Permit CITY TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00163
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/1/2008
PARCEL: 1 S136CA -05402
SITE ADDRESS: 11255 SW 78TH AVE ZONING: R -7
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: STONE
Project Description: Replacing furnace and adding heat pump.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
REPAIR
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
RON STONE Description Date Amount
11255 SW 78TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 4/1/2008 $72.50
[TAX] 12% State Surch 4/1/2008 $8.70
Total $81.20
Phone: 503 - 639 -2261
Contractor:
SMITH HEATING & AIR COND
14212 S MUELLER ROAD
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 227 -5550
FAX 503- 632 -7227
Reg #: LIC 52754
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.
4811. A
Issued By:` Permittee Signature: / , �q//./
Call 503. 3 .4175 by 7:00 a.m. for inspections that business da
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.
•:93/31/2008 06:00 5036327227 SMITH HEATING PAGE 01/03
Mechanical Permit Application 1 rcpt , OFFICE ESE ONLY',
City of Tigalyd 13125 SW 9 Received
Date /By: L, QA Permit No.: , l /y7
/! „, Hall Blvd, Tigard, 0 3. 008
C...0 ''�
s �t n ' Phone: $03,639.4171 Fax: 503.S98.1060 R — 4 2 Plan Review Other Permit.
Ins ection Line: 503.639.4175 Oate/By:
•1'1 GA R D p D Date Ready /By: ruri,: 0 sec Page 2 for
Internet; www.tigard- or.gov CITY 0� T,GAR Notified Method:
��fy t��AA�° �`'��� Supplemental Information
1,,.. IL�J Addition/alteration/replacement � r e �V ,, ” y1
❑ New construction
tion /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, a ui met labor, overhead, at, i roti
1- I altd 2 - '!:;: dw; .• ,00 .1 0.)(01 Ohio' i�11 Value $
y elling ❑ Commercial /industrial El Accessory building ` 1r 1 fM
Multi-family [] Master builder CD Other For special information use checklist,
J i 01,10 I Fd1P S ri( LW ; ; f I At ,. r Description qty. Total
1 � �� d ', I „ Heati� /cooling
—
Job site address: "� Q AA, conditioning or heat pump
(r 1`
u ,. , t AA
`� e wires site Ian showing placement) 9 p P ) �. 14,00 �7, 00
City /State/ZIP; ' . � .� ,, 40 •' • r, Li Furnace 100,000 BTU (ducts/vette) / 14.00 Pit pp
Suite/bldg./apt, no.: Project name: SJ� 1 Furnace 100,000+ BTU (ducts /vents) 17,90
>l� ` � Gas heat pump 14.00
Cross street/directions to job site: mm Duct work 10.00
Hydronic hot water s tem 14.00
Residential boiler (radiator or
hydronic) 14.00 _
Unit heaters (fuel - type, not electric),
in -wall, in -duct, sub ended, etc, 14,00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map/parcel no.; Other fuel appliances
li�i4xK'CVIs1 O&'A t : _Watcrheater 10.00 _
Y J Gas fireplace µ 10.00
7 P , �1' _ C t ( • _ Flue vent for water heater or gas
fireplace 10 00
Log lighter (gas) 10.00
4 • e • t 111 'rY1_ _ Wood /pellet stove 10.00
Wood fireplace /insert 10,00
iii I iIE1td , •}& . It. a', t i 1 x, .:.:w "",7 Chimney/liner/flue/vent /liner /flue /vent
.I,� t ..,.ti •'R , 1
0,.:: r { . Ii : 'l P!g1i t 11 y 10.00
41}
Other: 10.00
Narrse. - R o . 1 , 5+, 6,' Environmental exhaust and ventilation
Addres v Y V 4 (] , / ( C? Range hood /other kitchen
— r6 �a equipment l 0.00
City /State /ZIP: \ - 1,0 d a' r f Clothes dryer exhaust m 10.00
1 Single -duct exhaust (bathrooms,
Phone: (
,�,`, � 4,, , Fax,
( ) toilet compartments, utility rooms) 6.80
., , : ', i. 4> 'I Nth 1l! C 4,01' 0:00, •!: Att /crawlspacc fans 10.00
Business name: Other: - 10.00
Fuel i in
Contact name: 35.40 for first four: 31.00 for each additiona
Address: Furnace, etc. J
- Gas heat purl
City/State/ZIP! Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail: il: Range
l; ,I C N.. OPIA� t::i ; . Barbecue
Business name: ,-,�y + , , k_. • 11 Clothes dryer (gas)
r� ' QtEreT
�
Address; �► lie.: T
/�
l_/`( •s-se CitylStateIZlP; eJL • �.,,_ „ . Subtotal 02 eoC7
Phone: (CT)'`a-,'aa 5S� Fax: {y n a Minim perrtrit fee ($72.50) e ,
�^�ss� _ Flan review (25% of permit fee)
CC r 7
I3 V / ()
S _ state surcharge (12% of permit fee) }� I
c. TOTAL PERMIT FEE i7.. g5
Authorized signature: �1�/ ��� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: �/cJ(' S r-r7, ` � Date: /O s _ �` Fee methodolog act by T, i-Co my Building 1ndUitr' Service Board
1: IBuildineU 'ormltc\MEC•PermirApp4o 01 /19/07 v� 4 1/02 /CCM/WE5)
•
.93/31/2008 06:00 5036327227 SMITH HEATING PAGE 02/03
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CITY F TIGARD
BUILDING DIVISION PERMIT #:
3125, SW Hall BIvd;, Tigard, OR 97223 DATE ISSUED: MEG2ff0 Ot)18:
-, 1
Phone: (503) 639 =4171 Alk pu�ii�pi� 4/102008
C dhspection Requests:(24 Hrs.): (503) 639 -4175 L ____W - _..
1'NSPECTION :WORKSHEET FOR DATE: TIME: PAGE:
8/14/2008 7:00AM 26
ti SITE ADDRESS: 11 SW 7 3TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
STONE
DESCRIPTION: Replacing furnace and adding heat. pump.
OWNER: "TONE, I=ZON PHONE #:
503
CONTRACTOR: SMITH HEATING & AIR GOND PHONE #: 50:3,-227-5550
Inspection Request Scheduled For: Date: 8/14/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
580 Mechanical final 074064-01 603.639 -2261 N
Corrections /Comments/ Instructions:
1 -"'PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ) CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / Date: 0 -gi -� -g3 Phone #: (503) 718 - - �
•
a CITY_OETTIGARD
BUILDING DIVISION PERMIT #: Mf C )I3 At7163
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 411/ 2008
Phone: (503) 639 -4171 1,,k
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/1/2008 TIME: 7:00AM PAGE: 108
SITE ADDRESS: 11 255 SW 78TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: STONE
DESCRIPTION: Replacing furnace and adding heat pump.
OWNER: STONE,' RON PHONE #: 503- 638 -2261
CONTRACTOR: SMITH HEATING & AIR COND PHONE #: 503- 227 -6550
Inspection Request Scheduled For: Date: 5/112008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 069054 -01 503-227 -5550 N
Corrections /Comments/ Instructions:
v a< Prep I-K-71 6,9aeiz
Cyr
n PASS _- ..n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
IL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: —/ 4 g Phone #: (503) 718-