Permit 4
d CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00437
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/19/2007
PARCEL: 2S 114BB -07400
SITE ADDRESS: 16233 SW 104TH AVE ZONING: R -12
SUBDIVISION: SWANSONS GLEN LOT: 015 JURISDICTION: TIG
PROJECT: BLAKLEY
Project Description: Install a/c unit.
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: 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:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
ROB BLAKLEY Description Date Amount
16233 SW 104TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 7/19/200i $72.50
[TAX] 8% State Surcha 7/19/200/ $5.80
Total $78.30
Phone:
Contractor:
D & R HEATING & AIR CONDITIONING
PO BOX 1292
CANBY, OR 97013 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 - 678 -2517
FAX 503- 678 -2097
Reg #: LIC 84489
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 J / , Permittee Signature:0 APirgt
a / N7/
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.
Jul 18 07 04:OOp DR Heating 503 - 678 -2097 p.2 ,
Mechanical Permit Application FOR oF ICE use ONLY
City of Tigard f Received
Error" Permit No.: u 13125 SW Hall Bl d., Tigard, OR 9722 Pla ie /• •, SL, + '� '!� -�� 43 � Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 a�., „. ' Date/By: Inspection Line: 503.639.4175 JUL g 2 00 7 J �, •J � DaleReady.By: ® See Page 2for
Internet: www.ci.tigard.or.us r Notified/Method 1 Supplemental Information
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TYI'E L UII '' ; c W ORK I 0N COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction Q Addition/alteration/replacement Mechanical permit fees" are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
0 I - and 2- family dwelling ❑ Commercial industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
iF Air conditioning or heat pump
Job site address: ' Z33 S- ( ti Z A•{,t
(requires site plan showing placement) L 14.00
City % State/ZlP: 1 I C.44frAS 02 0j 7 22-1-/ Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (dn rrervenls) 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: I Lot no.: .
Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
n /� Gas fireplace 10.00
Vol.— I Y1 S7} ,Zl l hiif Flue vent for water heater or gas
■ fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Ei PROPERTY OWNER I 0 TENANT Chimney /liner /flue/vent 10.00
, Other: 10.00
Name: 120 J L. A'' GE C tl Environmental exhaust and ventilation
Address: / l , � I Range hood/other kitchen
l4 S�tl oil equipment 10.00
City /State/ZIP: 71 ( Dig t3 71Z6/ Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ‘5D3) fr3D — 17 to 9 Fax: ( ) toilet compartments, utility rooms) 6.80
E APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: TQ 2 /4. 1 -• ( , Z m e i4/6
Other:
ipinR 10.00 _
Contact name: rT u »m , )1i,) Guy rpi..rzy $5.40 for first four; $1.00 for each additional
Address: IP 0,. iKor I Z f 2 Furnace, etc.
Gas heat pump
City/State/ZIP: C 4,1013,1 Dig 9 7 6/3 Wall /suspended/unit heater
s o
Phone: ( t Z'"/ - I Fax: : (5D3) & — 409 Zlj 9 7 Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
S Fa n _ /� _ Li f ism C -- Clothes dryer (gas)
Business name: Y I Y`'i'� V`TI� �Jrt� 1
Other.
Address: MECHANICAL PERMIT FEES"
City / State/ZIP: Subtotal J ci , 1)
Minimum permit fee ($72.50) y2.. 50
Phone: ( ) Fax: ( ) •
13,4-141 Plan review (25% of permit fee)
CCB lie.: Sq State surcharge (8% of permit fee) 5 • ?0
f � TOTAL PERMIT FEE .3 A , 3Q
. - Ul�
Authorized signature: T his permit application e xpires if a permit is not obtained within 180
days after it has been accepted as complete.
r
I Print name: v.hei S I - 14 ... r - y �� Date: —7 if 3/07 I * Fee methodology set by Tri -County Building Industry Service Board
i:l Building \Pcrrnits \MEC- PamitApp.doc 12103 440-46177 (11 /02C'COMiWEB)
HEATING & AIR
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P.O. Box 1292 Canby, OR 97013
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2007 -00437
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/19/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/30/2007 TIME: 7:02AM PAGE: 49
SITE ADDRESS: 16233 SW 104TH AVE CLASS OF WORK:
SUBDIVISION: SWANSONS GLEN LOT #: 015 TYPE OF USE:
PROJECT NAME: BLAKLEY
DESCRIPTION: In tall a/c unit.
OWNER: PHONE #:
CONTRACTOR: D & R HEATING & AIR CONDITIONING PHONE #: 503-6782517
Inspection Request Scheduled For: Date: 7/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Mes e
699 Mechanical final 052883.01 503. 678 -2517'
Corrections /Comments /Instructions:
O ASS r ARTIAL APPROVAL CANCEL NO ACCESS
I I FAIL LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 7 A ° / 9 7 Phone #: (503) 718- 2-‘77