Permit CIT OF TIGARD MECHANICAL PERMIT
tip I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00641
` 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/10/2005
PARCEL: 2S 112CC -07400
SITE ADDRESS: 15761 SW 82ND AVE ZONING: R -12
SUBDIVISION: LANGTREE ESTATES LOT: 006 JURISDICTION: TIG
Project Description: Furnace replacement.
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:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMM. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
BRENDA LEWIS, GEORGE CABLEIGH Description Date Amount
5761 SW 82ND. AVE. [MECH] Permit Fee 10/10/20C $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 10/10/20C $5.80
Phone: 503 - 598 - 8487 Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97224
Phone: 503- 453 -4822
Reg #: LIC 62196
Th is 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: Permittee Signature:
Call 503 - 6394175 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.
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J - ZUUS 5 :5811 GLINRTE CONTROL INC 5039687224 p.1
‘ychanical Permi FOR OFFICE I:SE ONLY - EDA ity of Tigard R By¢ \ 10 Permit No.: M a/Ae --O /a
' /
13125 SW'Hall Blvd., Tigard, OR 972 � plan Review
Phone: 503.639.4171 Fax: 503.598. V OT 1 A»r'e,,Ke i i :. Date/By: Other Permit:
Inspection Line; 503.639.4175 1 I) 2005 >_t1,1 - •) J. Date Ready/By: t El See Page 2 for
Internet: www.oi.tigard.or.us C ITY Notified/Method: ` Supplemental Information
, N r:::: J ;,« := ;'G07►iMRC1AI FEE *,;'
ddition/atteratio ement Mechanical permit fees' are based on the Value of the work .
❑ New.construction.
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:. • mechanical materials, equipment, labor, overhead, and profit.
::' -.. O u.
, �.:-:, . ;- 's'-:. ! ;:- ,.,. . :. : :. < . : ;., �. : . GATEG�RY..... � . CQNSTRUC170Pt :�= , ; > ",. ; :', ;.�,,� - :, Value: S
RESIDENTIAL •EQUIiPMENF / SY FEES *,'.
A R- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑.Multi- family ❑ Master builder ❑ Other: Description • 1 Qty. 1 Ea. 1 Total
: JOB SITE INFORMATION` AND:. LOCATION :'":'' '':'• ' '•-' Heating /cooling
Job site address ' �d' 1� A ir c onditioning or heat pump
(regtares site plan showing placement) 14.00 a
City/ State/ZIP: 1 �� • 497 Furnace 100.000 BTU (duetsNents) I 14.00
Furnace 100.000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
• 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. 10.00
Subdivision: Lot no.: Flue/vent for any of above 10.00
Other. 10.00
Tax map /parcel no.: Other fuel appliances
' ` DESCRIP N OF:' WORK ..
Wafer heater 10.00
V Gas f replace JQ i
D / Flue vent for water heater or gas
10.00
`T fireplace 10.00
. Log lighter (gas) 10.00 .
Wood/pellet stove 10.00
Wood fereplace/insen 10.00
... RO'ERTY OWM1ER I ` •. ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name:' ` . . . t 1 a' 1 ' t�0 1 " r , Environmental exhaust and.ventilation
Q Range hood /other kitchen
Address: ' U �n , equ pment 10.00
City /State/ZIP: • # ` 9 7 a z Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone' - ggi ( . ) toilet compartments, utility rooms) 6.80
yr1. APPLICANT . )0 CONTACT PERSON Atticicrawlspace fans 10.00
Business name: ( / t Other: 10.00 .. t �� �Y� -s..lb . • Fuel piping
Contact name: • S3.40 for first four: 51.00 for each additional
Address: , Furnace, etc. -
r•* n 1 Gas heat pump
City/State/ZIP: ,`,'-li ,� Al a Wall/suspended/unit heater
Phone: a MEI jTR --1 ►'� Water heater _
Firep; ace
E -mail: Rarae
CON7 Barbecue
�( / ` ' } • Clothes dryer (gas) •
Business name L�[�1�� [ 11 jjjjll7, !
� Other:
Address: 1 6) � ECHANICAL PERMIT FEE S * •
. City/ State/ZIP:, P UTTQ�
( (,•_( I r s:) M (47� Subtotal - . 51.,6b Phone)5 3 Q Fax ( i ^. Minimum permit fee ($72.10) � `�
Plan review (25% of permit fee)
CCB lie.: Ca . Q U / � t � . State surcharge (8% of permit fee) go
W C I CO TOTAL PERMIT FEE
Authorized signature: .7.41 ' This permit application expires If a permit is not obtained within ISO
• ` _ days after it has been accepted as complete.
Print name: 7 / i +T Date . irro s Fee methodology set by Tri -County Building lud,istry Service Board
MnuildinulPermiu`MEC -Perini .. 2133 440 41 I/02/CCM/WEE)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 'MEC2005 -00641
13125 SW Hall Blvd., Tigard, OR 97223 ' DATE ISSUED: 10/10/2005
Phone: (503) 639- 4171 ,� 1 d4p�� l
4
Inspection Requests (24 Hrs.): (503) 639 -4175 � - '
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 70
SITE ADDRESS: 15761 SW 82ND AVE CLASS OF WORK:
SUBDIVISION: LANGTREE ESTATES LOT #: 006 TYPE OF USE:
PROJECT NAME: LEWIS
DESCRIPTION: Furnace replacement.
OWNER: LEWIS, GEORGE CABLEIGH, BRENDA PHONE #: 503 -598 -8487
CONTRACTOR: CLIMATE CONTROL INC PHONE #: 503 - 453 -4822
Inspection Request Scheduled For: Date: 10/31/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 019780 -01 603- 453-4822 Y
Corrections/Comments/Instructions: � `// /� �y
bu-i• 44-0 /iI/`rC.YiL 5? %! -'2, ,Z6L./
C 4 ° 1 % L =-
•
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL Ili CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: A 1/J Phone #: (503) 718-