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Permit i . ti CITY OF TIGARD MECHANICAL PERMIT l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00717 6 4 11 DATE ISSUED: 11/1/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 25111 CB -01600 SITE ADDRESS: 15025 SW 100TH AVE SUBDIVISION: THE MARGUERITE OCHS TRACTS ZONING: R -3.5 BLOCK: LOT: 001 JURISDICTION: TIG CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: 0 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: WOODSTOVES: GAS PRESSURE: 50 + HP: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Replace boiler & vent. Owner: FEES KALLSTROM, EVELYN LOUI SE Description Date Amount J E [MECH] Permit Fee 11/1/200 $72.50 15025 SW 100TH [TAX] 8% State Surchar€ 11/1/200 $5.80 TIGARD, OR 97224 Phone: Total $78.30 Contractor: ROBBEN + SONS HEATING 2214 SE 8TH AVE PORTLAND, OR 97214 REQUIRED INSPECTIONS Phone: 503 Misc. Inspection Final Inspection Reg #: LIC 1884 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 . rect questions to OUNC by calling (503)246 -6699. Issued By: Permittee Signature: // Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busines day Mechanical Permit Application _ _ _ FOR_OF USE_ONLY . . t- City O Received Date/By: - � i/`� / 1 � PennitNo.: � / G 0� i i / '1?igard // 13125 SW 1 -fall Blvd., Tigard, OR 97223 Plan Review D ate /By: Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: • Inspection Line: 503.639.4175 ti i , Date Ready /By: NM El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information ��xv . -, xz� -� ,..... ..�':.. s;' -.: e ..,� i x i:; � .#ffiY." +n�. `Yw "`.�: ^',` ��. � :4n' ^d`:i :k J'.�:- m „': ; ,i ..i i.%�,: r ,,`r':.A^.z�� ` t„- .:g��ni1M,�.,`f��:�� a ".�P i�%+T. /4 -<• - -'-. ' -,,.- ''A iii; :.,;;.,. 7 ; :�. — .. .fi r . "g �R'f:�,±�;�. .:Y .L u.�. ;.;ii. a, . l - - 1 -- --, <. -TYP ^ O RK �? = � . _ =CQ MMERGI AL F EE SC HEDULE �e,USE CHEChL IS Mechanical permit fees* are based on the value of the work ❑ New construction ® Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. ARE . ,:_ :.f Va l u e: $ '� timp _= GAT.EGORI';'O e6igTRIJ. itc.„N. , „: ,_>' _...te ae 0 ; ?,pmijAi E� t,- SYSTElii FEES 'KtE ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Multi Master builder For special information use checklist. ❑ y ❑ ❑ Other: Description Qty. Ea. Total .:-- _ .,: :IOB 41TE' INF © N AND GA , -- ; Heating/cooling 100TH Air conditioning or heat pump Job site address: 15025 SW 100 AVE. (requires site plan showing placement) 14.00 City /State /ZIP: TIGARD , OREGON 97224 Furnace 100,000 BTU (ducts /vents) 14.00 Suite/bldg. /apt. no.: Project name: KALLSTROM Furnace 100,000+ BTU (ducts /vents) 17.90 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 l00 hydronic) i 14.00 r1 ' Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Flue /vent for any of above / 10.00 /0 00 Subdivision: • Lot no.: Other: 10.00 _ Tax map /parcel no.: Other fuel appliances ' =,_: Water heater 10.00 Gas REPLACE BOILER WITH 90% BOILER fireplace vent Flue vent nt 10.00 for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 itvit PERTY O miR. ` _,�` `" Et1,AN7 ' , ` Chimney /liner /flue /vent 10.00 ,- - _ _,_. ., .. - -= khk* .> - * . :3 A„ `. Other: 10.00 Name: MS. EVELYN KALLSTROM Environmental exhaust and ventilation Address: 15025 SW 100 AVE Range hood /other kitchen equipment 10.00 City /State /ZIP: TIGARD Clothes dryer exhaust 10.00 Single -duct exhaust'(bathrooms, Phone: (503)639 - 5945 Fax: ( ) toilet compartments, utility rooms) 6.80 '®. �,- ° Attic /cr awls ace fans 10.00 r�PPLIGANT' 4 , , Fl i ' CONTACT' °''PERS , v,t P Other: 10.00 Business name: ROBBEN AND SONS Fuel piping Contact name: RANDLE NELSON $5.40 for first four; $1.00 for each additional • Address: 2214 SE 8 AVE Furnace, etc. Gas heat pump City /State /ZIP: PORTLAND , OREGON Wall /suspended /unit heater Phone: (503) 233 -5841 Fax: : (503) 238 -8849 Water heater Fireplace E -mail: Range CONTRACTOR:';'z_- -- "'=` Barbecue Business name: ROBBEN AND SONS Clothes dryer (gas) Other: Address: 2214 SE 8 AVE -.h '�'y ;�,��` �lV1ECFtANIG > >AtiPERNii'I' FEES.::'. "':. 9�= :r »- ....,.:mow . �r.r „.,, -- �°: City/State /ZIP: PORTLAND , OREGON • Subtotal Phone: (503) 233 - 5841 Fax: (503) 238 - 8849 Minimum permit fee ($72.50) 7Z --5V Plan review (25n /s of permit fee) CCB lie.: 1884 State surcharge (8% of permit fee) Sq / //� //J� TOTAL RMIT FEE 7 L 7.'1 3 D Authorized signature: f/���” y T his permit application expires L if a permit is not obtained within 180 days after it has been accepted as complete. Print name: RANDLE NELSON Date: 10/29/04 * Fee methodology set by Tn- County Building Industry Service Board i:\ Building \Permits \MEC- PeimitApp.doc 12/03 440 -4617T (I I /02 /COM /WEB) ■ CITY OF TIGARD BUILDING DIVISION PERMIT #: MEC2004 -00717 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/1/2004 Phone: (503) 639 -4171 y��V6' Inspection Requests (24 Hrs.): (503) 639 -4175 �_' U INSPECTION WORKSHEET FOR DATE: 9/1/2005 TIME: 7:14AM PAGE: 94 SITE ADDRESS: CLASS OF WORK: 1 X025 SW 100TH AVE SUBDIVISION: THE MARGUERITE OCHS TRACTS LOT #: 001 TYPE OF USE: PROJECT NAME: KALLSTROM DESCRIPTION: R boiler & vent, OWNER: KALLSTROM, EVELYN LOUT SE, PHONE #: CONTRACTOR: ROBBEN + SONS HEATING PHONE #: 503- 233.5841 Inspection Request Scheduled For: Date: 3/1/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 014572-01 503-233-5841 N Corrections /Comments /Instructions: 1 1 6 ZO// /j 4JJ I A / / / � ' lai4X,7 6 . ?-' Mi 4 ' ' _A, Jfelkbeette - /Vole Y-4; 61/0/a/(A/4' (I'. e , ( , A 4 , , , ,ri Ai 4,441--- k w,e1 / 4)trZtk //t4 ( 7.'s 4-0 _ — /)—/.,e) . • r /� L• . G/ j _ ! / e i �_'� Lac! S " ,/ lr Ce T C I __ Ago Jze, ed4ni d ' � - .. 14 4, A to--/i LA/ AA nor Ivra (Zee (f,(4,4,11i pri,c, ,eitce cA, alrvi k,l'e4, /1 /of' ke 1‘i.,,,,e r t / r A. � / , - /ir �� ■ zi t s.j —,� / • ■ . P ASS PARTIAL APPROVAL ❑ CANCEL NO ACCESS FAIL I I CAL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1 Inspector: 74 - Date: 9" kv Phone #: (503) 718- . ,�