Permit -- h
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00830
�LII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/23/2004
PARCEL: 2 S 103 DA -02600
SITE ADDRESS: 10760 SW DERRY DELL CT
SUBDIVISION: DERRY DELL PLAT 2 ZONING: R -3.5
BLOCK: LOT: 028 JURISDICTION: TIG
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:
GAS 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: 2
> 10000 cfm: GAS OUTLETS:
Remarks: Convert from oil to gas furnace, install gas fireplace & new water heater.
Owner: FEES
STOUDER, CHARLES H TR + Description Date Amount
SUSAN K [MECH] Permit Fee 12/23/20( $72.50
10760 SW DERRY DELL CT [TAX] 8% State Surchar€ 12/23/20( $5.80
TIGARD, OR 97223
Phone: 503 620 - 8076 Total $78.30
Contractor:
REX HEATING & AC
14015 SE STARK
PORTLAND, OR 97233 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 66418 Heating Unt Insp
Final Inspection
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.
Issued By: p Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nextLsiness day
12/23/2004 10 01 FAX 5032576317 REX HEATING AND AIR CONO ZJ003/003
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ermit Appl'
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City of Tigard E® _ y Received _ _ /
a • Date/By: `, ` PermitNO C 0 13125 SW Han Blvd , Tigard, OR 97223 _ y �3
Phone, 503,639:417I Fax. 503.598.1960 ,,,It Plan Review
,tlt ° a� Date/By; Other Permit;
Inspection Line; 503.639.4175 ]J � Date Rea /B
Internet' www.ei.tigard.or,u9 y S See Page Z for
Notified/Method' Supplemental information
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❑ Ncw construction ►7 Addition /alteration/replaeement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
12 Demolition ■ Other:
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1- and 2- family dwelling ❑ Commercial /industrial li� ! }1 1i � r , U r. � l l.,,;,,..��„ ��(EI?r .l.`lfil. 4 N ;. ;, � , , -
16
❑Accessory building
Multi- family ❑Master builder ❑Other: For special informatlari use checklist,
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l�eatln cooli'n
Job site address: /Q7O 6 L f ., r l Air conditioning or heat pump
I (requires site plan showing placement) 14.00
City /State /ZIP: i s, a, d S f( is Fumaee 100,000 BTU (duets/venn) _ 14.00 ILL Oa
Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17,90
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 -
hydronle) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in-duct, suspended, etc, 10.00
Subdivision: Lot no.: Flue /vent for any of above
10.00 10, DO
Tax map /parcel nu,: 1 ,00
Other;
0
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Other fuel appliances
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Gas fireplace 4.„ 10,00 lo. 00
a n ft, (O fat O i • 9 4S uf - "te • CL, Flue vent for water heater or gas
L4.2 U_ • / 0 / fireplac . 10.00 2a. p
Log lighter (gas) 10,00
Wood/pellet stove 10.00
Wood fire place/insen 10 -00
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l I �i 1 1. , `� 6� ltii A(r f / n 1 I � r i � r � „I � 4 1 r 1 Si e > rl�ii Ir[i 1 - S^ICi ttl rtm Y call� r I Chmine / liner /tiLLe/Venf
lays « ,11 jI i4 I �1 `1I i�,P, 4 r s l I S l 1, 11 1 7 ai , l '+ Lt 1 4i } y 10.00
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Name: ; t - 4 .. C
Other: 10.00
,� C` obt,c,te,K environmental exhaust and ventilation
Address: 0 60 w ■ , r ■ , r , Range hood/othcr kitchen
equipment 10.00
City /State /ZIP; /• ., rd • 9 '.z-3 Clotlescol cr exhaust 10.00
Phone: (03 U — „CO (!p Fax: ( t (b athrooms,
Single-duct exhaust
toiler compartments, utility rooms) 6.80
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;'i I ,..�,..: ,:rkl .ill } .,.._ .l. "S. " + ',^at Is .�� { : ,y -',l; , ttis N I!�ll It. YLI rl I !lr ,'r1,, I. e /crawlspace fans 10.00
:. .. ....: .. .. .. :,.... J_� ... rt d.u.,r. Ill ' 11 .v .,.:..'._.a::.. ...'
Business name: Other; 10.00
Fuel piping
Contact nano; $5.40 for first four; $1.00 for each additional
Address: Furnace, etc. I S too /-../1°
Gas heat pump
City /State/ZIP: Wall /susoended/unit heater
Phone; ( ) I Fax: : ( ) Water heater I
E -mail: Fireplace
R,11,
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a.., ....,..,_ .sr...,_.., xIO..,r..�_ tar, ... .._, alai 1 lE. Yr :rrvL4r.,c.,.,.Gi�.L Barbecue
Business name: ge r , .a /1 td 4/e Clothes dryer (gas)
Other
Address: /'- /Q /5" J Y L ` ^ i , .1,t h 11 , , yr.,;;;;,,,, r : r rl i • 1 ^
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City/State/ZIP: 'P . a . 1►: ' a 3 Subtotal t
Phone: 68 )25S" _7, 3 Fax; (93 ), ' 3 Minimum permit fcc (572,50) 2 • •
CCB lie.: , / _ Plan review (25 °/s of permit fee) �,
State surcharge (8% of permit fee) $p
TOTAL PERMIT FE :.:. 1,'30
Authorized Signature: This permit application expires if a permit Is not ohtiined within 150
` days after It bee been accepted as complete.
�L • D / a • Date: 0 , - Fee methodology set by Tti -County Huilding Industry Servo Board
r. Suildmg\PerminlMfC- PermligOpdo; 12/01 4d0.1617T(Ill.'COMAVEB)
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received / 7 / 7 Date Re uested ( 1 /� AM PM BUP
l
Location 6 ' 6 vG 4- Suite MEC 2 (r OC g3O
Contact Person Ph ( ) . SS 7x33 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes - _ SIT
Post & Beam C f " `� - LI
Jams- ?�.�'-
Shear Anchors L `--- --- -
Ext Sheath /Shear � ' 0 a
kit Sheath/Shear —
q I FL-- Framin V Y l l �(,. Jl/�
Insulation (� �.� 0 O — 4 Od 1' 5 (
(
Drywall Nailing l ��
Fi reveal l C.41,5 r/ 5 €- t /.Y 74 � ( n
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof 6 of � ( t.A
Other:
Final
PASS PART FAIL i(Lo PLUMBING ° ° t \ \ 0 ( '~ G ,
Post &Beam C 4:\-1 � d
Under Slab \ C. (
Rough -In *AO
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: 'YJ
Final
PART FAIL \L Co 12)
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
ina \i/\)\
- PART FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
g
PASS PART
_ _ El Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date - ° 5 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record f om th ob site.
PASS PART FAIL