Permit -c? ‘c-= is - OD -��
CITY TIGARD MECHANICAL PERMIT
4 411 4 DEVELOPMENT SERVICES PERMIT #: MEC2005 -00692
a 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 D ATE ISSUED: 10/18/2005
PARCEL: 2 S 102 BA -01100
SITE ADDRESS: 12220 SW GRANT AVE ZONING: I -P
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT: 058 JURISDICTION: TIG
Project Description: Cold air intake & combustion air vent. 10/21/05: Added flue & vent for water heater & furnace. Valuation:
$500.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B 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:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
JOHN HADLEY Description Date Amount
2656 FAIRMOUNT
PORTLAND, OR 97201 [MECH] Permit Fee 10/18/20C $72.50
[TAX] 8% State Surcha 10/18/20( $5.80
Total $78.30
Phone: 503- 297 -7670
Contractor:
MILWAUKIE HEATING & COOLING
PO BOX 220716
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Phone: 503 -557 -5562
Reg #: LIC 104102
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: Permittee Signature: S - C.,
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.
"b' CITY OF TIGARD MECHANICAL PERMIT
��� DEVELOPMENT SERVICES PERMIT #: MEC2005 -00692
7 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/18/2005
PARCEL: 2S102BA -01100
SITE ADDRESS: 12220 SW GRANT AVE ZONING: I -P
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT: 058 JURISDICTION: TIG
Project Description: Cold air intake & combustion air vent.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B 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:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
JOHN HADLEY Description Date Amount
2656 FAIRMOUNT
PORTLAND, OR 97201 [MECH] Permit Fee 10/18/20C $72.50
[TAX] 8% State Surcha 10/18/20C $5.80
Total $78.30
Phone: 503- 297 -7670
Contractor:
MILWAUKIE HEATING & COOLING
PO BOX 220716
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Phone: 503 -557 -5562
Reg #: LIC 104102
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: % a ' - Permittee Signature: Q,
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.
Oct 17 05 01:20p Milwaukie Htg & C1g 503 - 557 -0790 p.1
I‘r chanica1 Permit APP u� ® Received ED FOR OFFICE USE ONl
{ �
City of Tigard Date/By a 699 i. Permit N . 7 g C,
13125 SW Hall Blvd., Tigard, OR 97223 C Plan Review
Phone: 503.639.4171 Fax 503.598.1960 C7 1 - / �..i Date/By: Other Permit:
Inspection Line: 503.639.4175 ® 1 _La. . i I Date Ready/By: Sall El See Page 2 for
Internet www.ci.tigard.or.us Natificd/Method: Supplemental Information
G1SYO � F ( � TIGAFt
Tvio b 11 t � I O N
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1 * COMMERCIAL FEE " SCHEDULE - USE CHECKLIST
❑ New construction ® Addition/alteration/replacement Mechanical permit fees" are based on the value of the work
❑ Demolition performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other mechanical materials, equipment, labor, overhead, and profit
• CATEGORY OF CONSTRUCTION Value: $ 7 `jZiCl. `•=
0l and 2 family dwelling ® Commercial/industrial ❑ Accessory building RESIDENTIAL. EQUIPMENT /SYSTEMS FEES"
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other Description 1 Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: '� r Air conditioning or heat pump
/ 0 2 2 2 t0 5. L.AJ , V re. n - (requires site plan showing placement) 14.00
City/State/ZIP: 0 R. q - 3 Furnace 100,000 BTU(duets/vews) 14.00
- , ,� Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg. /apt. no.: Project name: 0 Co 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
Subdivision: ' Lot no.:
Flue/vent for any of above 10.00
Other. 10.00
Tax map/parcel no.: Other fuel aePlianees
DESCRIPTION OF WORK Water heater 10.00
�tj' 1 Gas fireplace 10.00
C ,..':h 1. c a 1 , ., k R. (cwt V1,.aS 4 Del � � le Jt et 4- Flue vent for water heater or gas
fireplace 10.00
Log lighterSgas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER ❑ TENANT Clurnrteyllmer /IIue'vent 10.00
Other. 10.00 •
Name: it 1 S )eC NC, I - h ) Environmental exhaust and ventilation
`� Range hood/other kitchen
Address:
° Z O s . L� C7 , ^,_ „,....A_ equipment 10.00
City/State/ZIP: T\ y.,.,-Cl • C y(L. 9 - 7 a O3 Clothes dryer exhaust 10.00
Phone: ( ) Fax: Single -duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 6.80
® APPLICANT ® CONTACT PERSON Attic/crawlspace fans 10.00
Business name: /� ,� ( , i Other: Can wt �:n S�t n ::. - 1 10.00
1 t 1 t lt, tai. IL t F. k-�'t 't7 419 Fuel igying
Contact name: er 'V i t .- ii 55.40 for first four, SI.00 for each additional
Address: � .� vx o:26 ( Furnace, etc.
_ f Gas heat pump
I V`
City / State/ZIP: 1 k w.Pa ut ll7 t C a 1- 97 D» 7 Wall/suspended/unit heater
7 • Fa x:: ( 3) Water heater
Phone: ( c63)
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• l t ( w e..... IC t ``mil S ,,) ` Range E -mail: :"-
' � � � �� C. tr /l.-` Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
Address: 4ift,
MECHANICAL PERMIT FEES"
5p, City/ State/ZIP: N E Subtotal \ tJ
Minimum permit fee ($72.50) 7 2 ,s
Phone: ( ) Fax: ( ) Plan review (25% ofpermit fee) 0 . it ;�
CCB lic.: -1 L.\ t C.; State surcharge (8% of permit fee) a- •
`'� TOTAL PERMIT FEE '7' . 3c
Authorized signature: ( J This permit application aspires if a permit is not obtained within 180
I r days after it has' been accepted as complete. v.
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CITY OF TIGARD
I BUILDING DIVISION PERMIT #: MEC2005-00692
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/18/2005
Phone: (503) 639- 4171 i�1> + �
Inspection Requests (24 Hrs.): (503) 639 -4175 "� �i
INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7 :13AM PAGE: 101
SITE ADDRESS: 12220 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 058 TYPE OF USE:
PROJECT NAME: S1 rOo ALT,ESD
DESCRIPTION: Go air intake & combustion air vent. 10/21/05: Added flue & vent for water heater & furnace.
Valuation: $600.
OWNER: JOHN HADLEY, PHONE #: 5503-297 -7670
CONTRACTOR: MILWAUKIE HEATING & COOLING PHONE #: 503-5557 -5562
Inspection Request Scheduled For: Date: 11/21/2005 Pour Time:
Code # Inspection Description Confirm # Message
699 Mechanical final 021916 -01 503 -891 -5491 ='
S�hUJ
Corrections /Comments /Instructions: CA C --
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it
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I ?/PA ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION n ADDITI NAL F ES ASSESSED
,A ,, / 'a "Z-- t5S
Inspector: IF . Date: Phone #:. (503) 718 -