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Permit - CITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2005-00035 - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/24/2005 PARCEL: 2S103DD -00420 SITE ADDRESS: 10825 SW FAIRHAVEN WY SUBDIVISION: FAIRHAVEN COURT ZONING: R -3.5 BLOCK: LOT: 013 JURISDICTION: TIG 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: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: 1 Remarks: Gas to range. Owner: FEES SAMPLE, SUE & AL VARNES Description Date Amount 10825 SW FAIRHAVEN WAY [MECH] Permit Fee 1/24/200 $72.50 TIGARD, OR 97223 [TAX] 8% State Surchart 1/24/200: $5.80 Phone: 503 620 - 5231 Total $78.30 Contractor: MODERN PLUMBING CO D + D ACQUISITIONS INC 11120 SW INDUSTRIAL WAY REQUIRED INSPECTIONS TUALATIN, OR 97062 Mechanical lnsp Phone: 691 - 6166 Final Inspection Reg #: LIC 00087906 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)246 -6699. Issued By: / �� �. / Permittee Signature: �)-- Ce Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day 01) 16:56 5036916771 MODERN PLUMBING PAGE 01 DITZ eLanical Permit A ts �E �i FOR OF 1:1(' I.1. USE. ONLY of Tigard I D j _ .Iy -o 5 P6 permit Nein_ _ 4! —eve) 3,5 B T . 13125 SW Hall Blvd., Tigard, OR 97213 Plan Review Phone: 503.639.4171 Fax: 501598.1960 h= Inspection Litre: 503.639.4175 JA 21?,'',,,,,-,, 1 y�"N `� i t Date glltar Pm [niL ,, .+ . i. ' „ ^,,,, Date iteady/$y: El See Page ? for Internet: www.ei.ti�d.or.us CITY OF TIC - Notified/Method: EN Supplemental 'Information BUILDING nIVISION . TY PE Q F . FVORK ': COMMERCIAL .PEE* SCH0: HOLE - `USF CHECKLIST 171 New construction 1Addition /alteration/replacernent Mechanical permit fees' arc based on the value of the work performed. Indicate the value (rounded, to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit ... CATEGORY OF CONSflt*JCrION Value:$ 1 }O'0 E, 1.. and 2- family dwelling ❑ Commercial/industrial Accessory RESIDENTIAL .IEQUI.I'1Vl> N'C' 1 8Y�'rlh:MS.1 k S :'' ❑ essotY building � . © Multi-family builder ❑Other: For special iryjormari?n use checklist_ Description 1 Qty. 1 Ea. I Total . . JOB SITS INFORMATION AND LOCATION • ' Heating/cooling Job site eddresy: /� '} {{ r hove Air conditioning or heat pump I O as � i 5 v) T"' Ci' % r r U)o _ requires sire p ..... -- lan allowing placement) 14.00 City/State/ZIP: } `are J - Furnace 1 ETU (duets/vent -0 14.00 t fbldg. /apt. no.: Project name: Furnace 100 0004- BTU ducts/vents ' I Suite/bldg./apt. Q ��� I �. Cat heal' pump 1.4 rin Cross street/directions to job site: Duct work _ 14.00 Hydranic het water .system 1.4.00 - Residential lmiler (radiator or h drone 14,00 Unit heaters (fuel -type, not electric), in - wall, in duct•, suspended, etc. 10.00 . ... Subdivision f Lot no.: Flue/vent for a of above 10.00 Other; 10.00 Tax map /parcel no.; Other fuel a .. lances . • - DESCRIPTION OF WORK . . Water heater - . 0.00 • S Gi Oas fireplace 10.00 l-. Q vm Plus vent for water heater or gam fire . lace 10.00 Log lighteras) 10.00 Ili Wood/pc:ttct stove _ r r r Wood fire .lace/insert 10.00 :El PROPERTY OWNER 0 TENANT Chimney/liner/flue/vent 10.00 I . Name: A .e-- ` Lie •l Environmental exhaust and ventilation A,ddresa; Range hood /other kitchen equipment 10.00 City/State/Z1P Clothes dr�+er exhaust 1 Phone: . Single -duct exhaust (bathrooms. l 03:) &av — s D - ( ) toilet cam. anneals, :Ali moms 6.80 . ❑ APFLICANT ❑ CONTACT PERSON fens MOO Other Businems nimme: Contact name: $5,40 for first four $1,00 for each additional Address: Gas t turn. City /State/ZIP_ Wait/sus . ended/unit heater NM r ` Phone: ( ) ! Fax:: ( ) Water heater =�� i ' 111111112 B- natil: Rtmge • CONTRACTOR • Barbecue Clothes dryer (gas) I3ttgittccs tratnte: M' r1 1 �vY. Li t v� Cloth Address: 1 % ZQ , . . v.7 .■ 1_ ."4 Ct I V J M ClANICAL PERMIT I ES* • City /Statefr_IP: - 1 1,,�.a,,1 rn 1 O._ 97 O( o 2 Subtotal Phone: (563) ( I ( i ti , j .. Fax. ( 5)3 ) L 9 1 . & 7 7 I Plan review (25% of permit fee) MIIII CCB lie.: 7 ct () /' - 0'2 state surcharge (8% of permit fee) wars TOTAL PERMIT FEE 0 , c C Authorized signature: 4.. r Ilia permit A pplicatlan expires if a permit i no1 obtained Wit In 180 days after it has been accepted as complete. Print ,ati :. u , o r- c k I. , G . �� Date! 1 . - z` - ,r • Pee methodology sct byTfi- CotmtY Building tndw3try Service 'rkoard t: V3ulldinatPcrmtrtMEcc- rermtcApa.doc 12/03 4444 171' (I 1/02/CAhutWrfll CITY OF TIGARD , BUILDING DIVISION PERMIT #: MEC2005 -00035 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/24/2005 Phone: (503) 639 -4171 ��i�N��ii� @�f�lti Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/5/2005 TIME: 7 :16AM PAGE: 61 SITE ADDRESS: 10825 SW FAIRHAVEN WY CLASS OF WORK: SUBDIVISION: FAIRHAVEN COURT LOT #: 013 TYPE OF USE: PROJECT NAME: SAMPLE DESCRIPTION: Gas to range. OWNER: SAMPLE, SUE & AL VARNES, PHONE #: 503 - 620.5231 CONTRACTOR: MODERN PLUMBING CO PHONE #: 691-6166 Inspection Request Scheduled For: Date: 6/5/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 006167 -01 503 -691 -6166 N Corrections /Comments /Instructions: nn , '� - ' / / ' / // Pe ; J 4 +J --/--v . br� l r ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS 41 ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: \((..,,‘‘, Date: , -Phone #: (503) 718-