Permit 1r,
CITY TIGARD MECHANICAL PERMIT
Airtfr I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00395
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/30/2005
PARCEL: 2S1 04 DA -02400
SITE ADDRESS: 13469 SW 128TH PL ZONING: R -4.5
SUBDIVISION: QUAIL HOLLOW - WEST LOT: 010 JURISDICTION: TIG
Project Description: Furnace replacement and modify duct work.
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
MESHA ROPER Description Date Amount
13469 SW 128TH PL. [MECH] Permit Fee 6/30/200° $72.50
TIGARD, OR 97223 [TAX] 8% State Surchaq 6/30/200` $5.80
Phone: 317 - 966 - 9777 Total $78.30
Contractor:
OREGON HEATING + A/C INC
PO BOX 397 REQUIRED ITEMS AND REPORTS
DUNDEE, OR 97115
Phone: 503 - 538 - 2953
Reg #: LIC 125815
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. '
(. , , i,
Issued By: / L (4 A ifn, Permittee Signature:
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.
Jun 29 05 01:10p _ 503- 537 -2172 p.2
ECEWE
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Mechanical Permit Applic
��J FOR OFFICE USE ON
City of Tigard JUN 2 9 200[ Received 3 O 05 J / Permit No. /� __.Dl� _ 7 ) •
� Date/By: rJ V c v
13125 SW Hall Blvd., Tigard, OR 97223017 Pl R ev i ew
Y p F 7'1 Outer Permit:
Phone: 503.639.4171 Fax: 503.598 60 Gg Rp , + Date
V IL D I ^ I Dace Read •in lusts. E?( See Page 2 for
Inspection Line: 503.639.4175 N1.7 plV fir, � -- Ready /By: �"�l- `'` ""`- �m Supplemental v✓ww.ci.tigard.or.us Notified/Method: � � PP lementallnformation
;,•:%:':,:',...:':::...:...:.::...:,,:..;:,-.:::".-: .-..., 1::::::::-:;..::..,,,.:: ...1•. :E :OF WORI{ -ii: : = ;'.'' "r._ ,:.:.-.-,:,.::,-,:•:. , : _ _. COMMERCIAL `FEE *i:SGHx.Di1LE: = a1S ?
Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
Demolition El Other: mechanical materials, -. i.ment, labor, overhead, and .rotit.
':-::•::.:' .......::. ...... ... :::'':. :...G4TEGORY OF;CONST ° ..a;:�:. : ` ; : � . : ' . ::: : ; _ °.:' • ` : EQUIPM t k•I~ * :
1 and 2- family dwelling ❑ Commercial /industrial CI Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
' ,. .... ;: • ':JOB`SITE. : TNFOILnLAT'ION'AND I:O6 -:'•::':;:•:'...:.' .: Heatin cooling
(y[ y ) conditioning or heat pump
Job site address: t L /J f jS � "— (� (re.uires site . tan sltow•in •iacement) � 14.00 IIIII
City /State /ZIP: �` �j� �j' 7 '3 Furnace 100,000 BTU (ducts /.•cots) - ,I 14.00 111111 ' / "" It � Furna 100,000 +BTU (ductslvents) i 17
Suite/bldg. /apt. no -: Project name 14 heat .um. . NM
__ Cross street/directions to job site: Duct work 14.00 lirall
H dronic hot waters stem 14.00
Residential boiler (radiator or
hvdronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct sus. ended, etc. I0.00
Flue/vent for any of above 10.00
Subdivision: Lot no.: Other: 10.00
Tax map /parcel no.: Other fuel a. ltanees
„ :.: .:....:.:...:.. r
;: , : .: ..::': ::. .: :r : Sr: :`D Oi' 1:: OF"` WOIi�� ;
ESC}2dETT
...,:.:... ... . .... .. . .. Water heate
Gas fire.lace 10.00
/ t 6 �,t.ri' - ` ( ' � ' l (S�-t �- Flue vent for water heater or gas
mm I /� In , fre.lace 10.00
ill . • I ' I A .' 1 ''✓ U " Lo• li:hter :as) 10.00
Wood /.elletstove 10.00
10.00 _
.t . •P ERT toes, flue /vent . ROIY •:OWNE '
R. ;. : :, ::a:'. ❑ TEANF ::Pc , ;: :';a
10 -
.:..... :.: .,.. : i!:;.`;. "`' ` ' ';'N
' .:... -: Other 10.00
Wood fire• c ins rt
" Chimney/1" � _
Name: 1..3„6 ..k. Environmental exhaust and ventilation
Address: I A
/� Range hood'otlrer kitchen
1 (,�1 SIn) 1 lS/v` 19J v :.ui.ment 10.00
City /State/ZIP: —t �` 3 Clothes d er exhaust 10.00
�. �� iJ l ✓� r�' C7 -� Single duct exhaust (bathrooms,
Phor< I �) L (4> q � '7 Fax: ( ) toilet com.artments, utili • moms) 6.80
t
:.,--;,:%...,::,:;:!:;,;:;:i: .::.. • : .; : ,: .. ... , : .: t ctaw9 .ace fans 10.00
�!APl'LIG,AItT:: • . :
:-
❑ - - -
. . .,. : CONT' ACT ". PERSON':' > , c
l� it 1 l �` Other. _ 10.00
Businessname0/�6 ytr W Fuel •i.in;
Contact name: 11 } / 1 � J $5.40 for first four; $1 -00 for each additional
Address: .� (� Jot . Furnace, etc_
1 �, ( Gas heat .um.
City/State /ZIP: U v V n U. S Wall/su .ended/unit heater _ ==
Phone ) 3) V < 5 i a Fax:613) S 3-"7 Z/ 9-2_ Water heater
< Fire.lace
E -mail: Ran• e
a gy ecue
Business name: y * (f , h (1_,,G7-y. Clothes dryer ( • as)
Address: � r`` r6� /� I . : •
„. -..., : : M eRk -,IIC4 : FERhiiT ;: ;_
City/State/ZIP: :,'. , ;;;
td r1� V r L i 1 l L Subtotal mew
l Minimum permit fee ($72.50)
Phone: t<'.11 "1 1 u ( 9/7 4 Fax C3'7 7 Plan review (25% of permit fee)
CCB lie.: C � f V • t < State surcharge (8% of permit fee) N '. �� ,
�
i ` �IIa
TOTAL PERMIT FEE MINI
I • 1 , " • / C
This permit application expires if a permit is notobtaine. within 180
Authorized s':, attire:
days after it has been accepted as complete -
Print name: ,•h, it ' i B ► �, �l� ��� Date: '. lg ` Fee methodology set by Tri- County Building Industry Service Board
i:\Buildine\PamitslMEC- PermicAov doe 12/03 440 -4617T (I 1/02/COM'WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MIEf 20000395
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
6/30/2005
Phone: (503) 639 -4171 "Alt
Inspection Requests (24 Hrs.): (503) 639 -4175 !�i
INSPECTION WORKSHEET FOR DATE: 3/2005 TIME: 7:07AM PAGE:
9/2 89
SITE ADDRESS: 13469 SW 128TH PL CLASS OF WORK:
SUBDIVISION: QUAIL HOLLOW WEST LOT # 010 TYPE OF USE:
PROJECT NAME: ROPER
DESCRIPTION: Furnace replac :ement and modify duct work.
OWNER: ROPER, MESHA PHONE # : 317 - 966 -9777
CONTRACTOR: OREGON HEATING + NC INC PHONE #: 503 - 538 -2953
Inspection Request Scheduled For: Date: 9/2312005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 016397 -01 503- -638 -2953 Y /CV 1 Z
Corrections /Comments /Instructions:
i''' ► NI b& t- - Z 55'2 9 Z
l'i.F
1 K PASS Fr PARTIAL APPROVAL _ CANCEL n NO ACCESS
n FAIL r/ ` t LL FOR INSPECTION n ADDITIONAL FEES ASSESSED
p _ *Z. ' c
Inspector: L� �` Date: Phone #: (503) 718-