Permit 4 it CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00803
�' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/6/2005
PARCEL: 1 S133DC -04600
SITE ADDRESS: 11558 SW 133RD PL ZONING: R -12
SUBDIVISION: BRITTANY SQUARE NO. 1 LOT: 004 JURISDICTION: TIG
Project Description: Replace heat pump.
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:
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
PAUL JOHANSEN Description Date Amount
11558 SW 133RD PL
TIGARD, OR 97223 [MECH] Permit Fee 12/6/200; $72.50
[TAX] 8% State Surcha 12/6/2000 $5.80
Total $78.30
Phone: 503- 682 -2252
Contractor:
OREGON HEATING + NC INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -538 -2953
FAX 503 -537 -2172
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.
Issued By: 4 ; Permittee Signature: _I-e,-C., C6T
Call 503 -63 9 -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.
Dec 05 05 04:42p 503 - 537 -2172 p.2
Mechanical Permit A tic -at a FOR OFFICE USE ONLY .
City of Tigard Received ,/
Date /B y : r l I Permit N i • : / �(� ",
i _
13125 SW Hall Blvd., Tigard, OR 97223" Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 0 VA /[ ` Date /By: Other Permit:
t
Inspection Line: 503.639.4175 C r ex f a Date Rea dy /By: J t r 8 See Page 2 for
E C Supplemental Page2 for
Internet: www.ci.tigard.or.us D p II t y Notified/ ,�
1 �
, r�
F
VW
l�
:,..; ::': '.: :..'�. :: 1:(1)V-...: " ;:' :.:., '::•.,.-,: .coivv ltci , ,::.. 1
.....,;''..,':•:.;:'.- ., AL F l0nULE. . .... :.. ,..
E] New construction It OTh � ion /replacement Mechanical permit fees* are based the value of the work
performed. Indicate the value (rounded d to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
•_ : GATE O P: CONSTRUCT101� :: :.:,';',`;:1'.,:: ' -;
EQUIPMENT ;'- SYSTEMS
_ ...:.RESIDENTIAL:. ......FEES`:;`:`
DT- and 2- family dwelling Cl Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total
:.. ....... . .. .rOB: SIT:E1 I21YT D
�AN LOCI? �TION "'.'_` .. Tieating / cooling'
: d Air conditioning or heat pump
Job site address: � � I YG l / (requires site plan showing placement) I 14.00 •
City/State /ZIP: 1 lit V4 ' `' 93.3 Furnace 100,000 BTU (ducts/venrs) 14.00
Furnace 100,000+ BTU (ductsivents) 17.90
Suite/bldg. /apt. no.: Project name: ,.!)beat pump / t 14.00 1 ( - _
Cross street/directions to job site: Duct work 14.00
Hydronic bat water system 1 14.00
Residential boiler (radiator or
hydronic) , 14.00
Unit beaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision. Lot no.: Other. I 10.00
Tax map /parcel no.: Other fuel appliances
la oo
a er ea
°cif .. ..:.... . . .. , I:• ....n .._:..., ...::, Gas fireplace 10.00
I 1 1 l � iL ,� _ i k�i i V," iv G ,Lj, nt .2 Flue vent for water heater or gas
{ J 1 fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
;: Chinmey/iiner /IIue/vent 10.00
R OPERTY.. .:0�3r ®'TE?�F NF''..t
::; - '::t. ...,., P - :.,._. .........,._.., .: �.. . ;�: :. �' .. ., 10.00
..,., .., �....,_,.. _ .... ,.. ��� �' :. Other.
Name: , GL
//' f ] � t r r i GL % � �� ' Environmental exhaust and ventilation
� � (✓
� � Range hood /other kitchen
Address (( � r L I equipment 1 10.00
City /State /ZIP: t i t ( / Z i g 1 3 :3 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ') 16 : ] AV i' Fax: ( ) compartments, utility morns)
� / rc craw p ace fans
ore co
SA:PERSON;,:'`;; ' ,:;'�,; At1 1 s a 1000
III -.:..: ': r. 4 a _ : .,. . �, :;... Other 10.00
Business name / AA 1:1 / � . ..� � S U i l�'-4 Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
, ' � , , Furnace, etc.
Address: ' y F"1D� °3Q, r-� I Gas heat pump
City/State /ZIP: U /l U Ire Q V V- ( 4n ' I, S � - Wall/suspended/unit heater
/ . - / - Water heater
Phone � , ) 41 •� ` _ Fax. _ . 1 j 1 � Z Fireplace _
E -mail: Range
t : G � RACTOR,:;, . .:'.:::: :. : < ::,,. ' Barbecue
q:';',.: ... :, . �l':::...:'''.;.:,:',:.:.,:,-.-:.:,, ; ` . . � : ..` . . , . . Clothes dryer (gas)
Business name: ' . 4,/t / / �� / / C . / Other i l
Address: . j r) _ MECHANICAL:.PERtyIIT.FEES ;'2 -
City/State /ZJP: . ! fi ' / 6 n c`c Subtotal
. t Minimum permit fee $72.50
Phone: )/) C 3 ✓ z ; _ Fa - 3 , cS 37 017 7 Plan review (25% of permit fee)
CCB lie.: M1 � " State surcharge (8% of permit fee) 5 , SL
TOTAL PERMIT FEE ]
J � ( � ^7 � l This permit a pplication expires if a permit is cot obtained within 180
Authorized sirmature: t f l {)I 15 1 6 G�4_ = 6, - days after it has been accepted as complete.
Print name: I � r `�
l ) Date: I A j g ` Fee methodology set by Tri- County Building Industry Service Board
i_\BuiIdjneWcmiis\ EC- PcrmiAvt,doc 12/03 440.4617f (11 /02 /COM/WEB)
5
Dec 05 as 04: 42 p 503-537-2172 p.3
,.,
r -
P) s,
0
v
A
k
1 :
i 1
1 . 1
1
1 .
1 .
i t
--...
0 :
t _ .
i .
•
1 .
____________
171
Ts
i
.
.._
..__. .
... ,.... ....... . _._.,.....„.
______---_________________________._.___•.--
l
CITY OF TIGARD fl1 C
BUILDING DIVISION PERMIT #:a0Y5 d C$d3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 1 ai Nip ( '
Inspection Requests (24 Hrs.): (503) 639 -4175 �'' �,
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ! 53- g /3 3,4d /'- - CLASS OF WORK:
SUBDIVISION: / LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: / — a 3 -0 e II Pour Time:
Code # Inspection escription Confirm # Co act "J Message
(0 ? •
o a 1 -ol cce.)2.6Rot...t
Corrections /Comments /Instructions:
0
/ tat
-. 11 ice:_ v
1 f )tk ________
t -----
•1W
1.
PASS I I PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i , i k Date: I e Phone #: (503) 718- Z7-
CITY OF TIGARD
A :
BUILDING DIVISION PERMIT #: MEC2005.00803
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/e4200b
Phone: (503) 639-4171 a M ° .1 1 1130°111
Inspection Requests (24 Hrs.): (503) 639-4175 AU- li,
INSPECTION WORKSHEET FOR DATE: 1/2012008 TIME: 7:00AM PAGE: 105
SITE ADDRESS: 11558 SW 133RD PL ,,' CLASS OF WORK:
SUBDIVISION: BRITTANY SQUARE NO, 1 LOT • 004 TYPE OF USE:
PROJECT NAME: JOHANSEN
DESCRIPTION: Replace heat pump.
OWNER: JOHANSEN, PAUL PHONE #: 503.8812252
CONTRACTOR: OREGON HEATING 4 NC INC PHONE #: ,5113-638. 2953
Inspection Request Scheduled For: Date: 1120/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 P M
699 Mechanical final 025296-01 503-538-2953 y
ea2._ 2
Corrections/Comments/Instructions: Leas 4- Tim's> . _ 704
0 C ez.frj X - ..E.,
/
2, 4/ (
-
I I PASS 0 PARTIAL APPROVAL fl CANCEL ki NO ACCESS
K FAIL It CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspectot
d Date: / g9 &‘ Phone #: (503) 718-