Permit r4. ,
CITY TIGARD MECHANICAL PERMIT
j �i a DEVELOPMENT SERVICES DATE ER #: 7/ E -00461
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103CC -08700
SITE ADDRESS: 12170 SW KELLY LN
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 034 JURISDICTION: TIG
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:
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:
> 10000 cfm: GAS OUTLETS:
Remarks: Install A/C unit.
Owner: FEES
DON MORISSETTE HOMES INC Description Date Amount
4230 GALEWOOD STE #100 [MECH] Permit Fee 7/14/200 $72.50
LAKE OSWEGO, OR 97035 [TAX] 8% State Surchart 7/14/200 $5.80
Phone: 503 387 - 7538
Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 72623
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. —
Issued By: ` /( 2:t Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Jul 09 04 09:07p TriCounty Temp Cntrol 5035570919 p.1
Mechanical Permit Application i 1 r� FOR OFFICE USE ONLY
•
City of Tigard ° V Received
13125,,Sti"` H(rl',�3lvd., Tigard, OR 97223 Date/By: lc/ -O41,911....... Permit p , /�J[ /, - �/�r /�
Phone: f03.639.4171 Fax: 503.598.1960 Il t• 1,4 .
Plan Review � Gv - ° O � VV �� t'
Inspection Line: 503.639.4175 J 1� l., 6 - e t,4 if
Date Ready/By: Other Permit:
www,ci.tigard.or.us� Date
,._.::.-, s,.� " ... p C efl t Votlfied/Mcthod. Information ��99��ggpp OF 1 'r . "' T) /� Supplements! See P age for
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CQi� IML� T IiC ' I�e1G..ii� 1 - • •'I J iErCHECKi;"LST
❑ New construction r r V9 . ddition/alteration/replacement " Mechanical permit fees* are based on the value of the work
❑ Demolition /� performed. Indicate the value (rounded to the rearest dollar) of all
❑ Other: mechanical materials. equipment, labor. overhead, and rofit.
. ;.,3 : CATEGORY: O1? CONSliiTJCTION = a
���,,,{{{ � .. . .. -. .. . . ...... .. - Value: 3
p� y dwelling ❑ Conimercial/industrial b I S Ei`G E E Q . CIIP VIEnT. ( SXSTE1vi
1- and 2- famil dwlli S:FEES*
-
L`� ❑ Accessory - 14414 --
u Multi family ❑Master braider ❑ Other: For special information use cher dist.
�= '7QB:SITE Description I Qty. I Ea. I Total
� - L�FFOX21tiMr1?7ON `, D LOCATION.. • : ,',
a ' : `: " ' :'• .. _s • •.r , r�'t.'':, , . ,._ HeatingJcooting
Job site address: 121 70 SW 1� t /j �' air conditioning or heat pump
LLM t\! (requires site plan showing placement) 1 14.00
City / State/ZIP: T g q7/f Furnace 100,000 BTU (duets/vents) 14.00
5uite'bldg.;apt. no.: (' ` / I Project name: • Furnace 100,000+- BTU (ducts/vents) _ 17.90
1 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 appliances
. , ; UESCRIP I = OE WORK :. - :. • .' , " .:� : -; : _ - S'•" '` Water heater
• � � 0.00
1
tr` f Gas fireplace 1 0.00
Flue vent for water heater or gas
fireplace 0.00
Log lighter (gas) 0.00
Wood /pellet stove 0.00
_ Wood fireplace/insert 0.00
.. ,,_. IR OPEItTY . OWhI Chimney /liner /flue /vent 0.00
:...1.- , � yy � �'yYyy�p�� _- �p ......, W ... , ' :Ti✓ i -" -' 1 I
Name:
1 V r f It �S_ r _ Ocher: 0.00
Environmental exhaust and ventilation
Address: ant, Range hood/other kitchen
���� equipment '0.00
City/State/ZEE: _ Clothes dryer exhaust 10.00
Phone: (9®b .. "1/.� Fax: ( ) Single -duct exhaust (bathrooms,
`
toilet compartments, utility rooms) 5.80
. ........ ;f =. ' �:''; ; _X :: COY A ttic/
'�'`".` � �•'- � . x ; �;',, , TA�CT�E�RSON -� ;4�� crawlspace fans 10.00
Business name: Tr) C, I y T 0 F-r,) Other: 10.00
`) ` f l 1( 1 Fuel piping I
I
Contact name: $5.40 for first four; $1.00 for each adcitional
Address: (a 00 S. CI /';� ,/V1 j(S Rj ' � r�tr, T /t°, Furnace, etc. I
en ` 'f1 `�l.0 R _ q 4 � 7 0 `JJI (�)\J Gas heat pump
City/State/ZIP: Q CI i (�� � � Wall/suspended/unit heater
(�-Q. ) J 0 t `f C U1
Phone: 55�7� --1 ��SJ Fax: �) .�,���7`l -�"l 1 q Water heater
E -mail: Fireplace
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Range
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t,.r : r. . .., ._.,. ,;f,.,: a , Barbecue' . - T o f) cm ] Clothes dryer (gas) l 1
Business name: 1 0 co `)1 � I . L m �j (� jay-► Other: I 1
Address:
V)15 t G. �s� 1 1 lt-I� (SI ��,1 )1 1 �� 1' M � `:ME,C�ANICAT`;�. FEE r' `
City/State/ZIP: or ' P � C) - f7r4 Subtotal
Phone: (55) S5
\� `/ 22.C� Fax: (60 X5.7 ...6q f 61 Minimum permit fee ($72.50) 72 b0
Plan review (25% of permit fee)
CCB lie.: / State surcharge (8% of permit fee) i
,,i p y)7CL �
- -- -- TOT2.L PERMIT FEE e 4
Authorized signature: r ` C ( This permit application expires if a permit is not obteine rn 130
�y � 1 ,ij n days after it has been accepted as comp!'te.
Print name: �a Lt 3i. Date: 1 010Z - Fee methodology set by Tn- County Building Industry Service Board
is 1ButldingU ' =nits \MEC- PccmitApp.doc 12/03 440.4617T (I UO2/COM/WEB)
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