Permit j ^r
CITY OF TIGARD
MECHANICAL PERMIT
��� DEVELOPMENT SERVICES PERMIT #: MEC2005 -00181
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/20/2005
PARCEL: 2S103BB -11400
SITE ADDRESS: 12145 SW 123RD CT ZONING: R -4.5
SUBDIVISION: YE OLDE WINDMILL LOT: 033 JURISDICTION: TIG
Project Description: Installation of A/C.
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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
WEBB, THOMAS E AND JUDY A Description Date Amount
12145 SW 123RD CT
TIGARD, OR 97223 [MECH] Permit Fee 4/20/200: $72.50
[TAX] 8% State Surcha 4/20/200E $5.80
Total $78.30
Phone:
Contractor:
ANCT1L SHEET METAL CO.
4320 N WILLIAMS AVE
PORTLAND, OR 97217 REQUIRED ITEMS AND REPORTS
Phone: 503- 281 -0752
Reg #: LIC 8897
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: .�
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business aay.
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.
vlecnanicai _vermin Application , • .,... FOR OFFICE.USE ONLY -::. '.:.; •: • .
4 iiy of Tigard � �' Receives )� � ,/�JJ Perm No.. o
3125 SW Hall Blvd., Tigard, OR 97223 R C Y ' - , Date /By; (7 `t� `). -961— t` �6C-..2odS 0/ Q l
Plan Review
'hone: 503.639.4171 Fax: 503.595.1 960 ri)rn" .
nspection Line; 503 639,4175 APR 1 g 4 n ,� l� l .', DateB
Other Perm's;
' ,__ Dalt Ready /By: suns: GI Se. Poge 2 for
nternet: www.ci,tigard.or.us rrotifiodiMethod; T1 ( Supplemental Inform:Won
• CITY OF TIGARD 1
• TYPE 0 �1(A$1' 13 DIVISION COMMERCIAL FEE` SCHEDULE – USE CHECKLIST
New construction ,�) Addition /alteration/r Mechanical permit fees" are based on the value of thc work
performed. Indicate the value (rounded to the nearest dollar) of alt
Demolitiotr ❑ Other: performed.
materials, equipment, labor. overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special inforn)ation use checklist.
❑ Multi family ❑ Master builder ❑Other:
--- Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Iteatin: /coolie_ •
G Air Conditioning or heat pump
Job site ad dress: 5
_,S a 3rd C (requires site plats showing placement) l 14.00 ly Da
City /State/ZIP: QCQ c i 2- 3 Furnace 100,000 BTU ( ducts/vents) 14.00 •
t {J,* Furnace 100,000• BTU (ducts/vents) 17.90
Suite/bldg./v t. no V Project name: _
_ Gas heat . urns 14.00 •
Cross street/directions to job site: v � Duct work 14,00 MI
— ' H dronic hot wafers stem ■ 14.00
.. , Residential boiler (radiator or
1 i15\ -6-9-0-- A' hydronit:) 14.00
/ .... Unit heaters (fuel -type, not electric),
in -wall, in -duct, sus :ended, etc. 10.0Q
Subdivision; T.0[ no.: Flue/vent for any of above 10.00
_ Other: 10..00
Tax map /parcel rlo.; Other fuel alaelanees • •
DESCRIPTION OF WOR1 Water heater 10.00
Gas fireplace .. - 10.00
Flue vent for water heater or gas
r _ fireplace 10.00
— - Log li *hter(,as 10.00 •
Wood/.ellct stove 10.00
Wood fireplace /insert 1111 10.00 IIII
Chintne /liner/flue/vent 10,00
El PROPERTY OWNER 0 TENANT
Other:
Name:
Environmental exhaust and ventilation
�� Range hood/other kitchen
Address: f' Cory--4 e. ui . ment 10.00
City /State /ZIP: tt C� Clothes 4 cr exhaust .
.. — Single -duct exhaust (bathrooms,
Phone: ( 666) ,3 �f b -- 0 i ,33 Fe1e (5os) 74 1 -- 3 (o toilet cam . artments,.utility rooms) 6.S0 ^
❑ APPLICANT C ONTACT PERSON Attic /etawts• ace fans _ 10 -00 1
Other: _ 10.00
1 Business name: Fuel e ipin g
Contact name: 12. O L --- $5.40 for first four: $1.00 for each additional
Furnace. etc,
Address= _ Gas heat pump II
C —"
City/State/ZIP= Wall /sus .ended /unit heater
• Water heater
Phone: ( ) fax :: ( ) Fire. lace
i E-mail: Range
E IIIIII
I CONTRACTOR Barbecue
Clothes d er tas)
Business name; , k 4` t , 14e. Cc , ■ . R v. . , & Other:
MECHANICAL PERMIT FEES'
Address; l -
let ` ( S Subtotal
I City/State /ZIP: nC t { ( ��_._ Minimum permit fee (572.50) 7 _
3 )
i Phone: ( p n1 Z Fax' ( ) a - - 5 Z-.� — Flan review (25% of perm feu)
.. 5 , state surcharge (8'%, of permit lee) �, 1
i.(B re.: TOTAL PERMIT FV -E _7 - o -
-___ Tltis Permit uppltcatian espircl if a permit is net ubtitined eithin ltla
days after it hat: beet% �c cepted as e(mptcte.
AtII1\Ol'I /.id SI Ilillll'C. _ __ - -- — —" 1 Tn -C oUntY f3ulldiei: lndu;v;. $c'ru'et R''''d — —.. I 'cc 1»c tlludplo )' gel by •
) Pfeil naine'. — --
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E SHIPPED SHIPPED VIA • TERMS SALESMAN F. O. B. OUR ORDER NO.
)UANTITY DESCRIPTION UNIT PRICE AMOUNT
SHIPPED
•
PROMISED PERMIT AREA NUMBER
C. H. N
'ANEL AMPS OTHER SUBS AS INFO
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TECH COMPLETED
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005^001$1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2005
Phone: (503) 639 -4171 i I nspection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: 7/1/2005 TIME: 7:14AM PAGE: 88
SITE ADDRESS: 12145 SW 123RD CT CLASS OF WORK:
SUBDIVISION: YE OLDE WINDMILL LOT #: 033 TYPE OF USE:
PROJECT NAME: 1A/EBB
DESCRIPTION: Installation of A/C.
OWNER: WEBB, THOMAS E AND JUDY A, PHONE #:
CONTRACTOR: ANCTIL SHEET METAL CO. PHONE #:• 503 - 281 -0752
Inspection Request Scheduled For: Date: 7/112005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 010384 -01 503- 740 -3635 Y
Corrections /Comments /Instructions:
p , 1,uloiI- , sC. _ 4S / 6 q ,6/9-AzczYi
PASS n PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
❑ FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Date: �� ---- Phone #: (503) 718-