Permit J I I c�
CITY TIGARD MECHANICAL PERMIT
i I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00363
.��' ''�L DATE ISSUED: 6/20/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S114AB -13900
SITE ADDRESS: 09355 SW JULIA PL ZONING: R -4.5
SUBDIVISION: KNEELAND ESTATES NO.2 LOT: 108 JURISDICTION: TIG
Project Description: 30' of gas piping to range.
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: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVS:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS: 0
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
PEDERSON, BRENT Description Date Amount
9355 SW JULIA PL
TIGARD, OR 97224 [MECH] Permit Fee 6/20/200E $72.50
[TAX] 8% State Surcha 6/20/200E $5.80
Total $78.30
Phone: 503- 968 -2498
Contractor:
KOEHLER CONCEPTS LLC
10772 SE HWY 212
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Phone: 503- 650 -9550
Reg #: LIC 120277
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: !,72 Permittee Signature: Cy (J
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.
06/20/2005 02:37 FAX 5036501220 KOEHLER CONCEPTS 12 002/002
:„
Mechanical Permit Application, n , . -- •- • FOR ()HALF 1 ONL Y
City or Tigard Date/13y; , � / I _ - Permit IQo � Q(<J (.o J 3
13125 SW Hall Blvd., Tigard, OR 97223 jF EC , Plan Rev oow _ V °
Phone: 503.639.4171 Fax: 503.598.1961 /Mtr,.I,l l " n i∎ i + '•`• Date/By: Other Permit:
inspection Line: 503.639.4175 . 14- - 1 _ I l � •
pots R6ady/By; El See Page 2 for
Internet: www,ci•tlgard.or.us JUN 20 206 r..., Notified/Method: Supplemental Information
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❑ Ncw construction EtA iddR/ i aatViiif'ill'alment Mechanical permit fees' are based on the value of the work
perfbrmed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: , mechanical materials, equipment, labor, overhead, and profit.
. , r Iu , ' 11 ��!!' t' . 6'I'I5 IC , 1 ,! � w„ �, 9 " ,N ,� 1 , Value: $
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.: i ; l • ' e l i .. r,5 ;i, ri's it � = ',� I � , Ii1 :+ t : [I t .71 �, i' v i !I P . I g r t r II.I,14 i Ill '� ,y1, !..a ,a"tit. - - z ,
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'turfe, ttis� . i�alit)ci'ajhiiNliti It 1 i ) zdtr lasn�I 1 inktr I pli .:•,'twit MR i n'
!ri4 10�'; 1 j 12 r, to hl I rM� '"∎ � ✓ , I'; ; I
E1 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special irrforntarlon use checklist,
❑ Multi family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. I Total
/ n Rri +R nm iya oral l t',�p.0 ,��s
.li !I, "' I �;: ,i4 ;, i'' ;;; �f1 rb' S]ft1 I 7 1;r.ii4 a @. •(6 W ;• `m �C iI ;n :yl;i;:I,iih . ;Ina,
".1!i� � ^ „ . � •, i ''�L{ :, f'll, n��il(s•� + 1 , 17I'11f � , . �' :�9, E Heatinp/coollnr;
iG Putt_ ` Alr conditioning or heat pump
Job site address: .055 {,.t! t7VUll Pu tt_ (requires site plan showing placement) 14.00
City /State /ZIP: T bl�D OR 773_1+ Furnace 100.000 BTU (duets/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
- Suite bldg. /apt, no.: Project name: . pay 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: I Lot no.: , Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
, I,'e ,6' hfl�
ii „d;l.j ; ��lfuq' , ct _ t i q, !t �rrl1't ^' , „I:nan�,,� 10,00
;Ip 11 : , 1 f s I q' i1I Water heater
:i'• „ii' " "l;;!�,;;I';� ,,,:; I,�; i ;I;i.i� „,w #� ,.'' i. ��: ��: 1��! fi��. i �3���f 41 ��fsll�9i ;�,ll; {!^I'.IiRi,dE:iIIi�Y
Gas fireplace 10.00
RVNNING .1 PP Oi 3 6 FEET OF 6 4 5 FUE-L- Flue vent for water heater or gas
fireplace 10.00
P )p Hut) r0 R•-M*E L-0CAT 101%l _ Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
°, ;i,:tl ,; ., �� I . ' raRt�1i I ' e1 :''j, i i .., iij; '� > y „ 9� , ;'ti'i iij '1'..r n. tin I 1 ? ME
Chimney/liner /flue/vent ^ 10.00
'
j�� { �r� ,��j, ry�1911Ni
� ti 1 .1'd i�'mil ,a "M Le IIIli•m1 la k kilt Other: • _ 10•00
Name: 81-euT PGD c25oN Environmental exhaust and ventilaion
: LA) 3 V u /t P Range hood/orhar kitchen
Address:
935 5 5 ") � equipment 10.00
City /State /ZIP: T I MAD 0 e 97 LL-1- Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone; ( 0 5 ) ci LS - L -96 Fax: ( ) toilet compartments, utility rooms) 6.80
ace fans 10.00
of,, „; t„ 1,, iil'1,. t* °tt kjt(Eff i ,' ,' , ',:f ; i (i }$�f
, tL {'lty ri4ilOia;l1a(ll IllimP ilia l wild. � iT � Attic
, � 1 /crawls
'11: :; „ ,, `,;„Skai t `i'. I' ' e 7�, Ifi girl 02Wf hl,� yr- gillb 4 ' S iLlf.1r ! eWiY.ltini p
Other: 10.00 I
Business name: ie_criok CatJcf75 U
Fuel piping
Contact name: /ODD $5.40 for I1rst four; $1,00 for each additional
Furnace, etc, l
Address: M771- 7 S• il WI Lit_ Ons heat pump
City /State/ZIP: C., t-AucAlting 0/. 9 76 f5 Wall/suspended/unitheater
Phone: ( 503) 650 - 7545 0 I Fax: : (5Q3) 650 - 11_2..0 Water heater
Fireplace
E -mail: Range 1 5.16 5.10
I „ u , tii , It �, m, . 1• ! [ft h N 1 1 d P 1
1 ,,, ,,, 3;: { { „ j1„ m I ' !la)F,, I igiy, M r r1`1 r 1 " !• ;I' t " ,P ' ��ie Barbecue
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'I' „ ",'Ili'' ; l;k "f ii. :;i, .1 4, T. i r I�i l �a ��.�� 1,1111: f� „t' PI'
" Business name: 1 keD� COACfl/3 t-(. Clothes dryer (gay)
O ther:
Address: to
O S F_ u, ZlL I $tP1 ' I lra Ul• a e a j1 J' 1 y U ,O.fI, 11Jti , 3, ( tf c ( 'f;
I ? L H 1 t�l�' E >i�i�a_�,,�r: +a��r,��' , E I
City/State /ZIP: CLP • piAs OR 9'7O/5 Subtotal 5 ,41)
P D 6 Fax: Plan review (25 Minimum permit fee ($72.50) - so
hone;
(5 3) 650 - 155 0 (5 ) I 3/o of permit fee)
CCB Iic.: 1L0 Z -2 7 r State surcharge (8% of permit fee) 5, to
TOTAL PERMIT FEE '7 s. 3 0
Authornzcd signature; Tom / 044.-- This permit application expires If a permit B not obtained within 180
R � day. niter if t h Nooy been accepted an complete.
Print name: 7ro f D �4.7 / Date: • Fee methodology set by Tri- County Building Industry Service Board
1:\ eulldlnak PermilrAMEC•PomltApp.dac 14/07 440.4617T(11 /02/COMIWas)
CITY CAF TIQARD
BUILDING DIVISION PERMIT #: MEt�2005 00363
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: . 6/20/2005
Phone: (503) 639 -4171
AA y�u�plj�h� �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/21/2005 TIME: 7 :11AM PAGE: 22
SITE ADDRESS: 09355 SW JULIA PL CLASS OF WORK:
SUBDIVISION: KNEELAND ESTATES NO.2 LOT #: 106 TYPE OF USE:
'PROJECT NAME: PEDERSON
DESCRIPTION: 30' of gas piping to range.
OWNER: PEDERSON, BRENT, PHONE #: 503 -968 -2498
CONTRACTOR: KOEHLER CONCEPTS LLC PHONE #: 503 -650 -9550
Inspection Request Scheduled For: Date: 6/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact it Message
610 Gas tine 009776-01 503. 968 -2498 N
Corrections /Comments /Instructions:
o
�!�.% QA'S C /o/z /5' /.ti Z
•
PASS 0 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: — 2 Phone #: (503) 718-