Permit ,w
CITY OF TIGARD
MECHANICAL PERMIT
S DEVELOPMENT SERVICES PERMIT #: MEC2004 -00759
^= �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/18/2004
PARCEL: 2S1 11 AD -04600
SITE ADDRESS: 09020 SW PINEBROOK ST
SUBDIVISION: PINEBROOK TERRACE ZONING: R-4.5
BLOCK: LOT: 069 JURISDICTION: TIG
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:
GAS 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: Furnace install.
Owner: FEES
TARASAWA, FRED H Description Date Amount
CONSTANCE J [MECH] Permit Fee 11/18/20( $72.50
9020 SW PINE BROOK ST [TAX] 8% State Surchart 11/18/20( $5.80
TIGARD, OR 97223
Phone: 503 639 - 8417 Total $78.30
Contractor:
THERMAL FLO
14865 SW 74TH AVE. #190
TIGARD, OR 97224 REQUIRED INSPECTIONS .
Phone: 503 - 670 - 8383 Heating Unt Insp
Final Inspection
Reg #: LIC 151847
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: iZe......4-L, Permittee Signature: 05)-1_ Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit ED hOR OFFICE USE ONLY
City of Tigard / '`x Received
13125 SW Ill Blvd.; Tigard, OR 97223A Date /By: �� 011 Permit No.: nIt�Lj� 0 ' A
1 8 2004 Plan Review
Phone: '503.639.4 L 71 Fax: 503.598.196NOV ' /,a l� ( Date Other Permit:
Inspection Line: 503.639.4175 ,�
Internet: www.ci.tigard.or.us CITY OF TIGAR 9=""1J"4 , ` °' I Date Ready/By: 1 See Page 2 for
BUILDING DIVISION Notified/Method: ((( Supplemental Information
' TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
- CATEGORY OF CONSTRUCTION Value: $
Gal - and 2- family dwelling ❑ Commercial/industrial RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
❑ Accessory building
El ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: q 0 0 suu V �.u(cc� Air conditioning or heat pump
`� (requires site plan showing placement) 14.00
City/State /ZIP: Tl� n ', a q Furnace 100,000 BTU (ducts/vents) k 14.00 l 4 - ----
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: heat pump 14.00
Gas 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
DESCRIPTION OF WORK Water heater 10.00
` � J kA 0 0 Gas fireplace 10.00
l V � �C�� ���Q (' Q__ Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
C]- PROPERTY OWNER ❑ TENANT
Chimney/liner/flue/vent 10.00
Other. 10.00
Name: 0 nil in i C, `-1- ,(..l j a Environmental exhaust and ventilation
Address: C 04_0 siA) t' 1 Yyy k) ry(�L el- . Range hood /other kitchen
equipment 10.00
City/State/ZIP: 01 2 q 7 Clothes dryer exhaust 10.00
_ Single -duct exhaust (bathrooms,
Phone: (�7) (V/ cL:pk 1l Fax: ( ) toilet compartments, utility moms) mpartments, utili rooms 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: ) l Lk P , Fuel r m
P�P� g
Contact name: -3?. . G o.,-- $5.40 for first four; $1.00 for each additional
Address: l -\_z —r+41- - o 0 Furnace, etc.
Gas heat pump
City/State/ZIP: T d/ C 7 n 3_4 Wall/suspended/unit heater
Phone: ( Fax: ( ) Water heater
' �r � t>— 3 F S °'� �o - 7 b q Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: i Arro c ) �T. .--t...- Clothes dryer (gas)
Lam" Other.
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: S , stal
Phone: ( ) Fax: ( ) Minimum permit fe:i� �f 2 5-D
�( � � Plan review (25% of pe I
CCB lic.: �. �
l -7 State surcharge (8% of permit fee) be�
n TOTAL PERMIT FEE 73 -- , o
Authorized signature: i X�' This permit application expires if a permit is not obtained within 180
4 , u C N /l / days after it has been accepted as complete.
Print name: 7�_ M / Date: (Lt • Fee methodology set by Tri -County Building Industry Service Board
i:t Building∎ptrmits∎MEC- PamitApp.doc 12/03 440 (I I /02/COM/WEB)
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CITY OF TIGARD 1
BUILDING DIVISION PERMIT #: MEC2004 -00759
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/18/2004
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 , '.�
INSPECTION WORKSHEET FOR DATE: 3/31/21' TIME: 7:05AM PAGE: 77
SITE ADDRESS: 09020 SW PINEBROOK ST CLASS OF WORK:
SUBDIVISION: PINEBROOK TERRACE LOT #: 069 TYPE OF USE:
PROJECT NAME: TARASAWA
DESCRIPTION: Furnace install.
OWNER: TARASAWA, FRED H, PHONE #: 503- 635.8417
CONTRACTOR: THERMAL FLO PHONE #: 503 -670 -8383
Inspection Request Scheduled For: Date: 3/31/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 003265 -01 503 - 670.8343 N
Corrections /Comments / Instructions:
plutivriL (_,,j9,c)2 Et/ 4: r 5 2 5-C-3 7
(Ks) 2SSv C t�5
Govt P
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SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL , _CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: .AL■■ — Date: Phone #: (503) 718 -