Permit ••
CITY OF TIGARD MECHANICAL PERMIT
i�'III DEVELOPMENT SERVICES DATE ISSUED: MEC2204- 0842
`--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S114BB -09300
SITE ADDRESS: 16216 SW 104TH AVE
SUBDIVISION: SWANSONS GLEN ZONING: R -12
BLOCK: LOT: 034 JURISDICTION: TIG
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: COMML.INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Reconnect furnace and WH.
Owner: FEES
HAYDEN, DAVID R AND CAROLE M Description Date Amount
16216 SW 104TH AVE [MECH] Permit Fee 12/30/20( $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharl 12/30/20( $5.80
Phone: 503 684 - 8181 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 640 - 3607 Mechanical Insp
• Heating Unt Insp
Reg #: LIC 66578 Final Inspection
•
•
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.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nex // business day
09/18/2000 15:23 FAX 1 002/002
l
1, f' t
• Mechanical Permit Are
d tn.... \, Fort OFFICE use olvt,Y
City of Tigatsd 1 V , xaee;ved .
13125 SW Hall Blvd., Tigard, OR 97223 Davy I, 0 . 6,i Permit No.; D , am!
L , -- a g
Phone: 503.639.4171 Fax: 503.598.1960 Platt Review 7 1
(DEC ,� k Date/By Ocher Permit:
Inspection Line: 503.639.4175 l'
Intemet: www.ci.tigard.or.us O �.�t *a ml '7 `` .. Dam Ronda /py; 8 See Page 2 For
NodSed/Methad: WM Supplementallororrnedon
4 r "i 'it,. ,4- ♦"'Y 4�d, 'L- , . -, r ' 7 a' . { , }:1 r :i , ., N : I . r - 4 : �,�
� �'r �., .i ���
�� 1 �` � a , i?�i �scxil��;t - .rrs��'>carzcta.>s�r
❑ New cons7ruerion ❑ Addition /alreration/>•eplacetnent Mechanica permit fees are based an the value of the work
[] Demolition performed, Indicate the value (rounded to the nearest dollar) of all
❑ Other:
�,: • . _ y, mechanical materials, equipment, labor, overhead, and profit.
f15`^lit;t ; xCA.4. r,,, : M;I�.,t?F '�'�'tir't
.;�h� � rah :,1- r 9Fr� '��0 1 QCTT<OlY•. 'r�.R�- `t'. r'I,� ; � Value; $
1- and 2-family dwelling ❑ Commercial/industrial El Accessory building ''�� ' EQUIPMENT / S YSTEMS, RE)r9*
❑ Multi-family 1:1 Master builder Other: Far special information use checklist,
: �
-1' / , , Description I Qty. 1 Ea. I Total
,;� ;a'. �,w.; . ,:,.�,, , ta, �'TI01�F! I LOCAi�'1 01v ,bie, ' , : _ -, I , .� ,
��¢�� ''; � ,' I � Elea tinR/coollhg
Job site address: I toil Lii A- V r Air conditioning or heat pump
�i'"� (ro5ulrea site plan showing placemeei 14.00
City/Stoic/VP: I q S/ _} 2 2r
_Furnace 100,000 BTU (ducts/vents) 1 14.00
Suite/bldg,/apt. no.: 1 Project name: - Furnace 100,000+ BTU (duels/vents) 17,90
-
Gas heat pump 14.00
Cross streer/directians to job site: Duct work 14,00
Hydronic hot water system 1
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fl.iel -type, not electric).
in -wall, induct, suspended, etc. 10.00
Subdivision: Lot no.. Flue /vent for any of above 10.00
Tax map /parcel no.:
Other: 10.00
-� h tt Other fuel a�liancas
i!` , : rya.; ;„ , c F `i 1 ,,; A SCEiIP T I�, p R ' qty : ^�a.!y.; ; : j , '. _ Water heater 10,00
Gas fireplace 10.00
Flue vent for water heater or gas
,3t./ $ / if fireplace 10,00
Vt, F� Log lighter (gas) 10.00 '
1 . Wood /pellet stove 10,00
Wood 6replace/insert 10.00
y; ',�;:,II � j.nt�. S {„r' w.. e' y. Chtmne /liner /fluev
- 1 IQI RV?) 7? m **- vt i I'',' :',i'v'.. � S ' / eat
I� �,t,:� I �i �d, / _ i � .���. � "- "•, "I'rFj� hit'- ' ° L'Jl?`!'`r. , F. -.f �Z""�'I� �' 10,00 T 4 �._4�1 .. , �. . a,K: � :.I ; Other: 10.00
Name: Li �� �t 1? Environmental exhaust and ventllatlon
Address: Range hood/other kitchen
equipment 10.00
City/S tatNZip: Clothes dryer exhaust 10.00
Phone: (( _p (,{ r" Fax - Single -duct exhaust (bathrooms.
hone;
( ,ti ) W 'i o " Fax: ( ) toiler compartments, utility rooms) 6.80
'•. : J �" YI1 ti� N I ) h - Ni • - I }tF,b, ` .. i1 , y��_d.IV �, Irlf �-
. ,r s �, �r1'•x�it:i„ � � � r, l .h ��� �'l ,h �� c I; �'''r., Atticicraw f ans INN 10,00
Business name: Other: 10.00
-f -L C. 4..... l j (--/- E� C � ' � Fuel piping
Contact name: 8 (. � LL J ,7 { 'S �,�, r — ,- 55.40 for first four; 51.00 for each additiona
Address: 0 iR Gi- _ .-- •-,1 X e,-1. \ pumace, etc,
Gas heat pump
Ciry/5tatdZlP: _
7 I I l ( t;'• rC - L ,� Y'L / 6 . / L S Wall/suspended/unit heater _
•
1?hoxi : ($11 s ) La U (C c � Pax:: (S'' ? l ,C^ r7 / - C �- `l f Water heater
E -mail:
Ran Fireplace
) .1i';'9,.",:.., r e
4 .: 41'411.4414, '^ ^, ' ;! 4p1!' s 140. '1' '� i; .w "`, 71,;..II +�11.,,. _, _ R
"' r ry .,J.Op.L� '��:•� ��t.'f +:'��c;� s :. I. � �titiMa'� ', ��C�'���' ' ,'llh� Sarl)eCUp
Business name: Clothes dryer (gas)
Address: Other:
Ciry /S[ate/ZIP: 4 u 1; ". 14eitAIV ,LIC�'�,� *12.1titr
Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) - 4-2. .c").,
CCB lie.: . (�. Plan review (25% of permit fee)
State surcharge (8 % ol' perm' t fee) ,iii%
TOTAL PERMIT FEE -
Au[170TIZed signature; 1 ` C. y, L`' Thus permit application expires 111' a permit la not abtnlned wi fin Tse
days after It bee been accepted es complete.
Print name: /CI n. a i. Zti / C c i C Date: 1 � / 6 '� - Fee methodology set by I'd- County Budding Industry Service Board
ct PennitA l `Jn] een_ut rr h, mv■rnt.nwent
CITY OF�TIGARD
�
BUILDING DIVISION PERMIT #: MEC2004 -00842
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/30/2004
Phone: (503) 639 -4171 , / ,,,, A i ��lpi pl : i
Inspection Requests (24 Hrs.): (503) 639 -4175 :�� __..
INSPECTION WORKSHEET FOR DATE: 4/15/2005 TIME: 7:08AM PAGE: 90
SITE ADDRESS: 16216 SW 104TH AVE CLASS OF WORK:
SUBDIVISION: SWANSONS GLEN LOT #: 034 TYPE OF USE:
PROJECT NAME: HAYDEN
DESCRIPTION: Reconnect furnace acid WH,
OWNER: HAYDEN, DAVID R AND CAROLE M, PHONE #: 503 -684 -8181
CONTRACTOR: SPECIALTY HEATING & COOLING PHONE #: 503 -640 -3607
Inspection Request Scheduled For: Date: 4/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 004555 -01 503-684-8184 Y
Corrections /Comments /Instructions:
p/ . =Gel 1 L QA., _ - 5 Z A //3
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
A �
Inspector: Date: 1� — �J Phone #: (503) 718-