Permit CIT OF TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00643
� � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/10/2005
PARCEL: 1S134BD-01200
SITE ADDRESS: 11625 SW HAZELWOOD LP ZONING: R -4.5
SUBDIVISION: ENGLEWOOD NO. 2 LOT: 100 JURISDICTION: TIG
Project Description: Furnace replacement.
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:
•
ELE 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
BLAKELY, ROBERT C AND REBECCA L Description Date Amount
11625 SW HAZELWOOD LOOP [MECH] Permit Fee 10/10/20C $72.50
TIGARD, OR 97223 [TAX] 8% State Surchaq 10/10/20( $5.80
Phone: 503 - 590 - 5002 Total $78.30
Contractor:
D & R HEATING & AIR CONDITIONING
PO BOX 1292 REQUIRED ITEMS AND REPORTS
CANBY, OR 97013
Phone: 503 266 - 1229
Reg #: LIC 84489
This permit's 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: .41(., _ /' Permittee Signature: AL, ,� / _ AL
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.
Mechanical Permit Application FOR OFFICE USE ONLY . •
City of Tigard EN ED
p Received •
`J E® Date /By: o f a Permit No.: �F.d �O r) 9 1. 13125 SW H Bl TigarA 'i. " Plan Review
• Phone: 503.639.4171 Fax: t 0' .5 ` :.1960 - ; :�: +� 1 , Date/By:
Other Permit .
Inspection Line: 503.639.4175 n 2oo�.�
11 _ Date Ready /By: ® See Page 2 for
Internet: www.ci.tigard.or.us OCT - Notified/Method: MI Supplemental Information
CITY TIGARD
� 1 'V ' W COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction 8 b Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
a performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition • Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY. OF CONSTRUCTION Value: $
RESIDENTIAL' EQUIPMENT /SYSTEMS FEES* '
land 2- family dwelling ❑ Commercial/industrial ❑ Ac cessory building
d Multi -family For special information use checklist.
y ❑ Master builder ❑ Other:
Description Qty. I Ea. Total
• „ .JOB SITE INFORMATION AND LOCATION Heating /cooling
/ �� 7
Job site address: Air conditioning or heat pump
/4zs S.t . �/}j LfL t 7 i rl%1 (requires site plan showing placement) 14.00
City /State /ZIP: ; A 2.... - b 1 a CZ o 7 2 2...3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: � - Atc>_t_y Gas heat pump 14.00
Cross street /directions to job site: 'f? � Duct work 14.00
Hydronic hot water system 14.00
SCl- -c,S CE tz.fLy sO 1-t- Or- 1 Z. I Residential boiler (radiator or
hydronic) 14.00
w ' o �/ 1I 1 S 1 P� I � �"�� Unit heaters (fuel -type, not electric),
/ /o r 14 0 r- t A 2.6 t_ w caz 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 appliances
• . . - DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
/ Flue vent for water heater or gas
,0 ✓E OL7 r 7f� +‘KGG` /'r R_ /Liei∎J/ 1C-cF fireplace 10.00
✓l
Log lighter (gas) 10.00
• /A/1/741-4. /V tfw 67) ".5r(C D / it t 4Q Wood/pellet stove 10.00
Wood fireplace /insert 10.00 •
Chimney /liner /flue/vent 10.00
PROPERTY OWNER - ❑ TENANT Other: 10.00
Name: . La 4. ' LE, acy :t_nKE L y Environmental exhaust and ventilation
Range hood/other kitchen
Address:
i 1 6 Li 5 S ,.? /-1i4 zct L�-cz- P equipment 10.00
City /State /ZIP: t G AQ: O (Z 7 7..z3 Clothes dryer exhaust 10.00
i Single -duct exhaust (bathrooms,
Phone: (,G3 )590 -rjce' Z Fax: ( ) toilet compartments, utility rooms) 6.80
- ❑ APPLICANT ❑ 'CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:` --'R OEA I t -4 Al Q r'
Fuel piping
Contact name: A4 7, az t < v .. _ $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:�C;..„4 i Z`j
Gas heat pump
City /State /ZIP: C A „ szy I G Z , CI 701 3 Wall /suspended/unit heater
Phone: (53 )/�7 > -Z5 i•- Fax: : ( ) Water heater
Fireplace
' E -mail:
Range
• . CONTRACTOR Barbecue
,� k-\ A Clothes dryer (gas
Business name: -_-- E A. ...4 fl l g_ CoNs
Other: •
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: S� l/v/ �� Subtotal
Phone: ( ) p er: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: �t 9 State surcharge (8% of permit fee)
�� TOTAL PERMIT not FEE
Authorized signature: This permit application expires if a permit is nut obtained d
within 180
�� / days after it has been accepted as complete.
• Print name: / jC1 Oa2*N /L k Date: * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Pemuts\MEC- PermitApp.doc 12/03 44 0-4617T (11/02/COM/WEB)
R?
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation : , Permit Fee:.
$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.
i: PermitApp.doc 12/03 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2006-00643
13125 SW. Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/10/2006
Phone: (503) 639-4171
Inspection Requests'(24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/18/2006 TIME: 7:10AM PAGE: 65
,ti See.AIG
SITE ADDRESS: 11625 SW HAZELWOOD LP CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO. 2 LOT #: 100 TYPE OF USE:
PROJECT NAME: BLAKELY
DESCRIPTION: Furnace replacement.
OWNER: BLAKELY, ROBERT C AND REBECCA L, PHONE #: 503-6906002
CONTRACTOR: D & R HEATING & AIR CONDITIONING PHONE #: 503-266-1229
Inspection Request Scheduled For: Date: 10/18/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Mes - e
699 Mechanical final 018597-01 503-880-1169 Y
4FJ
F 4 " -9-1
Corrections /Comments/ Instructions:
/0 LC
rS a/7C
igi •
PASS TIAL APPROVAL El CANCEL El NO ACCESS
[Th FAIL 0/ FOR INSPECTION ADDITIONAL FEES ASSESSED
_■■■■11■-••■•= Date: /6' ' Phone #: (503) 718-
%