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Permit !s. CITY TIGARD MECHANICAL PERMIT �A DEVELOPMENT SERVICES PERMIT #: MEC2005 -00757 �� 13125 S W Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/15/2005 PARCEL: 1S136DC-03100 SITE ADDRESS: 11680 SW 72ND AVE ZONING: MUE SUBDIVISION: ELNOLA HEIGHTS LOT: 007 JURISDICTION: TIG Project Description: Furnace change -out. 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: 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: CLO DRYERS: FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS: FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Owner: FEES JUANITA AMACHER Description Date Amount 12060 SW ROSE VISTA DR [MECH] Permit Fee 11/15/20( $72.50 TIGARD, OR 97223 [TAX] 8% State Surchar€ 11/15/20( $5.80 Phone: 503 245 - 6460 Total $78.30 Contractor: BELL HEATING 15550 SE PIAZZA AVE REQUIRED ITEMS AND REPORTS CLACKAMAS, OR 97015 Phone: 503 656 - 1184 Reg #: LIC 447 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 -33 - •• . Issued : y: A _ / 0 ,/ ,�� _ ■/_ Permittee Signatur Call 503 - 639 -4175 by 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 inspection. J y 0l Mechanical Permit A' t ; " iT 't w. n � FOR OFFICE USE ONLY City of rt ig , ~ - L �� LU/ Received / / D1 / Permit No.: , S ''� . 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review u Phone: 503.639.4171 Fax: 503.598.1960 NO u `t C 9 00 .14'''''."1V D Date/Bate/By: Other Pe 't /inspection Line: 503.639.4175 Date ReadyBy: �` 21 See Page 2 for BU Internet: www.ci.tigard.or.us C I I y Q � �� �jA�® Notified/Method: I(3 Supplemental Information • .. ., TYPE QF ; wqi c :,.' ?„ '_' c, , C RC i.,:k.OLIK'SC.HED.L E VSEE.CHECKLIST• 12 New construction ❑ Addition/altera on/replacemerit- Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: -- - mechanical materials, equipment, labor, overhead, and profit. .4.;:l• *•' •• _ ekTEGGRY O1 • CONSTRUCTION ... _ _ r ? Value: $ $ 1 - and 2- family dwelling ❑ Commercial/industrial '`i 0. 'Q NT 5 FEES* ❑ Accessory building For special information use checklist. ❑ Multi 0 Master builder 0 Other: Description 1 Qty. 1 Ea. 1 Total L: `'. . `t -z.y=' 1 .OB -SITE _).NFORI7J TI'QN !IU LOCS.T1ON J. >: .?1 ''ri #a'. 2'; Heating/cooling Air conditioning or heat pump Job site address: t. 43c)3 Z. •.k (requires site plan showing placement) 14.00 City/State/ZIP: ' 1 ,. z Ell q 1 3 Furnace 100,000 BTU (ducts/vents) C 14.00 Iy,60 Furnace 100,000+ BTU (ducts/vents) l 17.90 Suite/bldg. /apt. no.: Project name: E. e Jo Gas heat pump 14.00 Cross street/directions to job site: C a _ Duct work 14.00 Hydronic hot water system 14.00 • 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 • C 10.00 ID , tai Other: 10.00 Tax map/parcel no.: Other fuel appliances 3 • iL��� i • �� '��' •a ' y� s �a . ^° 1s sr N W ater heater 10.00 = "S.^s"}r � •:.ryotir� y. ,+ i '`.' � t � n`�a:d� �� � YK " ?�r1 i! •� �fa 1 ,a •'n '�ir' F 2 ACC:->, . T � � Gas fireplace 10.00 0 V ` Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 Chimney/liner/flue/vent /liner /flue/vent 10.00 l y ?. i '''' = ) ItOP, , ;', ':OW I�IE I er i - « o .3s . ' -.',.. ) E 9 ' wi... : P Y - Other: 10.00 Name: - 1)1 .. `► , = - Environmental exhaust and ventilation Address: Range hood/other kitchen d 6, • ti a equipment 10.00 City/ State/ZIP: ` e _ e ` Ct-4 `aa� Clothes dryer exhaust 10.00 `, Single -duct exhaust (bathrooms, Phone: (5_ r_1,S- CaLi (Q Fax: ( ) toilet compartments, utility rooms) 6.80 r te.,; ..x i, s,. ;, 7 •s , ;` _ ,} �C _ 1S : y ; ; : =,i ;,. Attic /crawlsnace fans 10.00 Other: 10.00 Business name: ti Fuel _ . piping P Contact name: A - J- $5.40 for first four; $1.00 for each additional Address: \ - Os - r � Furnace, etc. Gas heat pump City/State/ZIP: L AA. r Wall/suspended/unit heater Phone: ( ee , -:-5 it 0 MIIMMEIN/IMI Water heater Fireplace E -mail: Range �L d .'i' , . , ,;aCON1Sl24 CTOR' ,i1;',..:•,-,,,.-,; . t‘' . ;., Barbecue Business name: J. i [4-1-- i c , Clothes dryer (gas) Other: Address: '1 1. ?:. i d.' ', MECl, g I T .. .. 1:1 - - Y. . a1� City/ State/ZIP: / _ Subtotal a. Minimum permit fee ($72.50) Phone: ( ) Fax: ( ) _ Plan review (25% of permit fee) .` State surcharge (8% of permit fee) i ,4 510 I' TOTAL PERMIT FEE Authorized signature: 1��1 _ This permit application expires if a permit h not obtained wit in 180 d ays after it has been accepted as complete. Print name: t : - i Date 0 • C -) • F me th odology set by T ri- Count Building Industry S ervice Board .. 6 -- f iA BuildingTemtits \MEC- PcrmitApp.doc I:J03 440 4617T {I 1/02/CONI /WEB) • Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule,: . �gPcl ill`r a u © * v $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50' r the first $2,000.00 and $2.30 for each kiditional $100.00 or fraction thereof, to d including $5,000.00. $5,001.00 to $10,000.00 $141.50 for t ee first $5,000.00 and $1.80 for each : dditional $100.00 or fraction thereof, •• and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first 10,000.01. and $1.31.for each addition.. $101.00 or fraction thereof, to and ; clu .. .g $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,,.l ► 00 and $1.25 for each addition ' 10' .00 or fraction thereof, to and u clu• • • $100,000.00. $100,000.01 and up $1,396.50 for the firs $100,000.0 ► and ' - $1.10 for each additi na1$100.00 o •' fraction thereof • Note: All new commercial buildings r: quire 2 sets of plans. i:\Building\Permits\ MEC- PermitApp.doc 12/03 2 CITY OF TIGARD BUILDING DIVISION PERMIT #: MEC2005.00757 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2005 Phone: (503) 639- 4171g�III Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 11/16/2005 TIME: 7:03AM PAGE: 72 SITE ADDRESS: 11680 SW 72ND AVE CLASS OF WORK: SUBDIVISION: ELNOLA HEIGHTS LOT #: 007 TYPE OF USE: PROJECT NAME: AMACHER DESCRIPTION: pace change•oufi'} r( OWNER: AMACHER, JUANITA PHONE #: 503 -245 -6460 CONTRACTOR: BELL HEATING PHONE #: 503656-1184 Inspection Request Scheduled For: Date: 11/16/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 021411 -01 503-656 -1184 Clr- /4 M Corrections /Comments /Ins uctions: 11414105 4rt6-t° 6 ,!.___e____ ff./IVe r --' • x PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: i 1/ Date: 11 ` Phone Phone #: (503) 718-