4111F .: -. •
City/State/ZIP: ( , 4..____ 6 k.3 Subtotal
Phone: ) ZA.Al(�
ff __ . LCti Fax: 60> ) D 't t Minimum permit fee (572.50) 72_, gb
Plan review (25% of permit fee) -
CCB lic.: , 8 State surcharge (12% of permit fee) b' , -76
TOTAL PERMIT FEE 3 ( ,
r • This permit application expires if permit is not obtained within 180
Authorized signature: 1 �ft,Q tUre: ` � /,t h days after it has been accepted as complete -
Print name: k 41 +
is [ Date: l U l 7 (0/ . Fee methodology set by Tri -County Buildin Industry Service Board
11 Building I Permits\rtEC -Perm App.dor 01119107 _1 440-46171(11 /021C0M,IWEB)