Permit GA CITY T Y ®F 1 I G A R® MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005-00554
n' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/7/2005
PARCEL: 1 S134CB -09100
SITE ADDRESS: 11145 SW 123RD PL ZONING: R -7
SUBDIVISION: ANTON PARK LOT: 053 JURISDICTION: TIG
Project Description: Replace furnace.
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: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
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
KAREN RATHKE Description Date Amount
11145 SW 123RD AVE
TIGARD, OR 97223 [MECH] Permit Fee 9/7/2005 $72.50
[TAX] 8% State Surcha 9/7/2005 $5.80
Total $78.30
Phone: 503 -557 -2220
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Phone: 503 -557 -2220
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Reg #: LIC 72623
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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: ' i ) 1 7 Permittee Signature: ; c''t ')\ •
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.
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Sep 05 05 02:50p Tri Count Temp 5035570919 p.1
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- lechanIcal Permit A-Wli,eafro.Ail E r9
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City of Tigard trAil t.-.0 6 Received.
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j, - . Permit NoW-ve 5-
13125 SW Hail Blvd., Tigard, OR 97223 „. Date/By: 9 ' 7 , 05 . ‘ ,... i .„,
Phone: 503.639.4171 Fax: 503.598.1960jtr 0 7 2005 plan Rcview
Other Permit: 1
Date/By:
Inspection Line: 503.639.4175
,„;AIII,;.-44: , Date•Ready/By: -
luris: El See Page 2 for :
Internet: www.ci.tigard.or.us
CITY OF TIGARD : Notified/Method: I" i ( Supplemental Information
BUDII\II frnSION ,
"iif-•:::'•-:W..r.-'2.t.'-.7...''''''_i'l;t:A.;;;IrrAiii:-;;.;;':::'-'7-''ItYllik`Ot,,**.',:f":*1;',"T':!''-::''''':':'-'-''''' '':'.:'' -*:.'''..:- '''. 1;:tt_I■NLIVLiiiC.Ekt. FER* USE taEcic...IsT
0 New construction XAddition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
• 0 Demolition P Other:
mechanical materials, equipment, labor, overhead, and profit.
''':.'"'",.:7.:1,1•.7.1.si:'..;• 2A .: 1 16:: I iiY*:6# - :6N's:Tiiiitl - ri6.rsi , '' .** '-' 7, .'; :--.--... : : : : ,, •-': . - ., '"i. 1 :•:* , - - ' - - - - '..'alue:_73 . •
1- and 2-family dwelling 0 Commercallindusial 0 Accessory buld
itriing
6,
1 lu lti-farnily 0 Master builder 0 Other: _ Description ,.;#01)::).01:.#4 ('SYSTEMS FEES*
For special information use checklist.
Qty. Ea. J Total
•••.:::.:„.:"...-•":-.-':':. ij"::..-::',:i:::-`.?'•rridii:_1i..i.io-icif614.1i6n$ tdCki-ioW.-.j--:''. HeatinWcoolin . 1
Job site address: I I 14 45 - 6W12- -f.--r‘l01117C) . Air conditioning or heat pump I (requires site plan showing placement) 14.00
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City/State/ZIP: mai 41122 Furnace 100,000 BTU (ducts/vents) I t 14.00 . ' .• ,
....
Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: .
Gas heat pump 14.00
Cross street/directions to job site: Duct work i 14.00
• 1 lt,•drorlic :lot water system : 14.00 ,
Residential boiler (radiator or
• hydronic) 14.00
Unit heaters (fuel-type, not electric),
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in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
I Other: 10.00 •
Tax map/parcel no.:
Other fuel appliances
"- .-.•••''."::.•:w'"•'-'•••:-•••iiykatitioieidsi".-4•34i., WORK .:, .:::.:Fi'...,,,,. -- ,. ,...., :. Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas '
1 i .
P , fireplace 1 10.00 1 :
ItI fireplace
1 Log lighte"(gas) 10.00
Wood/pellet stove • 10.00
Wood fireplace/insert 10.00
..•:. Chimney/liner/flue/vent : Chi 10.00
s'• ••% : iV: : : . "".:*•.* i ** 1i t-104:,41 ' ,.:•- -: " ? V,II . ,"• ; , ' - ' ..i. 1- ',' ' ",;n: 1 :':* • :FOI24:Nit ±,::',. .-',.: ."..,," Other .
10.00
Name: Karen ROCth KC
Environmental exhaust and ventilation
Range hood/other kitchen
1
Address: etainC
equipment • 10.00
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City/State/ZIP: Clothes dryer exhaust 1 1 10.00
Single-duct exhaust (bathrooms,
Phone: 60) ) 504- 6 zbz Fax: ( ) 1 toilet compartments, utility rooms) 6.80
. i%',i,.. i li - r;•;;;Z!i .. • : .4. , t0. ,- , 4iiii: c *, - t 07: 6 , 1 , 1 ..:, : s.- ? ..,.... :: , , , Attic/crawlspace fans 1000
Other: 10.00
Business name: Tr) Calfrry Tarp COatt-Oi Fuel piping
Contact name: biartcmastir, $5.40 for first four; $1.00 for each additional
Address: 000 S. C[a_ckairnao Rivcr-Timo , Furnace, etc.
Gas heat pump , i I .
1
i City/State/ZIP: OITC'On CI - N 0 tZ- q 7Q415 ,_ Wall/suspended/unit heater
Phone: (52) 557 y 290 Fax: : (52 ) 55 1 6/ Water heater
' 1 'Fireplace
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'E-mail:
., Range
::,E.:$1•:?;, k 1,.':-,'„f• • ,4::.: i k'',:klf'. ;;:f , ; k,.•.;::: : .I .*.i' , _ 4 .•:.•" - i•':i.k:Wdi'd'k".i.-:i="Wi - '•'':";,'-:4.41:14./.5.V.'•gf•i.''• • .f:'..:• • •::,'•cr'•;,••••i.•.'...:3i •• ; Ba
•"--•••••.&:"•it't =.-ili -_•. !.....,..:-•..-;- .i,,,,.,:.•::.,tr-'.ii.,::: -,-.-: i'•••-•:' ,p,-,i,„•.: -.,..:.1.-•
Business name: - Fri cc --Fc co Clothes dryer (gas)
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Address: 2 )1 ti 4l_r i q C KO rna5 Ri kir I rC '.', '''-'-''''' . MitetNiA.1,iA!iERIqi7F . .
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City/State/ZIP: oretion L C e_ (r77:-. Subtotal I
Mir.imum permit fee ($72.50)
Phone: (a: 55r- .222C: I Fax: ( EiC6 7 .- ( - ) ( 1, VI .
i Plan review (25% of permit fee)
CCB tic.: 72.4i Z,..
I State surcharge (8% of permit fe V
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TOTAL PERMIT FE
-,:?Z
Authorized signature: ' • 1 i
7.-Le i-77a.6 6-1Z--------. This permit application expires if a permit is not obt ' ed w - 30
days after it has been accepted as complete.
Print name: t,ia fie ma,50p) Date: 4 117105 • Fee methodology set by Tri-County Building Indusny Service Board
i. \ MEC-?crmitApp dot ;2/C3 . 4.40,.6I IT :11102:CONVW.7.11)
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CITY OF TIGARD
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BUILDING DIVISION ` PERMIT #: MEC2005- 00654
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/7/2005
Phone: (503) 639 -4171 h 14Pu0pll)ill';
Inspection Requests (24 Hrs.): (503) 639 -4175 =__I.
INSPECTION WORKSHEET FOR DATE: 9/20/2005 TIME: 7:07AM PAGE: 78
SITE ADDRESS: 11145 SW 123RD PL CLASS OF WORK:
SUBDIVISION: ANTON PARK LOT #: 053 TYPE OF USE:
PROJECT NAME: RATHKE
DESCRIPTION: Replace furnace.
OWNER: RATHKE, KAREN PHONE #: 5503 -557 -2220
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503 557 -2220
Inspection Request Scheduled For: Date: 9/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 016063 -01° 503- 557 -2220 Y
Corrections /Comments /Instructions: r—
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SS n PARTIAL APPROVAL n CANCEL 1 I NO ACCESS
FAIL n ALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
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Inspector: Date: 9 -2 -e ---- 0 O Phone #: (503) 718-