Permit CITY O F TIGARD
MECHANICAL PERMIT
are DEVELOPMENT SERVICES PERMIT #: MEC2005 -00430
r�Iil 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/18/2005
PARCEL: 2S 114BD -03400
SITE ADDRESS: 09500 SW RIVERWOOD LN ZONING: R -7
SUBDIVISION: COPPER CREEK STAGE 3 LOT: 074 JURISDICTION: TIG
Project Description: Approx 20' 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:
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: 1
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
BAILEY, LOUIS & KAREN Description Date Amount
9500 SW RIVERWOOD LN
TIGARD, OR 97224 [MECH] Permit Fee 7/18/200: $72.50
[TAX] 8% State Surcha 7/18/200: $5.80
Total $78.30
Phone: 503- 680 -2256
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: ✓7 :74:,('J�l Permittee Signature: Se
Call 503- 639 -4175 by 7:00 a.m. for inspections that business as .
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.
07/17/2005 21:17 FAX 5036501220 KOEHLER CONCEPTS a 002 /002
t Mechanical Permit Application i.oi ()Fyn I: 1 1st, ()NI.1
City of Tigard Re`°ivod Pennitxo
13125 SW Hall Blvd.. Tigard. OR 97 EC E l V E oi Data/By: 0 ' - ^ f � y30
Phone: 503.639.4171 Fmt; 503.598. j Pt un R ev i ew 'o � I ' ^ DsteBy: Other Permit:
Inspection Line; 5..4175 JUL 1 8 2005 ,III y
Internet: www.ci.t03ig,63eerdor,u9 in See Pepe 2 for
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200 Notified/Method: Supplemental Information
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Ire. i 1J1 c 7- ent Mechanical permit those arc based on die value of the work
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El Demolition ❑Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor. overhead, and profit,
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airy Value:S
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® 1- and 2- family dwelling 1:1 Commercial /industrial ID Accessory building' •'
12 Multi-family ❑Master builder ❑ Other:
For special i, jbrmadon use checklist
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,, , . , ,; . Description 1 Qty. 1 Ea. ) Taal
II , „' i,.:1'C1{�11:!^li�,hil l ,! '0 : l ' ' I,'i7 f i;∎ �.,in'iiil L (if „l . 1 Ii'll1` 11 Heating/cooling
Job site address: 9500 SW RIVERWOOD LN Air conditioning or heat pump
(moires site plan showing placement) 14.00
City /State/ZIP: TIGARD OR 97224 Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg./apt. no.: I Project name: BAILEY Furnace 100.000+ BTU (ducts/vents) 17.90
pas heat pump 14.00
Cross street/directions to job sitc: Duct work _ 14.00
Hydronie 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 Flue/vent for any of above 10.00
Other: J 10.00
Tax map/parcel no.: Other fuel appliances
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RUNNING APPROX 20 FEET OF GAS FUEL PIPING Flu fireplace 10.00 ,. Flue vent for water heater or gas
fireplace 10.00
LeR lighter (Ras) 10.00
Wood/pellet stove 10.00
Wood fireel ace/insert 10.00
0,• ,',• Chimney/liner/flue/vent 10.00
dj 'CH }.c�h :;• : „ Il ... ; ibi 1, ..1! d. mil ' � " 1: .ii!';:k l 1 , hulti a lsimittioiliilt other: 10.00
Name: KAREN BAILEY 1- ) OA: 1 Environmental exhaust and ventilation
Address: 9500 SW RIVERWOOD LANE Range hood/other kitchen
equipmcm 10.00
City / State/ZIP: TIGARD OR 97224 Clothes dryer exhaust 10.00
Phone: 503 680 - 2256 • Fax: (503 Single -duct exhaust (bathrooms,
( ) ) toilet compartments, utility rooms) 6.80
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Business name: KOEHLER CONCETPS LLC Other 1 0,00
Fuel EytIng
Contact name: TODD 55.40 for first !bur; S1.00 each additional
Address: 10772 SE HIGHWAY 212 Pomace. etc, I
Gas heat pump l
City / State/ZIP: CLACKAMAS, OR 97015 Walsuspended/unit heater
Phone; (503) 650-9550 I Fax:: (503) 650 -1220 Water heater
Fireplace
E -mail: Range I 5 • to S ,4b
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riti l? . {{I , �, t ' i . I ,, , „ i :, [ 'a''1' 1 'i� t. a 1 r 'ii;" L,i 3 ; i ,.. Barbecue
;,. 11 nh'i ,::.I„1 f I,.,', r,iln i i' t.l..',:,�li,�Ginl „l t I li�l'tl� 1 ,iA B
Business name: KOEHLER CONCEPTS LLC
Clothes dryer (gas)
Other:
Address: 10772 SE HIGHWAY 212 ,
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City/State/Z1P: CLACKAMAS OR 97221 Subtotal S •'fo
Minimum permit fire (572.50) 71.. So
Phone: (503) 650-9550 I Fax: (503) 650 -1220
Plan review (25% of per mlt toe)
CCB lie.: 120277 State surcharge (8% of permit fee) 5. 80
__ TOTAL PERMIT FEE 7 6 _30
Authorized signature: � This permit oppacation expires If a permit b not obtained within leo
i +-oT �j ��...--- days alter It hos bean accepted as camplete•
I Print name: TODD KOEHLER I Date: 1 • Fee methodology set by Id- County Building Industry Service Board
i \Buildi miteN C- PnmkAppdoc 12/03 4104612T (11/02/C01NAV®)
I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005 -00430
13125 SW Hall Blvd., Tigard, OR 97223 _ DATE ISSUED: 7/19/2005
Phone: (503) 639 -4171 ays p,� i
Inspection Requests (24 Hrs.): (503) 639 -4175 — - `_
INSPECTION WORKSHEET FOR DATE: 7/22/2005 TIME: 7 : 09AM PAGE: 21
SITE ADDRESS: 49500 SW RIVERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 3 LOT #: 074 TYPE OF USE:
PROJECT NAME: BAILEY
DESCRIPTION: Approx 20' of gas piping to range.
OWNER: BAILEY, LOUIS & KAREN, PHONE #: 503-680-2256
CONTRACTOR: KOEHLER CONCEPTS LLC PHONE #: 503 -650 -9550
Inspection Request Scheduled For: Date: 7/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 011975 -01 503680-2256 N
Corrections /Comments /Instructions:
( A/ _ (0 Ai ' ' •Ti =IS — ' -, - l // 1
1 ( 6 IL / ) .
L/ 0
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 7 t L - -- a5 Phone #: (503) 718-