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Permit 'PI CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00522 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/22/2008 PARCEL: 2 S 110 B B - 00900 SITE ADDRESS: 12357 SW DUCHILLY CT ZONING: R -1 SUBDIVISION: AMES ORCHARD LOT: 016 JURISDICTION: TIG PROJECT: HAUSMANN Project Description: Replace existing 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: 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: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Owner: FEES RITA HAUSMANN Description Date Amount 12357 SW DUCHILLY CT TIGARD, OR 97223 [TAX] 12% State Surch 10122120C $8.70 [MECH] Permit Fee 10/22/20C $72.50 Total $81.20 Phone: Contractor: RUMBOLD HEATING & AIR COND INC I: 14214 FIR ST SUITE D OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS Contact #: PRI 503- 656 -0475 FAX 503- 656 -4572 Reg #: LIC 172897 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. _ . . (------ ,_ / Iss i Permittee Signature: i By: . /`/ / .ii P itt Si t g 11����1� Call 503.639.4175 by 7:00 a.m. for inspections th.t business • - y. 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. i Mecbinical Permit Application FOR OFFICE UStONLY - Receiv City of Tigard t Date/By 6 Moe Permit No , G(� 111 q L,� 90 g ._ 13125 SW Hall Blvd , Tigard, O' ',49:..t1.1• -�, t NV" Plan Review • Phone 503.639 4171 v 51 Other Permit Inspection Line 503 63'l ' ( Date /By TIGARD Date Ready /By NE M See Page 2 for Internet www.tigard - •v' a .1 : t%; ,. Notified /Method Supplemental Information _4 - TYPE 0F 0� ,, COMMERCIAL FEE* SCHEDULE — USE CHECKLIST � Mechanical permit fees* are based on the value of the work ❑ New construction ddi t T?/ cement performed Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Othe0- mechanical materials, equipment, labor, overhead, and profit ' , , CATEGORY OF CONSTRUCTION _ - ._. Value $ ' RESIDENTIAL EQUIPMENT / SYSTEMS'FEES * IS--I- and 2 -family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ Multi- family ❑ Master builder ❑ Other: For specsl information use checklist. Description Qty I Ea Total 4 _ s'. ` ; ° JOB,,SITE INFORMATION' AND ° , , ,' _ , Heating/cooling Job site address: 1 i / Air conditioning or heat pump 7 i °3 S 7 � K ! y C / (requires site plan showing placement) 14 00 City /State /ZIP: T 5 . u 2d -� ` f Furnace 100,000 BTU (ducts /vents) f 14 00 d 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 10 00 /� Q/J Hydronic hot water system 14 00 Eig Lrt Residential boiler (radiator or hydronic) 14 00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc 14 00 Flue /vent for any of above 6 80 Subdivision: Lot no.: Other ] 0 00 Tax map /parcel no.: Other fuel appliances DESCRIPTION' OF WORK - ' • Water heater 10 00 Gas fireplace 10 00 �7��GG e _-- • - i / 2, iLtiu4. 11 - h/e% Flue vent for water heater or gas fireplace 10 00 Log lighter (gas) 10 00 ' Wood /pellet stove 10 00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10 00 , _ ❑ PROPERTY OWNER , , • . ' , ` , 'El TENANT - - Other 10 00 Name: e) •-/-7q._ ilo i.t S 1I /4-1-1'\. Environmental exhaust and ventilation T Range hood /other kitchen Address: 2 31 7 b . - i--t,) L 1 C-4 equipment 10 00 City /State /ZIP: ' i, • aC. j 6YL g ? 2. -- y Clothes dryer exhaust 10 00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6 80 r. - ❑ APPLICANT, ' ,' - ' ❑ CONTACT PERSON - Attic /crawispace fans 10 00 Business name: Other 10 00 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: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR " , Barbecue J 1012, Clothes dryer (gas) Business name: `win i 1 1A ` vi Other Address: 14Z44 Ft-,, S..r_ Si,. i ! T> * . • MECHANICAL PERMIT FEES* City /State /ZIP: b c C ► ©, 9 '7,:-$4'S— Subtotal t Minimum permit fee ($72 50) Phone: (52):5 ) J77. O 7 j Fax: ba3) 6 SI 4 S 7—_ Plan review (25% of permit fee) CCB lie.: / 7 z s- 9 7 State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signature: 1-�, �✓ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: V ,c, k \ I _ c , Date: /O a -v a" * Fee methodology set by Tri- County Building Industry Service Boaid 1 \Buddmg\Permns'.MEC- PermitApp doe 01/19/07 440 -4617T (I I /02 /COM/WEB) Mechanical Permit Application - City of Tigard - Page 2 - Supplemental Information Commercial Fee Schedule: 'Total Valuation: Permit Fee: - _ A $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 each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1 ,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1 \ Building \Permits \MEC- PermitApp doc 01/19/07 2 E\.1 «. . `` ~~' CITY OF ��n w m v�pw mo��m��o��� BUILDING DIVISION PERMIT ~�~~^~~~�""~~= ~°"°"~~"~~"" #: MErC2008-00522 13125 SW Hall Blvd., Tigard, OR 97228 DATE ISSUED: 10122/2008 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 4 1 �� INSPECTION WORKSHEET FOR DATE: 12i1 ^ OOH TIME: J:ODAivi PAGE: 27 ' , SITE ADDRESS: 12357SWDU0f|LiY CT CLASS OF WORK: SUBDIVISION: AMES ORCHARD LOT #: 016 TYPE OF USE: PROJECT NAME: MA0SIvIANN DESCRIPTION: Replace iating furnace and heat pump. OWNER: HAjSMANN.R|TA PHONE #: CONTRACTOR: RUMBOLD HEATING & AIR CDNQINC PHONE #: 503�056.0475 Inspection Request Scheduled For: Date: 12112V2008 Pour Time: Code # Inspection Description Confirm # Contact # Message ' 699 KHedlanice|fioa| 078992 503'856-0476 N Corrections/Comments/Instructions: .• - | ■ / z a IDA:, ri PARTIAL APPROVAL -- CANCEL NO ACCESS III FAIL CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED I '-- / � ),, /�y� Inspector: ^ ^���-_� Oate� / �� �--/=~ Phmnm#� (5O3\718' — / ` ' ~11Ib '-