Permit A CITY ' OF ' TIGARD MECHANICAL PERMIT
i j � DEVELOP SERVICES PERMIT #: MEC2005 -00306
" �� - 1 3125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/7/2005
PARCEL: 1 S133AD -11700
SITE ADDRESS: 10732 SW 127TH CT ZONING: R -7
SUBDIVISION: AMART SUMMER LAKE NO. 3 LOT: 173 JURISDICTION: TIG
Project. Description: Replace furnace and heat pump.
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: 1 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
JUSTICE, CLARENCE J + PAULA S Description Date Amount
10732 SW 127TH CT [MECH] Permit Fee 6/7/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 6/7/2005 $5.80
Phone: 503 - 524 - 3737 Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97224
Phone: 503 453 - 4822
Reg #: LIC 62196
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: Ar_ l/li..._. Permittee Signature: 67'7'1 -44' Cik
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.
.. t . . . • . . .
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' Mechanical Permit ,, i --. D FOR OFFICE USE ONLY
a
' ---...'---- Datemy: --T •
13125 SW Hall Blvd„ Tigard, OR - 9722.3
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DatelBy •
' Other Permit:
:
Inspection Line:. 503.639.4175 JUN 0 6. 2005 ' 1 4 4 11, V
Date Ready/By: .
..1 : 0 See Page 2 for
Internet: Nyww.citigard.orus CT OF TIGARD Notified/Method: • - Supplemental Information
• •
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VOAMEtetlag - 1.0*.t.:11.mill4; mti.t0,,togssuqq.47.oa
. Mechanical mit fees* are based on the value of the work.
- 0 1\lew construction ddit ion/alteration/replacement
. performed. indicate the - value (rounded to the nearest dollar) of all
Ej Demolition 0 Other: . mechanical materials, equipment, labor, overhead, and profit.
Value: $
q..„ utpx.m., , ---..z:vvt.,,,,,.„
Ri'
I - and 2 dwelling 0 Commercial/industrial 0 Accessory building
• For special information use checklist.
0 Multi-family 0 Master builder 0 Other: -
Description 1 Qty. !- Ea. Total
iiRoci o‘owttiwOgrarall:§VON404.51114-S0 Heating/cooling
.
Job site address: (W7 - D. s. , -6 u t - 3- - 7 + 24- - Air conditioning or heat pump
(requires site plan showing pIacement)• i ' 14.00
City/State/ZIP: \ 13 Ck e 9 70-0-3 Furnace 100,000 BTU (ducts/vents) 1 14.00
/ . Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project aame: .g 6 s 1 1 -7
Gas heat pump 14.00
Cross street/directions to job site: t 5,... - -- 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
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: ' 10.00 .
•
Tax map/parcel no.: Other fuel appliances .
soo.:42700plivgitiorgroworget:04.t4goript W ater heater 10.00 .
Gas fireplace 10.00
Flue vent for water heater or gas
• fireplace 10.00
6 C.S2--"" Ps-Pif - Plet•Vv\. Log lighter (gas) 10,00
Wood/pellet stove 10 00
-
Wood fireplace/insert • 10.00
i ........................................................................................ i;;;.;,;-1.,..-,..i, Chimney/liner/flue/vent 10.00
:,-- Other
10.00
Name: -''Z- -A cc-- Z-t-v_5-4,--tc.)2.,-. Environmental exhaust and ventilation
Range hood/other kitchen
Address: t 0 - -... 3, 5 ut..) \ -
'_- 1_* . equipment . 10.00
I City/State/ZIP: '1:: ark A...IA / ( - Cc 2 . Clothes dryer exhaust . 10.00
Single-duct exhaust (bathrooms,
Phone: ( 50) 6 LI --• 3 -- 3-7 Fax: ( ) . toilet compartments, utility rooms) . 6.80
4P22 Atli eicravvis ace fans 10.00
Other: 10.00
Business name: ( 1 i y yk 4 e,. C a" .. .\.y . N ie:, \ •
Fuel piping ..
Contact name: - 1 `, 1- k- . 535.40 for first four; $1.00 for each additional
aCt" t CL,IN1
L - . -1 1143
Address: I L 5 c n 6 c ,...5._) -7 (D lAck i - Fumace, etc.
Gas heat pump ,
City/State/ZIP: ---," r .. # I fula 12 9 - 7 P-8(4 Wall/suspended/unit heater
Phone: (S3) 4/53 -ii eaos Fax: : (565 ) ei - 7 90...q. Water heater . •
. Fireplace .
E-mail:
Range
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ue :1)::::,:kik.i".:,:i,,t14.;'.:-.#5.-r:V2z•-A,,,,3:,,,,,e...-A,.Ittiiii..,.q:=A3W,...1a.i.:r.,7t3.:,i17q::11;i:Fg.il,riftlf=iii111:"..44. bec
•-• . ......,..734 , q:4:7.7,5":.7c:ial.;;,=41;; ; IV , 1:;.:1.:.-,,-;.;, ;I:4
Clothes dryer (gas)
Bushiess name: te... CAC) v . ( Other:
Address: 1 / 5 - 0 0 51)) - 7 - - te- - • tgg:*lpagaicfAYcaeftllW.#.4kg5.TENP:.U'iF
City/State/ZIP: r ...\-- , vck 0 ¶7 - . .. Subtotal 9....c .
i n fee
Phone: (G q S 3 - r-i 1, 0..,a,,...... . Fax: ( 5 Mm permit ($72.50) - 7 ..5
153) G I (05 - 71.- Plan review (25°,43 of pennit fee)
CCB lic.: ( a t 9 6,, • State surcharge (8% of permit fee)
- .e - ' . TOTAL PERMIT FEE 7c2 , 3c:.
Authorized signature: . ,, • This permit application expires if a permit is not obtained within 180 •
days after it has been accepted as complete.
Print name: .-3 <_- 1-4 , • I Date: 6 G 6 . , * Fee methodology set by Tri Building Industry Service Board
0 Building\Pen1its\MEC-PetmitApp.doc 12/03 440:4617T (11/02/COM/WID3)
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CLIMATE C-ATROL 165r7N 72nd Avenue Portland, OR 97224
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503-453-4822 FAX: 968-7224
HEATING & AIR CONDITIONING 503
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SYSTEM DESIGN INSTALLATION SERVICE MAINTENANCE
PORTLAND • 453-4822 VANCOUVER • 360-254-3063
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CITY OF TIGARD
BUILDING DIVISION - PERMIT #: MEC2005 -00306
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 61712005
Phone: (503) 639 -4171 � ■` ' n ���ttjIiiNlnt���'� °
Inspection Requests (24 Hrs.): (503) 639 - 4175
INSPECTION WORKSHEET FOR DATE: 6/8/2005 TIME: 7:12AM PAGE: 63
SITE ADDRESS: 10732 SW 127TH CT CLASS OF WORK:
SUBDIVISION: AMART SUMMER LAKE NO. 3 LOT #: 173 TYPE OF USE:
PROJECT NAME: JUSTICE
DESCRIPTION: Replace furnace and heat pump.
OWNER: JUSTICE, CLARENCE J + PAULA S, PHONE #: 503 - 5243737
CONTRACTOR: CLIMATE CONTROL INC PHONE #: 503-453-4822
Inspection Request Scheduled For: Date: 6/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 008713 -01 503- 453 -4822 N
Corrections/Comments/Instructions:
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❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 0 -'` Phone #: (503) 718-
•