Permit C ITY OF TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2006 -00381
�f �l DATE ISSUED: 8/7/2006
'---• 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S133DA-04000
SITE ADDRESS: 12530 SW GLACIER LILY CIR ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT: 062 JURISDICTION: TIG
Project Description: Replace furnace and AC.
CLASS OF WORK: ADD 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: 1 DOMES. INCIN:
NAT 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
BLOOM, PAUL MARVIN Description Date Amount
NICHOLS- BLOOM, SUSAN
12530 GLACIER LILLY CIRCLE [MECH] Permit Fee 8/7/2006 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 8/7/2006 $5.80
Total $78.30
Phone:
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 656 -1184
FAX 503- 656 -4650
Reg #: LIC 447
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: S( X �,l , Permittee Signature: a"1'_ r,i T' T
Call 503 - 639 -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.
,„ a6o/c:? ff ---. i y. I s f t , xr : Fa r: -. - i t y i �uu h l
` MQchanical Permit A ` � , s I n;; ,' _ F S FOR OFFICE USE ON s � � ,e
�t fE Received S 3 .
City of Tigard �� P ormi iNo : �, g
13125 SW Hall Blvd., Tigard, OR 97223 Date z! ''� • t:. ...0,,b •'06 91 ` NEDA
Plan Phone: 503.639.4171 Fax 503.598.1960A 200 // yr,,. r' +\ Da te/B evie ' Other Perm t: -
2006 mot'; n r a4 I Y:'. :
Inspection Line: 503.639.4175 r-!' 1 .; Date • Read B �w,s 8 S ee F a e 2 for s • ;
[ „,. Ti Ready /By.. i - $ . Internet: www ci.tigard.or us CITY GARD •Notif ied/Method_ Supplemental Information -., ,•• •
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BUILDINr, 1I �( .'' y, :
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Q I M- . ;(u " `rli i ` -4 ' C C ' -)o Fr*•RCAF= litif'E-r i')S ;C-$Et KtrIST.,;
'' ❑ New construction • • '. Addition/alteration/replacement Mechanical permit fees! are based on the 'value: of,the work ••
�` performed': Indicate the value "(rounded to the.nearest dollar) of all
;,❑'Demolition ❑ Other: . . • mechanical matenals,:equipment, labor, overhead, and profit.
t �.� - a � M t 2 r•• iw a •- c r�. , rw. ; Value' $
_, 4 t $ y�� a V∎: 0 ` 4 ,1 r , r v e Kr a. ,�- ,', , �, -`e r
��a'•��� +a�� �ST �� 'IO.�;�C�li��tt =•. : s EC • � ��` t _ �tf.,.,t,��,..�'Yi:! • ,. • .
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• and 2- family dwelling Accessory building
�� ? = s S I EV , ; T ? >Q N SYST E M &FEES*
1
❑ C ommercial /industrial ❑ Accessor buildin
For special:information use checklist
❑ Multi- family ❑ Master builder ❑ Other.
Description Qty. Ea Total
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Job site address: � p2S 3 J ?)- e / ^ /'� I y / 1 (ie q are conditioning ite o plan showing or.hegtP ump acement ) / 14 00 /
OOOLLLttt ���--- !ll��� t' l 1 l ) r ts site l a)
City/State/ZIP: q Fumace 100,000 BTU (ducts /vents) / 1 4.00 Furnace , 07,
7-28 6 ��� �3 </
- Furnace 100,000+ BTU (ducts /vents) 17.90 .
Suite/bldg. /apt. no.: I Project name: Gas ... eat pump 14 00
Cross street/directions to job site Ductwork • • 14 00 - .
Hydronic hot water system . 14 00
• - - -- - Residential bdiler :(radiator or - -' - -- -
hydronic):,. ,: c.. _ , I -. • '14 00 tf: '
.',
• Unit heaters (fuel -type; not electric),
in -wall, in- duct etc. 10.00 '
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10 00 _
.:.Tax map /parcel no.: Other fuel appliances
. �,. ,2 �� Vii •... al,.,,. .. i3 yK .:41 1 : s ... "i ; : Water heater .'i <; 10.00 .
Lc'S �. .•'ilds . B k 1 .i k ,, ' �'• ` /);5 Et ,T,-I N, r 'O V _.,,") �� 'l I � • m.:,t � ,R f. ; t c *i .i • •i 15 t ", •.
r a• •,Y.�lr•. � lt�l +:: +a f•, t+GV+ �. �w,. ! 0 r9TiS .,
� // / ' Gas fireplace _ 10.00
...5..- p G 4 64( 1,n_,,tiA�L �- Flue vent for water heater or gas
7t4• wrc fireplace 10.00
— W �^� Log lighter (gas) 10.00
- Wood/pellet stove 10 00
. Wood fireplace /insert 10.00
o- o i i ,,� ra�l,F ,, +•: Chimney/liner/flue/vent /liner /flue /vent 10.00
4 R; ' r a ;rq' r. 4 {ist{•x�,3,,q t r .: Y
'+ ,:.it '_ t s :e_ iM. Ta - e PIE lti" <: E AP.: -. • 1 -4i `
._�� �:x �#,:�:�_. .w €i~ #><� �� � a. � r'?- i'ca�_ t..- Other: 10.00
Name: I 101/ el / Environmental exhaust and ventilat
vt+ ° " \ Range hood /other kitchen
Address: equipment 10 00
City/ State/ZIP: G( N'« Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: SG 3) 6 Z _ 10- 4 I Fax: ( ) toilet compartments, utility rooms) 6.80
'�t{;� "' �'`" �i'r`-�' t i A
d�-• t,r' ttic /crawlspace fans 10.00
u Y R` ® „ r i .I�`) g,5;� t 1 ys rOVt ®� COI�I�'E 01 ;.�,•tU% is
+ t•- i4 .•,w}a. .,j.,�Y+',w..... "t,v.. ..[, � >r. "Y'. ;-n Y.. ri"4 _.: ,5: -tn... .., - nar :yc.. �",,,`.� a�`..xai , x.7..'}.'.,Y:;:?
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: ( ) Fax : ( ) Water heater
Fireplace
E-mail:
Range
WLLt. M, TKO } "•
. 1Y 5.} } R`,'�, 11,'{ ?mid .r,,, � S:: ' �sts..ur..dl w.; " . W:•, - -..', ', ^;'ii+45X at r- i r; F'I'aF.W . Barbecue
n s r ,!; t " t ,,, s : k
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' ., pm, � .1w €;, g CO `� ) 4�OIt. i. ' � +,<;t�rs "� "rt ry�'" Ii tI;`�s?. ° . ^ �t� . , N n a.n s.: Qtak , t�C�e :;l �" za /P:'f�" •f. , i.rct•Y ... .:w, ar.tnva- i..)' t, r v -. - —
Business name: �L ! t �7 /� Clothes dryer (gas) --
/ Other
'�iY•rr}x} : Ys'w 1t i:.y ,. i k , _' ].�•
'Address: �22-�d /(-1, �'�' <�.�i ~ �1I�. �k1A' ��� • ,'`7�'E _ IL_112I�F'��EES *:.� '
Subtotal
; City/ State/ZIP: �� (le AI'Yl A . iS d . 6�
�l Minimum permit fee ($72.50) ' 7„?, 50
Phone] 3) ��� f /Pi Fax.)— v Plan review (25% of permit fee)
• CCB he.: e 4/7 State surcharge (8% of permit fee) ,1, g0
;8a I TOTAL PERMIT FEE' 7 3 (�
] ' Authorized signature
This p ermit application expires-it a permit is not obtained vvttliln 180
�^ l days after - It t has been accepted as complete.,
'•Print name: 74 y- (9n , S 6,, Date &/r2, i'',.‘ • Fee methodology set by Tri- County Building industry Service Roard
1 . 1 Bumtdmg\Permrts\MIC.PermaApp aoc, 12/03 440 -4617T l I 1/02!COtv:/V.'gBl '
SITE PLAN
'INDICATE NORTH FOR INSPECTOR*
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L CONTRACTOR A/C-1 PUMP ---7 UNkT SITE PLAN ,:.
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BELL HEATING, INC. .
15550 SE MAZZA AVE.
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r.XA6XAMAS, OREGON 97015 •
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/772006
Phone: (503) 639 -4171 µan i l illt
Inspection Requests (24 Hrs.): (503) 639 -4175 ':_..
INSPECTION WORKSHEET FOR DATE: 8/16/2006 TIME: 7 :05AM PAGE: 66
SITE ADDRESS: 12530 SW GLACIER LILY CIR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 062 TYPE OF USE:
PROJECT NAME: BLOOM
DESCRIPTION: Replace furnace and AC.
OWNER: BLOOM, PAUL MARVIN, PHONE #:
CONTRACTOR: BELL HEATING PHONE #: 503-656-1184
Inspection Request Scheduled For: Date: 8/15/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 034)47-01 503 - 208 -8935 Y
Corrections /Comments /Instructions: L
0 A-40z. cliCT12e, 1.,,..4_,_,,„,__ /& S l4riO F .47"-=-6-,-W , et- 22,'ui-7- ' ,CC:.
FR PASS / PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
I I FAIL I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: VI-7, Date: /S — I L) Phone #: (503) 718 - 2-