Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00203
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/22/2008
PARCEL: 2S114BD - 03700
SITE ADDRESS: 09545 SW RIVERWOOD LN ZONING: R -7
SUBDIVISION: COPPER CREEK STAGE 3 LOT: 077 JURISDICTION: TIG
PROJECT: MICKAELSON
Project Description: Install furnace and water heater.
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:
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Owner: FEES
NELS MICKAELSON Description Date Amount
9545 SW RIVERWOOD LN
TIGARD, OR 97224 [MECH] Permit Fee 4122/200€ $72.50
[TAX] 12% State Surch 4/22/200€ $8.70
Total $81.20
Phone: 503 -341 -5784
Contractor:
OREGON HEATING & AC
D BOX REQUIRED ITEMS AND REPORTS
DUNDEE, NDEE, , O R 97115
OR
Contact #: PRI 503 -538 -2953
FAX 503 -537 -2172
Reg #: LIC 172126
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 - -- Permittee Signature: �� Call 5139.4175 by 7:00 a.m. for inspections that business d27/
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.
IIP PIP A . pr 22 08 10:06a 503 -537 -2172 p.3
Mechanical Permit Application FOR OFFICE USE ONLY
1 Ci ty of Tigard Rece
q � � Y. Permit No.: , tc i
131 SW H alt Blvd., Tigard. O Lg r Date' I / "' (�(�'
Phone: 503.639.4171 Fax: 503. R Q Plan Review
Inspection Line: 503.639.4175 R 2 2 2008 DataBy. Other Permit:
T I G A R D Date Ready:By: _lurk la See Page 2 for
Internet: www.tigard- or.gov Noti
MAIM
CITY OF Ti t�2'11 +1] fied %M1ietlwd: Supplemental Information
TYPE
CITY ri v 71 S t' i + CN
COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
® 1- and 2- family dwelling ID Commercial/industrial RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
❑ Accessory building
ID Multi-family El Master builder For special information use checklist.
❑ O ther: Description 1 Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 9545 SW Riverwood La Air conditioning or heat pump
(requires site plan showing pla :etnenn 14.00
City /State /ZIP: Tigard, OR 97224 Furnace 100.000 BTU (duets/vents) I 14.00 14.00
Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg./apt. no.: Project name: Mickaelson /08-0158 Gas heat pump 14.00
Cross street/directions to job site: Duct work . 10.00
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. 14.00
Subdivision: Flue /vent for any of above 6.80
Lot no.:
Other. 10.00
Tax maplrparcel no.: Outer fuel appliances
• DESCRIPTION OF WORK Water heater I 10.00 10.00
Gas fireplace 10.00
Install furnace and warer heater Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert [0.00
❑ PROPERTY OWNER
1 Chimney /liner /flue/vent 10.00
( ❑ TENANT Other. 10.00
Name: Nels Mickaelson Environmental exhaust and ventilation
Address: 9545 SW Riverwood Ln Range hood/other kitchen
equipment 10.00
City/State/ZIP: Tigard, OR 97224 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
- Phone: (503)341 -57B4 Fax: ( ) toilet comportments, utility rooms) 6.50
® APPLICANT ❑ CONTACT PERSON Attic crawtspace fans 10.00
Other: 10.00
Business name: Oregon Heating & AIC
Fuel piping
' Contact name: Liz Scott S5.40 for first four; SI.00 for each additional
Address: PO Box, 241 Furnace etc.
Gas heat pump
City /State /ZIP: Dundee, OR 97115 Wall /suspended/unit heater
Phone: (503) 538 -2953 I Fax: : (503) 537 -2172 Water heater
Fireplace
E -mail: Iiz@orrr gonheating com Range
CONTRACTOR Barbecue
Business name: Same as above Clothes dryer igas)
Other.
Address: MECHANICAL PERMIT FEES*
City!State/ZIP: Subtotal I 24.00
( ) Minimum permit fcc (572.50) 72.50
Phone: ( ) • Fax: Plan review (25% of pennit fee)
CCB tic.: 172126 State surcharge ([ 2% of permit fee) 4.70
TOTAL PERMIT FEE I 8L20
Authorized signatu. - . VI r 1it.
This permit application expires if a permit b not obtained within 180
I �1 days after It has been accepted as complete.
Print name: Ln, Scott I Date: 4/22/08 I • Fee methodology set by Tri- County Building Industry Service Board
1.13uilding•Pa its'.AtE 'mnitgpp.doc Mg • 440 .46I7T(I l62COtv:•WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC200B -00203
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/22J2008
Phone: (503) 639 -4171 ' , I
Inspection Requests (24 Hrs.): (503) 639 -4175 1.L
INSPECTION WORKSHEET FOR DATE: 5/20/2008 TIME: 6:59AM PAGE: 23
SITE ADDRESS: 09545 SW RI VERWOOD LN CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 3 LOT #: 077 TYPE OF USE:
PROJECT NAME: MICKAELSON
DESCRIPTION: Install furnace and water heater.
OWNER: MICKAELSON, NELS PHONE #: 503 341 -5784
CONTRACTOR: OREGON HEATING & AC PHONE #: 503 - 538 - 2953
Inspection Request Scheduled For: Date: 5/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 070155 -01 503538 -2953 Y
Corrections/Comments/Instructions:
T_�tA -�
or /Comments /Instructions:
;) "
Gr% iiv.�/L hsah —•S'— is--9 -l�'lf ' ' e i e r*___
' ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r Date: S' 6 8 Phone #: (503) 718- 7
1