Permit CITY TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2006 -10037
�' �l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/20/2006
PARCEL: 2S 112CA -03200
SITE ADDRESS: 15220 SW 79TH AVE ZONING: R -4.5
SUBDIVISION: DURHAM ACRES LOT: 030 JURISDICTION: TIG
Project Description: Replace furnace, gas pipe (1) location.
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:
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
KELLY O'BRIAN Description Date Amount
15220 SW 79TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 4/4/2006 $72.50
[TAX] 8% State Surcha 4/4/2006 $5.80
Total $78.30
Phone: 503- 431 -2015
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: '7 / jt Permittee Signature: - e- 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.
Mar 13 06 10:25p TriCauntyTemp 5035570919 p.l
,�ehanical Permit .
�'
FOR OFFICE.USE ONLY
irity of Tigard Received
13125 SW Hal] Blvd., Tigard, OR 97223. DateBy:� ( 6 4L Permit No. 6 , � 1603 ,
39.4171 Fax 503.598.19 AR 1 A Plan Review
Phone: 503.6 vU
t 1 Z006 A Q'''''' `r I t'`' Date/By: Other Permit:
Inspection Line: 503.639.4175 (,.. I Y
lntemet: www.ci.tigard.or.us ` 1 Date Ready/By: Iuis:� I See page 2 for
CITY Of, 1 �� ��i� "fottEed/Mcthod J I pp mental Information
� � .. 9211VE I> Acj:. L T:J E•K. SCHEDULE - TJSE CHECIJL• LST` •
❑ New construction Addition/alteration/replacement ' Mechanical permit fees* are based on the value of the work
❑ Demolition ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
' . 3 OF CON TR.TJCT1OlNI ° i Value: S
❑ Accessory building
1- and 2- family dwelling ❑ Commercial/industrial { 12ESIDE }T'L•4I =E.' Mi
E'P,/ SY, TEMS.:FEES*
❑ ivlulti- fancily ❑Master builder El Other:
For special information use checklist.
Description I Qty. I Ea. 1 Total
- ', YOB SITE 1NEO.R,1iIiff ON"ati1D' LOCATION
Heating cooling .
Job site address: 622be"W Air conditioning or heat pump I f I `
•
�►A (requires site plan showing placement) _ 1 14.00
Ciry /State ZIP: "r U /'),�
Furnace 100,000 BTU (ducts vents) 1 14.00
Suite/bldg./apt. no.: Project name: • , Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat bump 14.00 a
Cross street/directions to job site: 1 Duct work 14.00 f
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: I Lot no.: , Flue /vent for any of above 10.00
Tax map /parcel no.:
Other: 10.00
;:
Other fuel appliances
-: DESCRIPTTION OF WORK -� - Water neater I i 10.00
14 . • � ���" ' """'r y I �� �` .�� J IO wl. 1�/1 1 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 • I20EERTi' 0.WNER � , �� Chimne lin /fl / vent 10.00
❑ TEN
-- Krill/ �� {VGA 1 .. ,t ,. _. _,.. .. Other: � 10.00
Name -:
Environmental exhaust and ventilation
Address: eadyr0 Range hood /other kitchen
v equipment 10.00
Ciry/State/ZIP: Clothes.dryer exhaust 10.00
Phone: ) l��j`"��ri, Fax: ( ) Single -duct exhaust (bathrooms, I
hone' (
� .. LPJ toilet IIet c ompartments, utility rooms) 6.80
s �.AEPLICANT _ 7. i ❑' .CONTACT PERSON r Attic /crawlspace fans 10.00 '
Business name:
- Fri C w ig //} r�y-o i Other: [0.00 ,_ i
l(, (,' Fuel piping 1
Contact name: ban() first S5.40 for rst four; 51.00 for ach additional
Address: 0 00 6 C[CCc.ka?'l(LS lv vor- V�) Furnace, etc. I
7 ( 7 ^ (JL , Gas heal ourrtp
r "� C
CitylState ZIP: I �i Wall /suspended /unit heater
Phone: (52) 55 7. - 2 90 Fax: : (Ci) 557-10611q ( 7 Water heater
E-mail: Fireplace
Range 1
F �,;._;r. 'r:v: :ry :y AGO RAGTflR :r .`"'. ' • .. ' "-'' r Barbecue
i Business name: ! r' Cc u - ° C t in-{ ro i Clothes dryer (gas)
�(� G. 11 r1� /!1(lCJ ,r� Other
Address: :� 1)6 ` . ' . t .1 1 / los Ri � �1 I ..._.,..::_.s ...: ...:..... ...
�� ::m4 H:4N)CAL EI E'EES
City /Stare/ZIP: � 0 C. q7 y Subtotal t
Phone: (5,-_,S) 55 - 2 ?9 o F ax: (. 03 ��('G7 .. i( 7 1 Minimum permit fee (572.50)
ill CJ J ( + Plan review ( o permit fee)
; CCB tic.: �� 25% f r
State surcharge (8% of permit fee
�7 TOTAL PERMIT F �$.
• Authorized signature:� K �� This permit application expires if a permit is not obis within 130
" n days after it has been accepted as complete.
1 Print name: biarLe /' Vl((,_ cii I Date: 3 (g6e4 * Fee methodology set by Tri -County Building Industry Service Board
i.'3uilding'v crmits'MEC- PermitApp.doc 1 2'03 4 40 - 461 7 r i 11/02/COMPNEB)
CITY OF TIGARD J_
BUILDING DIVISION PERMIT #: V\ C� & ° °37
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: Tbvr PAGE:
_
SITE ADDRESS: /S�`''- 711 Ave-- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE
CONTRACTOR: PHONE
Inspection Request Scheduled For: Date: - -0 co Pour Time:
Code # nspection Description Confirm # Contact # Message
0 1C7 , ( 099 4 —CAS c, v--e-
Corrections /Comments/ Instructions:
a l e "
•
� /0 - e te
•
PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION
1 L 7 ADDITIONAL FEES ASSESSED
Inspector: Date: it Phone #: (503) 718-