Permit C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2006 -00071
l,t���i� DEVELOPMENT SERVICES DATE ISSUED: 2/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 BD -02300
SITE ADDRESS: 09705 SW PEMBROOK ST ZONING: R -3.5
SUBDIVISION: CLOUD CAP LOT: 005 JURISDICTION: TIG
Project Description: Replace furnace.
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:
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
JOSEPHINE STAMM Description , Date Amount
9705 SW PEMBROOK
TIGARD, OR 97224 [MECH] Permit Fee 2/3/2006 $72.50
[TAX] 8% State Surcha 2/3/2006 $5.80
Total $78.30
Phone: 503- 620 -6185
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 624 -2704
FAX 503 -598 -0270
Reg #: LIC 76359 •
•
•
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: T Permittee Signature: __so ..
Call 503 -639 -4175 by 7:00 a.m. for inspections that business da
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.
fr
Mechanical Permit App °l:,t CIU FOR OFl lt 1 Si: ()NIA
,
i Received
City of Tigard , iii 13125 SW Hall lvd., Tigard, OR 97223 Date/By: - 0 I "' ` I / / ,
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ,.. « Ti , i; { � .: Da Other Permit:
FEB ''
inspection Line: 503.639.4175 0 ai . •� { ' ;., Dote Re
Internet www.ei.tigard.or.us Notified/Method. Supplemental Information
i ! F :WARD
TYP r " 11A", COMMERCIAL FEE+. SCHEDULE. USE CHECKLIST
��r �` ' `��� Mechanical permit fees* are based on the value of the work
El New construction ( Ad: i � .: .i :.o rep acement
❑demolition performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF. CONSTRUCTION .. Value: S
• mil- and 2- family dwelling ID Commercial/industrial 0 Accessory building RESIDENTiIAIC; EQUIPMENT/ SYSTEMS FEES* •
❑ Multi - family ❑Master builder For special information use checklist.
❑ Other: Description I Qty. I Ea. I Total
. JOB SITE INFORMATION AND LOCATION `'. Heating/cooling
� n /' Air conditioning or heat pump
lob site address:
-/ //5 ,5 lac,t 6QO ts /e-, (requires site plan showing placement) 14.00
City /State/ZIP: Furnace 100,000 BTU (ducts/vents) J 14.00
Furnace 100,000+ BTU (ducts;vents) 17.90
Suiterbldgfapt. no.: 1 Project name: Gas heat pump (4.00
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 !
Flue/vent for any of above 10.00
Subdivision: . Lot no.: Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK • . • Water heater 10.00
./a6 / Gas fireplace for 10.00
r l �72 / G– � /,//�,if/d Gt Flue vent r water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
PROPERTY OWNER I ❑ TitNANT Chimney/liner /fluelvent 10.00
J � 1 10.0D
Name: '—/ 05" /Ij 1,ve- <.. ; j 944 i y Environmental exhaust and ventilation
Address: /' Range hood/other kitchen
equipment I 10.00
City /State/ZIP: Clothes dryer exhaust • 10.00
Single -duct exhaust (bathrooms,
Phone) C./,/D ✓ Fax: ( ) toilet compartments, utility rooms) 1 6.80
❑ APPLICANT - a CONTACT PERSON Attic /crawlspace fans i 10.00
Business name: Other. 10.00
Fuel piping
Contact name: /2 4A V . /j , ` $5.40 for first four; SI.00 for each additional
Address: ��77 !C/Y Furnace, etc.
I
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone i5 3 ) G i/ c w/70 l Fax:: L :/C� 3) 55 O Water heater '
`� 7 Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business Dame: Clothes dryer (gas)
(' a / ciAi kte /4 60 / //4/
•
Other.
•
Address: 1°J ,g pX n7 3 0 3 9 4 : - . =::.MECHANICAL PERMIT FEES" •.
City/State/ZIP: 7 I Q g ari Subtotal
Phone: (� 2) 4.71/ � ef I gax _ 3) . 5 4Q T Minimum 25% it fee rmit fee)
�.0 �/ g Q Plan review (25 °/a of permit fee)
CCBlie.: 7 p State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: o This permit application expires if a permit is not obtained within ISO
days after It has been accepted as complete.
mQ�t
Print nae: , za A /L ,., 1 te; f2/� b/ _ • Fee metbodolo set by Tri• County Building Industry Service Board
is Building \Penoi I „ 9 O
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CITY OF TIGARD -
BUILDING D1VISiON PERMIT #:3—DD6 - -0D07/
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 , to
Inspection Requests (24 Hrs.): (503) 639 -4175 .- &.. ^:_..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 9-7 a s CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
P-(-0 ----,,,\
Inspection Request Scheduled For: Date: 3- Pour Time:
J
Code # Inspection Description Confirm # Contact # Message
egg �, 6� Lf - X 70
Corrections /Comments /Instructions:
/C-r__,e...) f 117)-
/ /peg- ,�.2.w ZI
i PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n C LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
, /
Inspector: .,ifi Date: Phone #: (503) 718- 2-/