Permit f ,
CItY TIGARD MECHANICAL PERMIT
PERMIT #: MEC2004 -00510
in DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 7/30/2004
PARCEL: 2S102AB -00903
SITE ADDRESS: 12040 SW LINCOLN AVE
SUBDIVISION: KIMBERLY ADDITION ZONING: R -7
BLOCK: LOT: 003 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace furnace & install new A/C unit.
Owner: FEES
FRAZEE, CHRIS P Description Date Amount
12040 SW LINCOLN AVE [MECH] Permit Fee 7/30/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 7/30/200 $5.80
Phone: Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503 - 453 - 4822 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 62196 Final Inspection
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: % , �1 , , Permittee Signature: S' p ciN
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next bu iness day
Mechanical Permit AppliCatioii V , 7, ' _ FOR OFFICE USE ONLY
City of Tigard* Received 7 _
Date/By: /
OR 97223 ,
Or 4 1-WiirElaii
13125 SW 1411 Blvd., Tigard, ,,, ,., , ,,,,,,-r. ., Plan RevMw
.-- s
Phone: 503.639.4171 Fax: 503.598.1960 ",;1, '!'. , , - it,..q.l.rt'•; ,Agiliii Date/By: Other Permit:
Inspection Line: 503.639.4175 jJJ.. Date Ready/By. F.d See Page 2 for
rn
Inteet: www.ci.tigard.or.us , i/ :2
Notified/Method: Notified/Method: t Supplemental information
- 0:, \
g.:1 ':i . .1: - ':if-WP:; . ::' . :i ').
igirLigA iMgaoil .. :',.:,:,.....,74-: ;:.,: - .,..... ... .., .....-..., ... ;. ..- .. ,.. ._.,.„,,.„.... ....„...,..:....,._ ... ...
Mechanical permit fees* are based on the value of the work
0 New construction Z 4 ition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition El Ot er: mechanical materials, equipment, labor, overhead, and profit.
Master builder 0 Other: Der
iiriligig O
ttakS.V40331WitikpliggillO '4:.i::','..1;....::‘.:::: ''' ' ':: ' ::;::.,.' :::•.:,:-::::::::, r ..,..,,,.......:;,„.,,,,,,,,„:„.,...,,,,- . ..... . _----..,,:r.,..:._.,•-•„,___- .,.,..,•,... z f..
mi;:ithoi. ..::: . ”, -,,‘ •••-,.:•-• • •••• --• • • • •• • •••• •• - • " " • - • • aiDiiri.illEgffittOrAiv. wOuipmksitrekOisilEmsdiEtst;.:r..iii••::'• Value $
- and 2-family dwelling El Commercial/industrial 0 A:xessory building
. )N2r
Mult ID Description For special information use checklist
i-family
I Qty. I Ea. I Total
'4!'-`40§ZFF ...... ::.. - '- . i::: . :::. :::::: . ::::.: Heating/cooling
Air conditioning or heat pump
I
Job site address: i ,0 L. ,(C) L.k) L %A co( n AV __ (requires site plan showing placement) 14.00 i - 2. City/State/ZIP: " 1 6 \c..... c 17 9.rD-.7..S Furnace 100,000 BTU (ducts/vents) I 14.00 ( 1-1 -
C Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bIdgJapt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
(p 5 5 - t- 1- Residential boiler (radiator or
hydronic) _ 14
Unit heaters (fuel-type, not electric),
in in suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances • _
0 :c..:-.::: ::.. - ,:......::.,-.-..: .::::..::.:::::::;.- Water heater 10.00
ins.iimiArOgi.,^10?;;Rili'ikriifiT4IF.'4WIP`9.411' '-'-""'"'.....-.. t '. ''''''' ' 1 . ..' : " :" . Gas fireplace 10.00
K LAX' V 0.-.0 e_. \ i v'. s -k--,,(1. Av r Flue vent for water heater or gas
fireplace 10.00 _
C.CPIn _j, fireplace
C) vie_C • Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
. • - . ,... .,..... .
TENANT. Chimney/liner/flue/vent 10.00
- .: •- i'iffil.4.4- -- iie l .lieti 4 itiff i ieitkEitliqPiit=0,gginliPlinVilt.ViV; ,- .PP 1111 • • ' • .':7 .:-..: :-.....
.. ',_ ....„,-„......:;„„ r :-.,:,,,,:!■A!ir;:;.,;::::. , !''ii■i'li%i 7..:: : . -..!%:.. . ,, • . - . . . -. ' . ' . :: '.: '. Other: 10.00
e--
Name: CAAS --.‘ \-- ("0. .0_ e. Environmental exhaust and ventilation
Range hood/other kitchen
Address: vac) q C) '5 L c _.,,\ ,,, .)k-o e__ equipment 10.00
City/State/ZIP:7' j 0. 0‘ 6 et - I ';) 3 Clothes dryer exhaust 10.00 .
If Single-duct exhaust (bathrooms,
Phone: (-r)3) (,3A , 4 D $ '-5 Fax: ( ) toilet compartments, utility rooms) 6.80
:11
CONTACT PERSON :....::-: :.:::. Attic/crawlspace fans 10.00
M
: .., "":1 ..- - •• - - ..• - • - - "" ' • Other: 10.00
Business name: - Iti./AtAA-ft.„,_... LoN./‘%-k-N 1
Fuel piping
/
.
Contact name: 1 4-1 CULAA $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: 1 L _51 7 .-?...v}z._ 'k'
- Gas heat pump
City/State/ZIP: a (-...\_&
, C)V---, 9 "
=,9-14 _ Wall/suspended/unit heater
r
Phone: ( 513) L-I5 - -61 S 0..: Fax: : (5D) ) ti Log -7.0.,2.sii Water heater
Fireplace
E-mail: Range
fil,aiiiiiititX6,6•1:; ..-:.•:::.:: ; •• . • • • .. . ....' • .: .: -1 Barbecue
iKt: • • •••• ..]-•-'•-•-' --:' - - . •• • • • •
Clothes dryer (gas)
Business name: A irricc-4-e___ Co
Address: ((5C0 S L.13 .- 7 . z9 , ( ).!\ ' •:: itetai:liaii:ktitminvEEs*::' :-.. • . '..- '....-r•
City/State/ZIP: F 9.?.../.4 _.. . Subtotal ,3..
/ Minimum perrnit fee ($72.50) -7.?, ,S1)
Phone: ( ) 4 63 4 t 2.,.... Fax: (563 ) 9. 6, s .. --7?9,L4 Plan review (25% of permit fee)
CCB lie.: Led--1‘ 4-P State surcharge (8% of permit fee) 's 20
TOTAL PERMIT FEE - 713 4 30
This permit application expires if a permit is not obtained within 180
Authorized signature: , / T A.101 days after it has been accepted as complete.
Amiwit
Print name: IZEINIEMIDZREMIll Date: 110.1 ( • Fee methodology set by Tri-County Building Industry Service Board
il3uilding\PermitAMEC-PennitApp.doc 12103 440.4617T (1 /02/COM/WEB)
1 . ci 172 2 L. 896 EOS 1 o...iquoo elewT To dEZ:.bO t,o sa Inc
v
Jul 29 04 04:23p climate control 503 969 7224 p.2 •
O
O
0
•
e�
I
•■•■• �O J o
et, —
3J
CITY OF TIGARD s2-e
BUILDING DIVISIbN PERMIT #: ",0 d CI - 065/ d
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .. ' I I..
INSPECTION WORKSHEET FOR DATE: 3 - 1 TIME: - PAGE:
SITE ADDRESS: l )-( j l/ (� ∎� CLASS OF WORK:
SUBDIVISION: / LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: / #: F
CONTRACTOR: C� • PHONE #: �S3 _ c() z_z____
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
e r.A..ri ct_40
Corrections /Comments /Instructions:
,. Ls-•_i _IL .. -. 4 . .29 ‘ '5
`-7'��2/a-4✓ / " 4a
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
(74 Inspector: 7e Date: 3 7 ) Phone #: (503) 718-