Permit CITY TIGARD MECHANICAL PERMIT
I�� DEVELOPMENT SERVICES PERMIT #: MEC2006 -00121
' -- I ? ``` 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/24/2006
PARCEL: 2S 102BA -01800
SITE ADDRESS: 09865 SW JOHNSON ST ZONING: R -4.5
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT: 020 JURISDICTION: TIG
Project Description: Gas furnace replacement, gas outlet.
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:
NAT 3 - 15 HP: COMML. 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: 1
> 10000 cfm:
Owner: FEES
MATT PEARCE Description Date Amount
9865 SW JOHNSON STREET [MECH] Permit Fee 2/24/200E $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 2/24/200E $5.80
Phone: 503 - 557 - 2220 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045
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: Permittee Signature: , , 0 ._ ..
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day. P12-12.4
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.
Fe 06 04: 25p
Ilk Tr iCountTernp
5035570919
I . p. 1
NA.`echanical Permit Er 4/
ticr . FOR OFFICE USE ONLY
City of Tigard Received ., _
D a .3 \ a 0 6 gpS Permit No _
.t\i6e oc41/
13125 SW HaIl Blvd., Tigard, OR 9r1721 C 1 17
Plan Review
Phone: 503.639.4171 Fax 503.598.1960 * Date/By Other Permit:
Inspection Line: 503 23 .639.4175 t it :
Date Ready/By:
Internet: www.ci.tigard.or.us r-,
FEB 2001 Ati jt. fr ... 1 .
Notified/Method: Iiiris: 21 See Page 2 for
7 Supplemental Information
:.:!'2.".,.:4 1:,:-.05 *kiti.:Mt.,itt: -- .TtIgEiCLIECICLIST
New construction u....
r.:-; 1.11. .. 4 1Nki • ..• ... Mechanical permit tees• are oased on the value of' the work
E .. • . at wreplacement
r
, performed. Indicate the value (rounded to the nearest dollar) of all
E] Demolition El Other: _mechanical materials, equipment, labor, overhead, and profit.
Value
S
:T,::•.liT '"i' i'. , ,., • .. _ • . • • -, • ,
:13s1D0i-orw-,E0..r - / . sysTEms FEES*
04 I- and 2-family dwelling El Commercial/industrial 0 Accessory building
For special information use checklist.
El Multi E Master builder El Other: . Description Qty. 1 Ea. Total
,':::'•: LOCATION,Li':;' :':: ::' : Heating/cooling
Job site address: 11 SW real eftprr Air conditioning or heat pump
(requires site plan showing placementi 14.00
Ci ry/S tate/ZIP: -r, 4/ Furnace 100.000 BTU (ducts/vents) f 14.00
' Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: ,
Gas heat purrip 14.00
i 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),
i in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: LOC no.:
Other: 10.00 :
Tax map/parcel no Other fuel appliances
•,-•,.••••-,-• .:- : ;,... :..,;:.: :,. ,..,:,,,-,..::::, :---:- .}, 7 Water heater 10.00
Gas fireplace 10.00
kft, itinlalai C ICAA0 , 4 - (n., je-it Flue vent for water heater or gas
fireDiace 10.00
Log lighter (gas) I 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00 •
, ,...„ ..•........,._ . . :,>,,.........: .,.. ,_, ..... :.:;:. . ,,.....:.,.,:.:_.,.....:„.,....,,: Chimney/liner/flue/vent lo.00
,...... :Pwl`rkil., -..-:4 -..;:,'.:-.!:..:-: ...,... .. ':- .: i 1.• • .._ :, ::::-..., other: 10.00 1
Name: 11/161 4t-arM Environmental exhaust and ventilation
1 Range hood/other kitchen
Address: IcitainiL, 1 equipment _. 10.00
City/S tate/ZT:P: Clothes dryer exhaust 10.00
60) wit,/ tt I Fax: ( ) Single-duct exhaust (bathrooms,
Phone: (
toilet compartments, utility rooms) 6.80
12' 1 .:•,,,Ehra,s7fAtfTri,§13N.:."::::,•-„.:7:. Attic/crawlspace fans i 10.00 ..,
Other: 1 10.00
Business name: in Cau I cryip COrrtio 1 Fuel piping ,
Contact name: „piano 55.40 for first four; 51.00 for each additional
Address: 0 ia) 6 C[aCkaillaS Riva-dPVC) Furnace, etc.
Gas heat pump I
•
• Ciry/State/ZEP: Ci - 100 - 1 'i e C( 04 Wall/suspended/unit heater
•
Phone: ( - :•a) S5 • "
• .-222D i Fax: : (503) 557-Uilq Water heater I
- Fireplace
E-mail: Range
.. : '',..;it;::- 1 . ; .;_.' : :4 7 7.i . : . ,!::,: : :::::•:,'. 3 „ . : VT•7 . ::::••1 .- . :1 : •COSIiO42,C1 : 0 ; :•,...';'FM - i•:: :. F_4tIri1, 7 P; ' .17:k 7 : - .',:,1;: .: ,J",," : .•.---•,' : ' : : t] Barbecue
-•-• • •
Business name' In Cc . Terne coritroi Clothes dryer (gas)
Other: 1 , i
Address:
2 )F)0 GKarriciS Rikirrbri \it ..
.:.•r flEES'.'
City/State/ZIP: 0 re_gOn CI ki Cg_ C11(4_5 . Subtotal 1
Phone: (5_, 55 '.1_222.0 I Fax: ( '- I CS S57 .-n(1.1q Minimum permit fee (S72.50) ;
Plan review (25% of permit fee)
CCB lic.: -7210 2S 1 State surcharge (8% of permit fee)
TOTAL PERMIT FEEi
Authorized signature: e.,?1,e2-7 17 7 " C"-W.-- --' This permit application expires If a permit is not obta , o.E , c ..... , vn
426 days after it has been accepted as cornplete.
Print name: biane i v,364 ia Date: it!, - Fee methodology set by Tri-County Building Industry Service Board
v`Building■Perrnics■MIC-PermatApp.doc 12;05 445-4617T ( I 1/02./COt4'INES)
CITY OF TIGARD ,, ( _ c _ .. ,
BUILDING DIVISION PERMIT #: o� dQ6 _ DU I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
A. 11111l �� •
Inspection Requests (24 Hrs.): (503) 639 -4175 "` /VCS .2-00 6 — 00 /ad/
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
I .
SITE ADDRESS: l g6, ,....,a
.. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
I PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
_
Inspection Request Scheduled For: Date: 3 - 3- ae Pour Timer L ( n ' ,
Code # Inspection Description pttiionn Confirm # Contact # Message
I ki 0 6 ? q 7 ._ . ,,,..., ; __ .."
Co tdfis /Comments /Instruc ions:
k .4 ", 6•1 .6.7 2t - a.Jo' 4,46-z- ', 5 77 4 / Ai Ge:2Gc, z
� ., ,t2,v4 -cam
31-: ; i'°I 1I'S Ci< : - -- Z4 f? r /X... S lay y 4. 5
JD -- -A- f, , .- S✓ ' / - - - i�
PASS PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
Fl FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
. / ( A Inspector: - Date: 3— .7 Phone #: (503) 718-