Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005-00345
13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 DATE ISSUED: 6/15/2005
PARCEL: 2S1 12 C B -06900
SITE ADDRESS: 15425 SW 81ST AVE ZONING: R -7
SUBDIVISION: ASHFORD OAKS NO. 2 LOT: 083 JURISDICTION: TIG
Project Description: Replace furnace.
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: 0 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: IT
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR NIT S:
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
BURWELL, MARTA K Description Date Amount
15425 SW 81ST ST
TIGARD, OR 97224 [MECH] Permit Fee 6/15/200E $72.50
[TAX] 8% State Surcha 6/15/200; $5.80
Total $78.30
Phone: 503- 640 -3607
•
Contractor:
SPECIALTY HEATING & COOLING
7500 SW TECH CENTER DR #120
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Phone: 503- 640 -3607
Reg #: LIC 66578
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: j f Permittee Signature: jja..e., `O
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.
0805/2006 13:21 FAX a 002/003
„ or"' i"
'' ' .... - . 1.`. •
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard IN Er) Received i , --
Datenly: -6 7 ) 05
13125 SW Hall Blvd., Tigard, OR 97
Plan Review
Phone: 503.639.4171 Fax: 503.598 Oth Permit:
inspection Line; 503.639.4175 diie..6 f i!" i A;
. s 2005 __,
,41NY Date/By:
-
Internet'. www.cizigard.orus 1uN 1 Date Readyisy:
.--1 ?ifr 1. Sup f
D
,-,-ry cW TIG .
I\B.r,,.., NotificcVMethad;
1 il" - '; 1 1 - 1Pii N*010T.3017.0 '4:0 I I '1 Iigdke , * . EiE: 6 1 1 klitigAitr':=•EiEi I CHECKLISr
CI New cot trtCtion El Addition/alteration/replacement chanical permit fees* are based on the value of the work
.erformed. Indicate the value (rounded to the nearest dollar) of all
CI Demolition 01 Other: - mechanical materials, equipment, labor, overhead. and profit.
l . - , . . ‘-ralue: $
and 2-family dwellin Ci COmme'rcial/industrial 0 Accessory building '' .',_1 I sWrEm§
For special information use checklin
71 Multi-family Master builder 01 Other;
Descrip ",. Qty. Ea. Total
'ilAioh 4
■I '• i Q "; tifiti9 t,6,1;tIr . i iii He „ , cot:din
...J. ,,,,,, ti l'i IP 0,, ‘1 ;ii • • .4,. • 4 4 .. 1.-... . , o. 1 ,• .. d.. • ,1 ..:. 4: .. 01...1,1.'4: IP. ' „ ...:
lob site sdClress: LI ) . P. A , MI K:jorenldsiitlieoonlinagshoorwhicangt pump placement) 4
14,00
City/State/Z:
• ./..-L-dt - 3 - I )
FFuunirn:ce:!110000,000000:13TTUU(ducicu(51ctsv/evnemnts 14.00
i7.90
SUiteJbldglapt. no.: • ' %jeer name: punp 14.00
Cross street/diroctions to job site: Duct work 14,00
1-1 dronic hot water s i : 14.00
Residential .2
„ r 4 illy h dronic 14,00
0, ■ .
Unit heaters - .e, not . acme),
!Mr - 'Iiii117
in-wall ' • -d t, sus• endd
e, etc.
.., _ 10.00
r Elf 7 t • :n of above MI 10,00
S ubdivision: OE •
• As■ \ rar : 10.00
Tax map/parcel no.: AlIM rim ij i in pli P . or fuel appliances
1 K iii;;;;;;;;•!',.. Water hearer . 10.00
G as fireplace
water 10,00
heater or gas
)Lirk4;tALLI: 1 A
Wri fire . lace
l0,00
, ..... hi.A.... Log lifthter (gas) 10.00
% Wood/pellet stove 10,00
Wood fireplace/insert 10.00
1rp , llu.!. Chimne /1iner/flue/veriE 10.00
Ni'ri 4.u. ;v1.11 ,:,-, 77'. tt...ra 04,f,,,I ,. , ..,-, ALlii
Name; I
72
1 Environmental exhaust and vendintion
Range hood/other kitchen
Address:
equipment 10.00
/
City/State/Z1P: , Clothes dryer exhaust 10,00
/ ..
— Single-duct exhaust (bathrooms,
Phone; ( ) le f 5_ S 3/ Fax: ( ) i oilet com.artments, udli rooms) 6.80
.1:WaViilg,lfriat4Wi. Z ,..::',:.. • 'T,r"b'd 'si '06.1?'f;:iliqik:''41:'11 .i. r• L 10,00
10.00
Business name: _r c L es... ii,,j 1-1 e &b 1 0 ri_ '
lik
Contact name: I S
,.. . , A0 for first four $1.00 for each additional
L I,. e, i
.k. kJ i ( ,12.-.L I''e r — kr,
Furnace. etc.
Address: II r..4 i --
C I .‘" e--4.-1. Gas heat pump
City/State/ZIP: ./' I 1 g ... r i , q 7/ L.3 Wail/sus •ended/uni , eater
' ISMEI
Phone: ( • ) (, , _ 64- Fax: : ( 31'.-•? ) ' c f.: ._ 0 e y
Fireplace
E-mail: Range
,- 1,:F: 1 7.41:, AP' ilil -, 2 T Barbecue II
Clothes dryer (gas)
Business name:
Other:
Address: . OrAKI6 .' • '". '
•
City/StaCity/State/ZIP: Subtotal
Minimum permit fee ($72.50) '2-' .S
Phone: ( ) I Fax: ( ) Plan review (25% of permit fee)
• CCB lic.:
t - c i- e State surcharge (8% of permit fee)
\ TOTAL PERMIT FEE
Authorized signature: „ ,,J,...htit ......Z.e..._ C...; t• cc • .,) _,... Thill permit application eiplree If o pormli IN not obtalnod within 180
days after it him been accepted as complete.
Print name; t1 rut, p-e. e.,.. ( 1 _C_C.--C Date; / - _
1 ' Fee MethOdOlOgy Set by Tri-County Building Industry Service Board
l
018uilairMremiti 12103 440 TT (I 1/02/COM./WER)
CITY OF TIGARD
�
BUILDING DIVISION PERMIT #: MEC2005 -00346
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/16/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/17/2006 TIME: 7:11AM PAGE: 77
SITE ADDRESS: 16426 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 083 TYPE OF USE:
PROJECT NAME: BURWELL.
DESCRIPTION: Replace furnace,
OWNER: BURWELL, MARTA K, PHONE #: 503- 640 -3607
CONTRACTOR: SPECIALTY HEATING & COOLING PHONE #: 503-640-3607
Inspection Request Scheduled For: Date: 6/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 009525 -01 603-640-3607 N
Corrections /Comments /Instructions:
z
•
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
ki)
Date: &'" / 7 —®� Phone #: (503) 718 -
Inspector: Date. ( )