Permit ie CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00632
Aill- _, I-- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/6/2005
PARCEL: 2S103BB -02500
SITE ADDRESS: 12115 SW 124TH AVE ZONING: R -4.5
SUBDIVISION: BROOKWAY LOT: 025 JURISDICTION: TIG
Project Description: Furnace replacement.
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:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
JOHN GROSS Description Date Amount
12115 SW 124TH AVE [MECH] Permit Fee 10/6/200: $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/6/200E $5.80
Phone: 503 - 421 - 0212 Total $78.30
Contractor:
A -TEMP HEATING & COOLING
16000 SE EVELYN ST REQUIRED ITEMS AND REPORTS
CLACKAMAS, OR 97015
Phone: 503 650 - 9602
Reg #: LIC 71878
This permit is issued subject to the regulations contajped 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: I c U"YL
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.
FROM :A - TEMP FAX NO. :5035572990 Oct. 05 2005 12:02PM P2 /2
Mechanical Pe A licatio FOR 0F1 F l'SI: ONLY
City of Tigard °� -- � � Date/By: t /
/By: , V V 0 26 Permit No4 � - 0i , h ,3 1 ..... Date
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503, 598.1960, ' T ft:: l 2� o ( W <�, e•,: 1 , I Date/By: Other Permit:
Inspection Line: 503.639.4175 •
U s 1,1 ;1 � .la Data Ready/By: hi See Pagc 2 for
Sn emental Wormatlon
Internet www.Ci•tigard.er.us Notified/Method: ` PPI
CITY OF TIGARD
(��...., .� ( . !;:� m .�•'.nM `. ,.�...,, 1 ,: ; � 'i� ,;,,. ,�, ,_. ,. �,G �iif .. r.., �. {1� � 1,,•,;, r ,,.i. � �. _,,: g t .C.,. ,n .,m u naeu.u2Cl
[2 New construction :7.: A • dition/alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition 0 Other: mechanical materials a.ui.merit, labor, overhead and 'tofit.
`i ( I " " ' ) : }l, • ``�' '''',:i.''''' i C � i , Value S
,..,.., 1 ! S, l • �. � .�, ,�, ':.. ., • ,'. r, ,. (: , .,:. .. ' , , -_ ,. �};. , ,'�` ,.,,,, -..� � t t ., � ��t 1' �
M 1- - d 2- family dwelling 0 Commercial /industrial 0 Accessory building 1 " '` `'' " ' `� ` ''r'` " � °�' ' ' : ` .
For special information use checklist.
Multi - family ❑Master builder Q Other Description Qty. Ca_ Total
.. } i I., I n 1 .1: , ., . Hestia tiolln: _..,
Air conditioning or heat pump
Job site address (J � r
t �_ re. uirct tile ,lan 14.00
_____-_ '� - Furnace 100 000 BTU�ducts/venis II_ 14.00
City/State/ZIP: a . / ? � ,..
Furnace 100,0001: BTU Node /vents) 17.90 _
Suite/bldg./apt. Pro / Cpl'
g• /a P t. no.: J cct name: ( --„, o , .� l r _ Gas heat um 14.00
Cross street/directions to job site: Ductwork 16.00
Hydronic hot water system 14.00
Residential boiler (radiator or
h dronlc 14.00
Unit heaters (Iliel -typo, not electric),
in -wall In -duct sus. • nded etc, 10.00
-- Flue/vent for an of above •.111 10.00 L
Subdivision: _ Lot no.: Other: 10.00 -
Tax map /parccl no.: Other fuel appliances ,_, ._
.,,'.•.,:,',;'
pp I, ,77.;0. , , , }1,;',I.,:.,;,;,.:';;,'',;.71:::'. ` ,. i �
; � �
- T, %< p -,i t' I�I�I1�If,i Water heater 10.00
1.•� rr7,.1- ,fk•,I a ..,, 1 _.:5 __...-
ice ,•,....,., 11 Gas fire lace ,00
!iv 10
1 / - . j r Flue vent for water heater or gas
• I tire. lace _ 10.00
. Log lighter (gas) 10.00
Wood /.cllet stove 10.00 ,_
Wood fire .Iace/inacrt 10.00
, .00
l ,, i
.
�., �. :d., � I .1 � 4t r G, 1c r, .,„ (. ,< <) a,t i., _, ,. 'dy ,. •,w k Other: 10.00
Name: :-.? Environmental exhaust and ventilation
• ►�� Range hoo /other kitchen
Address: V so ;- :i- t't' -- at ._ _ c•ui.ment _10.00 _
City /State/ZIP: ` '0 C.' -) ..1•*' ..1•*' Clothes d r exhaust 10.00
Single -duct exhaust (bathrooms, -
Phone ( 6 Fax ( ) toilet eom•enmcnts unlit rooms 6.80
ry Alti ccraw/ls ace fans 10.00
, � , (.[ri ej i � 1 I n'��Ji + 1t il d ial �t g P! r� „ ?�+ it � -; i i it l r T� r { I { { l 1 i � + _{ 71 �� { p . , _.
r F (., ; : : :L ' ,' ? ' r �i a ∎,: ,.,:. .4,4 � Y r ' , t 1: ; t , a , � : ililf g (1i ><
Other: 10.
00
Business name: 0 . '' .r- L . . ' , , Fuel piping ,. _
Contact name: 55,40 for first four $1.00 for each additional_
Furnace, etc. _
Address: - a � � L „ ,. Gas Kent pump - --
City(State/ZIP: • '.�.1 Wall /suspended /unit heater
Water heater _ r Phone: ( )
Fax: ( ) �- Fireplace
E -mail: Range --
> F I i i i t , , . i I > Barbecue
,;-;,',;.i::,1 . „i, Sr,t` , ,;4f,.' , :),:0:: ,, -... 4 , : _ �' „ hi.,:: e,. k
Clothes dryer (gas)
Business name: . ^ ,Ak--1. /0_,L ia Other:
Address; . t.Q ® ) •-:, t_ 4 _Q 4 t Cam- 1 �` ,' S i '
{� J � Subtotal
City /State/7.1PCA CLQ (N`--(.C.. --'j 12:,61..,, G 70 l.< Minimum permit fee ($72,50)
Phone: ( j co q , (p C) Fax: 5j03 5 5 - �j- pZC�9, 0 �• Plan review (2594 of permit fee)
CCB lie.: t s `, _ State surcharge (R% of permit fcc) 4
." TOTAI, PERMIT FEE f
/ (_ f / This ptrmlt application expire+ if a permit la m obtained within I ac
Authorized signature: F . J A_S n \ Y deyt after It has been accepted as cempltle.
I
Print name: - . IA 1 . d aP
/ Date: i (� • ree methodology set by Tri- County Building Industry Service rhotrd
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