Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 - 00039
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/26/2009
PARCEL: 1 S134CA -05300
SITE ADDRESS: 11925 SW BURLHEIGHTS ST ZONING: R -4.5
SUBDIVISION: BURLWOOD NO.2 LOT: 026 JURISDICTION: TIG
PROJECT: MATTHEWS
Project Description: Replace furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: 1 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: REPAIR UNITS:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
MICHAEL & LESLIE MATTHEWS Description Date Amount
11925 SW BURLHEIGHTS
TIGARD, OR 97223 [MECH] Permit Fee 1/26/2000 $72.50
[TAX] 12% State Surch 1/26/200C $8.70
Phone: Total $81.20
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -557 -2220
FAX 503 -557 -0919
Reg #: LIC 72623
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: \ �, / 1 � � �,A Permittee Signature: � �p r� eA/�
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.
JAN -26* - 2009 03:56P FROM: RECEIVED TO:5035981960 P.1
Mechanical Permit Application 2 6 2009 I : lc (11FR I. 1 '.,l; O\l• . - .
City of Tigard Received Plan Re. Permit No. �_ w e � , 00��-
N...._ ° 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGARD plan Review
.1 Phone: 503.639.4171 Fax: 503.598.1 1 jILDING DIVISION Date/By: Other Permit:
1 i i . q RI) Inspection Line: 503.639.4175 Date Ready/By: liall la See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
- - TYPE, OF., WORK. - :. COMMERCIAL FEE* SLHI;DULE,= I1SE'CHEC)C1.IST ;
❑ New construction ® Addition/alteration/replacement 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.
- - __ = 7 ._ CATE OF CONSTRUCTION Value: $
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RE4IDEN17AL EQUIPhfIN 1(SYSTMS TEES * ?'
For special ihformallon use checklist.
❑ Multi- family ❑ Master builder ❑ Other: .
Description Qty. r Ea. I Total
. . 9 JOB'SITE INFORMATION AND LOCATION _ Heating/cooling
Job site address: I Nab 6 W 15 tin ► r V I 1 V V Air conditioning or heat pump 14.00
(requires site plan showing placement)
City/ State/Z1P: Tigard, OR Cri Furnace 100,000 BTU (ducts/vents) I 14.00
Furnace 100,000+13TU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
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. 14.00
•
Subdivision: Lot no.: Flue/vent for any of above I 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DE SCRIPTION " ON WORK '- Water heater 10.00
• Gas fireplace 10.00
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 10.00
1'ROI,'ERTY OWNI7R ` ', -, <,- ❑ TENANT . , Other: 10.00
Name: Ii 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: ( `)" Fax: ( ) toilet compartments, utility rooms) 6.80
C • NTAOT PERSON Attic/crawlspace fans _ 10.00
Other: _ 10.00
Business name: Same as contractor Fuel piping
Contact name: Diane Mason $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater , •
Fireplace ,
E -mail: Range
Barbecue .
Business name: Tr'i County Temp Control Clothes dryer (gas)
Other:
Address: 13150 S. Clackamas River Drive =.tME IlANICAI PERMIT FE '
City / State/ZIP: Oregon City, 97045 Subtotal
Minimum permit fee ($72.50)
Phone: (503) 557.2220 Fax: (503) 557.0919 Plan review (25% of permit fee)
CCB lie.: 72623 State surcharge (12% of permit fee)
GIi
`I��)IItiV "e' application TOTAL PERMIT FEE _ 0, t21)
permit
� � /� Q, This rmit lication expires If a permit is not obtained within 180
Authorized signature:
1 • days after it has been accepted as complete.
Print name: Diane Mason Date: 1 jet, ' Fee methodology set by Tri - County Building Industry Service Board
taBuilding\P rmiteRvlEC- PermitApp.doc 01/19 /07 440 - 4617T (I1 /02/COM1WEJI)
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CITY OF TIGARD ci X i , v
BUILDING DIVISION PERMIT #: MEC2009,00039
13125 SW Hall Blvd., Tigard, OR 97223 0 9 ,1 7 DATE ISSUED: 19512009--
Phone: (503) 639-4171 ,,,,ipatigitilti 6 a 7 oq3c
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/4/2009 TIME: 7:00AM PAGE: 18
SITE ADDRESS: 11925 SW BURLHEIGHTS ST CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.2 LOT #: 026 TYPE OF USE:
PROJECT NAME: IViATMEWS
DESCRIPTION: Replace furnace.
OWNER: MATTHEWS, MICHAEL & LESLIE PHONE #:
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503-557-222(1
Inspection Request Scheduled For: Date: 214/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Mesc,
699 tvleclianical final 06%
0201 503-557-2220
Corrections /Comments/ Instructions:
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4 :16C4(
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PASS 0 PARTIAL APPROVAL 7 CANCEL I NO ACCESS
F
AIL 0 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
R 7/qM 2)1
Inspector: Date: Phone #: (503) 718-