Permit CITY TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2006 -00427
"�'I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/1/2006
PARCEL: 2S111DB-14100
SITE ADDRESS: 15070 SW 92ND AVE ZONING: R -4.5
SUBDIVISION: LAUNALYNDA PARK LOT: 028 JURISDICTION: TIG
Project Description: Replace furnace & water heater.
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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
TOM LACEY Description Date Amount
15070 SW 92ND AVE
TIGARD, OR 97224 [MECH] Permit Fee 9/1/2006 $72.50
[TAX] 8% State Surcha 9/1/2006 $5.80
Total $78.30
Phone: 503- 968 -6270
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PM 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: it.0s /.C-- Permittee Signature: \ p p
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.
r1/011 : FAX NO. :53557O919 Sep. 01 2006 es 19AM P1
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IVIechanical Permit A.pnll
icaggil
1,1 `1 FOR OFFICE USE ONLY
OR 97223 R . .
City of Tigard tk=0.1" Received ,..., _ _
/ 0 6 ,..--2617.,..„ Permit Ne.:\v ''s, 6, c.,,, 00 ‘- -7
Date/By
13125 SW Hall Blvd„ Tigard,
Phone: 503.639.4171 Fax: 503.598.1960 SEP 0 1 2006 ,. ,,, r Ian Review
Other Permit:
Mspection Line: 503.639.4175 - : \
...J., ■.'a 1 Dacemy:
Datc Rcady/By: ..."-- Jura: 21 See rage 2 Mr
Internet: WWW.Ci.tigarcl.oreliS CITY OF TIGA*-- •
NOLiried/Methad: -r- I Cr Supplemental Information
BUILDING DIVISION -....--„ -.. ) ..
! ''I'i' USW
c] New nStrUCtion
Iviechanical permit fees'• are based on the value of the work
cO
performed, Indicate the value (rounded to the nearest dollar) of all
0 Demoliti %Addition/alteration/replacement
On 0 Other mechanical materials, equipment, labor, overhead, and p) t•
:.;:.1.,...t..14,4•4•4•lirli.".1‘00.0.;l:VektiP6d*ittltpa•A'ti.4,te„,k".0.1; :.'..,;..; ,.12 Value: $ .,
• ..• 109)0011:AC S QVI TKCIU NT i SYS'.1.1MISTEES*
PI: 1- and 2-family dwelling 0 Commercial/industrial El Accessory building
For special injOrmalicM tae checklist.
El Multi Ej Master builder f: Other: • 7
Description 1 Qty. I Ea, 1 Total
; . i 1 01N . W1;0i . e . ..:7 7 0t . r*,"VII!* . ::;;:i;',4,..:•: . „•,: ...H..;••;::;;: awing/coolin
Job site address: 15(1/ SZiO ° d\f/ ' A-A;e_,- Air conditioning or heat pump
i s
(requires sire plan showing placement} . ... 14.00
.
City/State/ZIP; CL_561 - 617))4 Furnace 100,000 BTU (duccsiyenia)_ I l4.00
7 PurnaCe 100,000t BTU (ducts/venol) 17.90
Suite/bIdg,/apt. no.: Project name: , ... - ,,...,
Gas heat pump 14 00
_
,.... ____ ... . - - -
Cross street/directions to job site! Duct work 14.00
„,....-
' • Ityclainic hot water system 14,1)0
Residential boiler (radiator or
-••••
hydronic) "..— 14.00
.
. , Unit heaters (ii,J=tYpe. not electric:),
.. , •
in in-duct, suspended, etc. 10.00
—
Subdivigion to ' Flue/vent for any of above 1 10.00 I
:
Lot :
_,— , „-- .. . Other; 10.00
...„.„.-
Tax map/parcel nO.: ' Other fuel appliances
• -..P.;' •••7777.7 • `,. . ' , -. 0 ••• •••___L... •••..1 • ., '.1_ .';' •', • .- ' • ■ • *". .:':'. , 1 ,..!" ' ' . . .: ' ' ':: !";Mr :7: ; 317 .. . '1 Water heater 1 10.00 /0..() 0
...,, tscRwuntq . r ,W( ' - ' ' .,' : pa' •'.' • -
.0411 • •• -....v-i.• - .... Tr !. ■41 e ,11 , ..t ,,,, : . 1...i •'. ' ''''.:',..,:';',..,'.":"':).• '
nr)nn Gas fireplace 10.00
. E.- tA )601<-4/'- Flue vent for water heater or gas . . .. _
, 1040
■ fireplace .,,,_
4A.0_,OL-k_A( 10,00
.. -- Lo:. Ii ■ hter (gas) 10 ...._
— .
Wood(pelIct stove 1(100 ._
....--- --- -... ..,
Wood fireplaec/insert 10.00
.. . , ,,,..., ..,,.,... ,_,,.,„,,,__,,,,,..,„,..,:, ,,..„..,..... ....,,,.,„..„...,.....,„ „.... , ..,:. .. ChimneyilincrAluelyent 10.00
., i ,;, , ,{:', . ii:I..i64 a :ii ..i . 3iel;j5i.q.l',''IkU
1000 ......- - ..,...
Nalitle: '. AAI OP C
Environmental exhaust and ventila ion
Runge hood/other kitchen _. .
Addreaw i p r., / ' 0 \ If - " , J 1
1 - eqtlipment 10.00
, -
Y • -
City/State/ZIP: ' ' • A. e- • p ., • Clothes dryer exhaust
..,..- 10.00 ...
•• .. a, • • i/toe-duct exhaust (bathrooms,
' ( - 03) '7 e .
Phooe . , .4 ,' / .,, C) Fax: ( ) toilet enrripartments, utility roornal
T.- '. zpv,.4. ■'.:Ad4; thie. ,.,...,,. ,.......„. Amekrawypa.ce fans 10.00 _.
11, T
!.,.:' --..1 t?,e :il. ,.,..lowr,....,,,A„,....., .. - )., A .1 ..- —.., •:. $........ -.. .. i o oo
Business name; ill ccw'rry Tc.Dmp (00#01
F piping - - • ---
.- —
Contact name: s.5.40 for first four; $ I MO for each additional
„,... '
Address: 0 I a 0 • 0, taCkai Rivrir wriuo .... . , ..,.. _.,
._.., Oas heat a_irrip ..
......--- _.
Ciiy/Siate/ZIP: CrEgen CI i\i f. (17045 Wallle spended/unit cater - •• .-
Phone: (te) S5-7-2220 LFax: : (62) r5r5..7_0 a
q1q Water heater
- ... _
' '• fireplace . -
E-mail; . Range ._,_, ..
;4_,iltilaZWO,PrA L ''' if- lie "Ti i7E , .iTp: . Z Barbc9e ....
Nitiek, .-Y; '... ',„;• • ,,,,,..-. "-
Business name: —
1 n COW L CV co notes dryer (as) , •,..- -
_• Other: ..
Address: OtF)0 , ' ' I. 1 L ° 1irr- .. . .■ lit vi-.11:t..:0?:;. • . ,,____
cir ()I/men ..C.t '' ok-
' Ct_. -. $ Subtotal
...-
-- (5
Phone: ( Fx: 7
) C55 - .2_./_./ ( .' M inimum pen fee ($72.50 —
•
... I a (S03 . 6 . . 1 " t(11(1
Plan review (25% of permit fee)
- .,-,„-- -
CCB lie.: t z u l 2s . .. State surcharge (8% of permit fee)
6'7
_._
. -7. _ - 'I OTAJ_, P ERMIT FE.E. ' (
..y 0 4,0•C1Z.....----.
Authorid gnature: l- ) ''''' 4 , ' - This permit uppliecidon expires if 2 permit is not otitli within CH
ze si -
days after It hat been aecepred ee comPlete.
• ' --- ___.,
Print name: IVQ)21% Aild,.'041 - . Fee methodology !let by 'fri oundiug industry Service Beard
—
CITY OF T4GARD
BUILDING DIVISION PERMIT #: MEC2006-00427
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1/1006
Phone: (503) 639 -4171 &All i i
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
• INSPECTION WORKSHEET FOR DATE: 9/8/2006 TIME: 7:00AM PAGE: 43
SITE ADDRESS: 16070 SW 92ND AVE CLASS OF WORK:
SUBDIVISION: LAUNALYNDA PARK LOT #: 070 TYPE OF USE:
PROJECT NAME: LACEY
DESCRIPTION: Repla furnace & water heater.
OWNER: LACEY, TOM PHONE #: 603 -968 -6270
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503 -557 -2220
Inspection Request Scheduled For: Date: 916/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical finat 036235.01 503- 557 -2220 Y
Corrections /Comments /Instructions:
4-
�, J : r ,> 4 2 �.s .`., c: 1-,a4 � a Z9 quo
•
f
PASS TIAL APPROVAL ❑ CANCEL I NO ACCESS
❑ FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: F Phone #: (503) 718- '74-4-