Permit CITY TIOARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00280
1111 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/27/2005
PARCEL: 25111 CC -23200
SITE ADDRESS: 10440 SW GREENLEAF TERR ZONING: R -12
SUBDIVISION: SUMMERFIELD NO.5 LOT: 290 JURISDICTION: TIG
Project Description: Replace furnace & add heat pump.
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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
SIPE, LOUANA Description Date Amount
10440 SW GREENLEAF TER
TIGARD, OR 97224 [MECH] Permit Fee 5/27/200E $72.50
[TAX] 8% State Surcha 5/27/200E $5.80
Total $78.30
Phone: 503 - 598 -9245
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Phone: 503 -453 -4822
Reg #: LIC 62196
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: f;i�Z Permittee Signature: ,{
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.
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6. •
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Mechanical Permit Application. 1.. .
FOR OFFICEl;SE ONLY
- 72g -
Ciirolliplifi
13125 SW Hall Blvd., Tigard, OR 97a2SFC II Plan Review
Phone: 503.639.4171 Fax: 503.590 Cl.'
1A"711110 I it DateiBy: • - . Other Permit:
Inspection Line: 503.639.4175 20 :...T4A AL Date Ready.'By: sift 10 See Page 2 for
Internet: www.ci.tigard.or.us
Wk 2' . NotifiecVMethoct: 1.-- / ( Supplemental Information
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New construction
Mechanical permit fees are ase on the value of the work
ID AtUtoR/Vgiation/replacernent
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition • 0 Other: mechanical materials, equipment, labor, overhead, and profit.
Jt.'-2: - Iii;ri:ay-t::aNa.:,
N „s-Arg.isi,:fi, - *R-,..:1.5,-;...,,•:-.,::...,, , ,...-4..13..,-,,„„-- ,,„ , •,_ ,,:, - ,,.. i.... „.,,,,.„:,....,:•.:.,,wim.m.:,...,,JE:i• -....= •, ,-.:..- titkri ,--
,_ and 2 dwelling 1:3 CommerciallinduStrial D Accessory building • v...F.t..Igi..1,-.1.nwt_,..i.,„?.....1....L.::.:,4,:..t-fle..-,,,a,,,r,,,r,,...-,,,,,,,t;.--ET.,..:-.:,,-..
For special information use checklist.
El Multi-family 0 Master builder 0 Other:
Description . Qty_ I Ea_ Total
,1,4 .M.0,4:01104,00.-trigt*0044.0 5 A.W. ' ;:1 7 .::„*TOMINI : 019.H • Heating/cooling
i ' Air conditioning or heat pump
Job site address: ( 0 t.-1 tip 5 Lk) .---0---- jet,,- ex- c .. (requires site plan showing placement) a. 14.00
City/State/ZIP: ''
f...k.- 0 q-.7 2L( Furnace 100,000 BTU (ducts/vents) 14.00 .
/ Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: ( .-LC-- Project name: . i 0 ---- C) C rn
...) Gas heat pump .
- 14.00
Cross street/directions to job site: Duct work - 1.4.00
• Hydronic hot water system 14.00
Residential boiler (radiator or
. • hydronic) . • 14,00
• Unit healers (fuel-type, not electric),
• _ in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above L0.00
Subdivision: Lot no.:
Other: 10.00
. _
Tax 'map/parcel no.: Other fuel appliances
-- ,..--- -., , AH. - Water heater 10 00
VAVigiAli:SAS13101010:tktiliKC 4:
.
10 00
A Gas fireplace
1 ck-C.4 -km • Flue vent for water heater or gas
fireplace 10.00
-
. - • I PLAA/1/1.4,r) ..
Log lighter (gas) 10.00
• Wood/pellet stove _ 10.00
Wood fireplace/insert , 10.00
•
Chimney/liner/flue/vent . 10.00
''.=&`•'• '-4rgigig,Mialiite iiiiNaii0lEteargitfit
10.00
Name; L.-.okxcutt vA . S 1 pe__. . Environmental exhaust and ventilation
Range hood/other kitchen
Address: ( 0 49 (4x .A3 1 G i eei-C-- 7 equipment L0.00 •
•
City/State/ZIP: - t.--).--R____ C I 7 2a1-1- Clothes dryer exhaust 10.00
1 Single-duct exhaust (bathrooms,
Phone: (563 ) ,5 .... 3 -• Fax: ( ) . toilet compartments, utility rooms) 6.80
- --- --• -.•,-.,,,,,---,,,,,,,.-fil•F'11•=" Attic/crawispace fans
q:!;; IMPI: "liadZiOHAPrOS1g$P1.41.451..I4::-57 . 10.00
Other: . 10.00
Business name: .1 ;16A , _ c e , ... en , \ Fuel piping • •
Contact name: K a ____ t-p A l i . ‘
et.,_viel $5.40 for first four; 51.00 for each additional
Fumace, etc.
Address: I L Ss 0 p 6. k5......) 7 ...D., LA A .2._._. . • . •
Gas heat pump .
City/State/ZIP: ---- e ,c-....\._1 ruita i P. 0 9 7 9,5-...ci . Wall/suspended/unit heater
• Water eater
Phone: (.5-03)Lis3-LigDo.., Fax: : (5!..), ) I t _7 .,
Firepla
E-mail: • Range ,
6 "..P. ,FN,- ,:t4.,..•.-.14131r4:11F0;'''I'Vt.---1:4-if-Ratg...:NOliriagi, Barbecue
Clothes dryer (gas)
Business name: C 1; vvt 44 .1 t _ e ___ O t o i .s c ,
Other:
Address: I i .5c) 0 ( 7 - *)e 5:-
_
.
City/State/ZIP: T i = '0 c ...\- \ c - ut...A, j C _ T D-2-'t ... Subtotal - ----
i Minimum pennit fee ($72.50) --- 1V. S
Phone: (d,'"1 qs 3 - 9s , Fax: (3) t=T ( - - 7,D....c.../ .
Plan review (25% of permit fee)
.
CCB lie.: L, G... L • • State surcharge (8% of permit fe.e) - 5"` ., 5 o
. ,
TOTAL PERMIT FEE 7 3 el
.
..
....
Authorized signature . . - This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. •
Print name: 1Z , (...1 ..„ Date: o 5 Fee methodology set by Tri-County Building Industry Service Board
i \BuildineWerrnitskMEC-Pennitrk.pp.doc 12/03 . 440-4617T (11/02/CdMIWEB)
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_irir OF TI CARD
BUILDING DIVISION PERMIT #: MEC2005-00280
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5l27/2005
Phone: (503) 639 -4171 '�'�
I nspection Requests (24 Hrs.): (503) 639 -4175 ___..
INSPECTION WORKSHEET FOR DATE: 7/18/2005 TIME: 7:07AM PAGE: 86
SITE ADDRESS: 10440 SW GREENLEAF TERR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.5 LOT #: 290 TYPE OF USE:
PROJECT NAME: SIPE
DESCRIPTION: Replace furnace & add heat pump.
OWNER: SIPE, LOUANA, PHONE #: 503 -598 -9245
CONTRACTOR: CLIMATE CONTROL INC PHONE #: 503 - 453
Inspection Request Scheduled For: Date: 7118/200. 5 Pour Time:
•-,, Code # Inspection Description Confirm # Contact # Message
...1
699 Mechanical final 011557 -01 503-453-4822 N
Corrections/Comments/Instructions:
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: �—/ � Phone #: (503) 718