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Permit r ifi - CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00601 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2008 PARCEL: 1 S134CB -09000 SITE ADDRESS: 11165 SW 123RD PL ZONING: R - SUBDIVISION: ANTON PARK LOT: 052 JURISDICTION: TIG PROJECT: LARSEN Project Description: Gas furnace installation. 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: 0 STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: NAT 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: OTHER UNITS: FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 0 > 10000 cfm: Owner: FEES JUSTIN LARSEN Description Date Amount 11165 SW 123RD PL TIGARD, OR 97223 [MECH] Permit Fee 12/10/20( $72.50 [TAX] 12% State Surch 12/10/20( $8.70 Phone: 503- 888 -5061 Total $81.20 Contractor: AAA HEATING & COOLING 5017 NE GRAND AVE PORTLAND, OR 97211 REQUIRED ITEMS AND REPORTS Contact #: PRI 503- 284 -2173 FAX 503- 284 -1552 Reg #: LIC 222 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: NACU O9 l Permittee Signature: .32.._Q__ 4\IN Q d 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. om: 12/09/2008 13:32 11632 P.001/002 . RECEIVE' . Mechanical Permit Application Eolt OFFICE USE ONLY City of Tigard DEC 0 9 2008 Received cis Q t � DatdBy: o� 11 I. ; 44 a • 13125 SW Hall Blvd., Tigard, g Phone: 503.639.4171 F503.598.190ITY OF TI ,GAR Plan Review T 1 G A R u Inspection Line: 503.639.4175 II Date/By: Other Permit: Internet: www•tigerd or.gov BUILDING DIVISI 0 I RdjM See Page 2 for bed/M ethod: Supplemental Information Lr' u.K_ _:, c .•Z_ '..; ._g n ' 7a��_ -n, ,,:F:F'c' ' t i` : ' tWii ai'r! t a "`, ar:ta� H -6 :, ' CI New construction ! , r ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded co the nearest dollar of all ❑ Demolition ❑ Other; ttip -- T t , ,, mechanical materials, equipment, labor, overhead, and profit. »., i Value S aa l7itiia't`:7at_�'y i �l�Vt�* g ❑ Commercial /industrial 0 building -� • ti•...� p ? �1 i in�, �� y '� d 2-family dwelling ID ❑ Master builder ❑ Other: For special information use checklist. •:. i a A " ' y Y Description I Qty. I Ea. I Total ti:_. 2: ..:° - ) u . t rf hS.eS* i t tc1* ''X1 I Heating/cooling Job site address: ///45 9 /23r J1 4 Air conditioning or heat pump City/State/ZIP: // K �$ (requires siteplanshowingplacement) _ 14.00 - t r ©[ " 7 2-2-3 Furnace 100,000 BTU (ducts/vents) / 14.00 / V. ?t. Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) _ 17,90 Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 I Hydronic hot water system 14.00 p Residential boiler (radiator or ttiLi -�TJ.( v /Z -laze / 4. C . j - : s �/. hydronrc) 14.00 • Unit heaters (fuel -type, not electric), .41 .. in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot Flue/vent for any of above 1 6.80 6. " Tax map /parcel no.: 10.00 F r-^-�� Other fuel appliances r �. �_..,. ....1._.y . ...:, , WetQheaty - - S l l • 0.S r�ha,�.* V e M- 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 s t 74 1 i er p a' 4 i a ', " , ,1[ ) 4 ,! 4 r ..i Chimneyflmer /flue/vent 10.00 Name: J St v‘ \...., &� 10.00 • ` - Environmental exhaust and ventilation Address: I L l tY 5 t. 1 Range hood/other kitchen --T---- / , equipment ._ 10.00 City/State/ZIP: o �V" f V `Y"" O 2_2-3 Clothes Phone: ( .---,,p 3 gg ► per I Fax: ( ) Single-duct exhaust (bathrooms, 10.00 _ � 4 toilet compartments, utility moms) 6.80 1<..t _. - •, ,.1,.� 1J 1'i"sY e/f>.4 -... ',L.: - 1:..,,: ..1011 {o •7V - i' > + a y 41 I , Attic/crawlspace fans 10.00 Business name: Other: 10.00 _ Contact name: • Fuel piping $5.40 for first four; $1.00 for each additional Address: Futmeee, etc. - City /State/ZIP: Gas heat pump Wall/suspended/unit heater Phone: ( ) Fax: : ( ) Water heater E -mail: Fireplace i IIT 'tom , g. .d: p :.• 1, =iFIJIh.r `: ':. O -yT i•71 `. a . Y i. ' ‘, '. Barbecue kv= T�'....3 . .:.. itl1 _ VJ .i... F 3 .�i.1.n..t.- ..f.,...u.. _ 81YQie Y Business name: ► a a - 0...e1 4.0 tt� Clothes dryer (gas) Address: � ` \ f . 4 ,, r is � Other p ` ;:r: ` r t - IS�Fa : - Co Fj)z ��, r r + : ,) City/State/ZIP: PI , l .��` • a.,.: - A...;.L._tn xSZI, r , --' =. cSu '. ' - Su Z./ - 7d Phone:) - y Minimum permit fee (572.50) -72. I r y CCB lie.: Plan review (25% of permit fee) State surcharge (12% of permit fix) $ , AP TOTAL PERMIT FEE 81- Zo Authorized signature: Thi permit application expires If a permit Is not obtained within 180 \ I � DT\ L l days aster has been y Building a complete. e. v` 2 I Print name: V I I Date: �' Z � ._ ®� 1 . Fa methodoloogy set by y Tri•Counry Building Indushy Service Board I: tBuilriaetrermits1MEC- PermitApp.doc 01/19/07 410 CITY OF TIGARD BUILDING DIVISION 417 < PERMIT #: MEG200R -00601 13125 SW Hall Blvd., Tigard, OR 97223 Q DATE ISSUED: 12/10 /2008 r Phone: (503) 639 -4171 ig " i - 1 Inspection Requests (24 Hrs.): (503) 639 -4175 I 1,t9' INSPECTION WORKSHEET FOR DATE: 71512009 TIME: 7 :OOAM PAGE: 32 SITE ADDRESS: 11165 SW 123RD PL CLASS OF WORK: SUBDIVISION: ANTON PARK LOT #: 052 TYPE OF USE: PROJECT NAME: LARSEN DESCRIPTION: Gas furnace installation. OWNER: LARSEN, JUSTIN ----y PHONE #: 5O3- 888 -5(X 1 CONTRACTOR: AAA IIEATING & COOLING /. PHONE #: 5 503.284 -2173 SI X 74 - is Inspection Request Scheduled For: Date: 2/512009 Pour Time: Code # Inspection Description Confirm # Contact # Message G99 Mechanical final 080221 -01 503.601 -5508 N Corrections /Comments /Instructions: TG S f d i 4 y, t , r, },/, 0 , iKASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS (l FAIL (l CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED �;,` Jo - •)-1 ?-1-( Inspector: Date: ' ( Phone #: (503) 718