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Permit CITY TIGARD MECHANICAL PERMIT e 1 DEVELOPMENT SERVICES PERMIT #: MEC2005-00629 �' e, I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/5/2005 PARCEL: 2S 102 BC -00110 SITE ADDRESS: 12505 SW BROOKSIDE AVE ZONING: R -4.5 SUBDIVISION: WALNUT ACRES LOT: 009 JURISDICTION: TIG Project Description: Replace electric furnace with gas 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: 0 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: 1 Owner: • FEES DIX, LOUIS JR + KATHI Description Date Amount 12505 SW BROOKSIDE AVE [MECH] Permit Fee 10/5/200E $72.50 TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/5/200E $5.80 Phone: 503 635 - 7818 Total $78.30 Contractor: A- WESTLAKE APPLIANCES & A/C 410 SW 2ND AVE . REQUIRED ITEMS AND REPORTS STE 20 LAKE OSWEGO, OR 97034 Phone: Reg #: LIC 75995 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 fol • - - adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 thr• .. OAR 952 -00 4100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 o 1- 800 - 332 -2344. / 1 ssued By: ,k �✓ ✓ �.'.��� Permittee Signature: Call 503 - 639 -4175 by 7:00 a.m. for inspection th��ess day. This permit card shall be kept in a conspicuous place on the job ...i a until completion of the project. Approved plans are required on the job site at the ime of each inspection. Mechanical Permit Application -FOR OFFICE USE ONLY iC f Tigard Received p l Date/By: 0 L1 L1 Permit No. / `_4,0.4, ' 06 / 9 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 /oc »a: ' Date/By. Other Permit: Inspection Line: 503.639.4175 ■ � II �� m ,... Date Ready/By: JurMi ®See Page 2 for Internet: www.ci.tigard.or.us = Notified/Method: MEW Supplemental Information 'TYPE OF WORK • _ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST 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 ❑ Other: mechanical materials, equipment, labor, overhead, and profit. - ' CATEGORY OF CONSTRUCTION Value: $ El 1 - and 2 dwelling RESIDENTIAL EQUIPMENT'/ SYSTEMS FEES* y g ❑ Commercial /industrial ❑ A ccessory building ❑ Multi-family ❑Master builder For special information use checklist. ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION • , Heating /cooling /,32.1.. �� W , / . ) n Air conditioning ho or heat a em Job site address: / !_"d ' /" (requires uires site plan showing placement) 14.00 City /State /ZIP: ` — A /T ^ / � Furnace 100,000 BTU (ducts/vents) -moo-- �� � `�' (/ � Furnace 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 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 DESCRIPTION OF WORK . • , Water heater 10.00 1 \ Gas fireplace 10.00 o_CiA '_I / .. ..014. III ! 1-hv Al / 4 Flue vent for water heater or gas _� fireplace 10.00 -��& , r APIA D Log lighter (gas) 10.00 . Wood /pellet stove 10.00 - Wood fireplace /insert 10.00 • ❑ . PROPERTY OWNER • - ❑ TENANT Chimney /liner /flue/vent 10.00 Other: 10.00 Name: Gt --/i f -��` Environmental exhaust and ventilation c ,� Range hood/other kitchen /.� Address: W / , c84 -- h �� � .e equipment 10.00 City /State /ZIP: ) �G, Ui Clothes dryer exhaust 10.00 �T Phone: ( / Single -duct exhaust (bathrooms, Fax: 6j 2�[� (03) (�� / 9 (.•) . toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) I Fax:: ( ) Water heater Fireplace E -mail: . Range ' ' CONTRACTOR o•. - Barbecue Business name: , -/// / ^ D / „ f /�' /��,, r- Clothes dryer (gas) ��' VVV���"'t"�' � / , `-r ( l moo” -t � Other: Address: /(,) `� vV /I pt., PERMIT FEES* City /State /ZIP: J_ cu ,.� 6 J '7 © 3 S% Subtotal / Minimum permit fee ($72.50) f. 6 Phone: '� �( -7,/ Fax: ) Plan review (25% of permit fee) • CCB lic.: '76 7 , /�b State surcharge (8% of permit fee) 54 V f O �) /0`rJ TOTAL PERMIT FEE obtained w i Authorized signature: �( � t. Th permit application expires if a permit is not obtaine within 180 days after it has been accepted as complete. Print name: \j/2/ '40 / Date(Q ,—,s---- � • Fee methodology set by Tri- County Building Industry Service Board • i:\ Building\Permits\MEC- PermitApp.doc 12/03 440 -4617T (I I /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: • Total Valuation $1.00 to $2,000.00 \ Minimum fee $72.50 • $2,001.00 to $5,000.00 `$72.50 for the first $2,000.00 and $2.30 for -ach additional $100.00 or fraction there. to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 or the first $5,000.00 and $1.80 for e. additional $100.00 or fraction thereo , o and including • $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,11 1.00 and $1.35 for each additional $101.:1 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.11 and $1.25 for each additional 10.00 or fraction thereof, to and • cluding $100,000.00. $100,000.01 and up $1,396.50 for the st $100,000.00 and $1.10 for each at . itional $100.00 or fraction there. . Note: All new commercial bu' dings require 2 sets of plans. • • i:\Building \Permits\MEC - PermitApp.doc 12/03 2 - CITY OF TIGARD BUILDING DIVISION PERMIT #: MEC2005-00629 13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 10/5/2005 Phone: (503) 639 -4171 i Inspectio n Requests (24 Hrs.): (503) 639 -4175 . INSPECTION WORKSHEET FOR DATE: 10/26/2005 TIME: 7:07AM PAGE: 17 tit 1„/4 -LN SITE ADDRESS: 12505 SW BROOKSIDE AVE CLASS OF WORK: SUBDIVISION: WALNUT ACRES LOT #: 009 TYPE OF USE: PROJECT NAME: DIX DESCRIPTION: Replace electric furnace with gas furnace. OWNER: DIX, LOUIS JR + KATHI, PHONE #: 503 - 635"7818 CONTRACTOR: A-WESTLAKE APPLIANCES & A/C PHONE #: Inspection Request Scheduled For: Date: 10/26/2005 Pour Time: Code # Inspection Description Confirm # Contact # Mes - t 699 Mechanical final 019406 -01 503 - 880-3900 0 Ael Corrections /Comments /Instructions: R6-1>°- t o - Z w' eY. ( z S c'.oj r6v' 1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I I FAIL 7 ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED / i . Inspecto 1 _ — Date: b,6-0 0 Phone #: (503) 718 - A CITY (WTI-GARD MEC200 00629 BUILDING DIVISION PERMIT #: 10/5/2005 ' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 �Ipypi" Inspection Requests (24 Hrs.): (503) 639 -4175 :.' � — ' 10/24/2005 7:02AM 25 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 12505 SW BROOKSIDE AVE SITE ADDRESS: WALNUT ACRES 009 CLASS OF WORK: SUBDIVISION: DIX LOT #: TYPE OF USE: PROJECT NAME: Replace electric furnace with gas furnace. DESCRIPTION: DIX, LOUIS JR + KATI-II, 503 - 635.7818 OWNER: A- WESTLAKE APPLIANCES & NC PHONE #: CONTRACTOR: PHONE #: 10/24/2005 Inspection Request Scheduled For: Date: Pour Time: C% # ImrPhctmorapten Sription Sgigt t 89-tg11900 Me age Corrections /Comments /Instructions: a 'r` i-a" O5 ( - z Z7 \E 6i g Z 6 P , J F d'i "< ,,/C1,46v- V� ai X n.i i r --- 1,/2- kI4-e4 - , Hips ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS FAIL I CALL FOR INSPECTION I 1 ADDITIONAL FEES ASSESSED Inspector: Date 6 — f- -) Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MEC200G -00629 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/5/2005 Phone: (503) 639- 4171n��4N Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/26..J2006 • TIME: 7 :07AM PAGE: 16 SITE ADDRESS: 12506 SW BROOKSIDE AVE CLASS OF WORK: SUBDIVISION: WALNUT ACRES LOT #: 009 TYPE OF USE: PROJECT NAME: DIX DESCRIPTION: Replace electric furnace with gas furnace. OWNER: DIX, LOUIS JR + KATHI, PHONE #: 503 635-7818 CONTRACTOR: A- WESTLAKE APPLIANCES & NC PHONE #: Inspection Request Scheduled For: Date: 100 Pour Time: Code # Inspection Description Confirm # Contact # Message 610 Gas line 019406 603 - 880 -3900 V Corrections /Comments /Instructions: - / 3 lc -14441A). • Ej PASS El • = RTIAL APPROVAL n CANCEL ❑ NO ACCESS FAIL = L FOR INSPECTION I I ADDITIONAL FEES ASSESSED /0 G ° Inspector: . , Date: Phone #: (503) 718-