Permit CITY OF T MECHANICAL
- 4a .. DEVELOPMENT SERVICES PERMIT
!J. 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # : MEC99 -0068
0 DATE ISSUED: 02/17/99
4 4 1 04 PARCEL: 1S134CD -06400
SITE ADDRESS...: 11720 SW SUMMER CREST DR ®�
SUBDIVISION • BURLWOOD NO.3 'NING: R -4.5
BLOCK • LOT :024 , ISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE °SF UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:R3 VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES ° 0 BOILERS /COMPRESSORS HOODS : 0
FUEL TYPES 0 -3 HP • 0 DOMES. INCIN: 0
. 3 -15 HP : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15 -30 HP : 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: 30 -50 HP • 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HP : 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 0
FURN < 1O0K BTU: 1 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN > =1O0K BTU: 0 ) 10000 cfm: 0
Remarks : Replace existing furnace w /new gas furnace and add gas piping.
Owner: FEES
JEFF C LASERSOHN type amount by date recpt
11720 SW SUMMER CREST DRIVE PRMT $ 25.00 GEO 02/17/99 99- 312978
TIGARD OR 97223 SPCT $ 1.25 GEO 02/17/99 99- 312978
Phone #:
Contractor:
OWNER
$ 26.25 TOTAL
Phone #:
Reg #..:
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Heating Unt Insp
applicable laws. All work will be done in accordance with Final Inspection
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 by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 - 001-0010 through OAR 952 -001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
/ '
Issue By: ,� /� /,`
Permittee Si Si nature• /1�J.l1!/ p
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
• Plan Check #
CITY] OF TIGARD Mechanical Permit Application Recd By
; ,13125 SW HALL BLVD. Commercial and Residential . Recd
TIGARD, OR 97223 �- Date to P.E.
(503) 639 -4171, x304 f ° Date to DST
Print or Type Permit# f141Fe f P - cic
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
Table 1A Mechanical Code Qty Price Amt
Job Street Address Uite# A) Permit Fee 10.00
-�
Address l I lvV s - 1) Furnace to 100,000 BTU
Bldg# City/State Zip including ducts & vents see footnote 1,2 / 6.00
e Zip 2) Furnace 100,000 BTU+
T / (R f 23 including ducts & vents see footnote 1,2 7.50
(or na a of siness) 3) Floor Furnace
Owner Vl including vent see footnote 1,2 6.00
Mailing Address 4) Suspended heater, wall heater
( ( -Z7 ‘—e-) /_ r or floor mounted heater see footnote 1,2 6.00
��C.Yf.�/ 5 ) Vent not included in appliance perm
CR /State Zip Phone 3.00
j Olt V l , G '• j T 2 S Check all that apply: *Boiler Heat Air
Name (or name of business) For items 6 -10, see or Pump Cond Qty Price Amt
footnotes 1,2 Comp •^•
6) <3HP;absorb unit to
Occupant Mailing Add 1100K BTU 6.00
�� 7) 3 -15 HP;absorb unit
City /State Zip Phone 100k to 500k BTU 11.00
8) 15 -30 HP; absorb
Contractor Name unit .5 -1 mil BTU 15.00
I„ � 9) 30-50 HP; absorb
(/( / unit 1 -1.1. 75 mil BTU 22.50
Prior to permit Mailing Address 10) >50HP; absorb unit
issuance, a copy >1.75 mil BTU 37.50
of all licenses City /State Zip - Phone 11) Air handling unit to 10,000 CFM
are required if 4.50
expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 12) Air handling unit 10,000 CFM+
database - 7.50
Architect Name 13) Non - portable evaporate cooler
4.50
or
Mailing Address 14) Vent fan connected to a single duct
3.00
15) Ventilation system not included in
Engineer City /State Zip Phone appliance permit 4.50
16) Hood served by mechanical exhaust
Describe work to be done: 4.50
/ 17) Domestic incinerators
0
New ' R air 0 Replace with like kind: Yes 0 No 0 7.50
Residentiar€4 Commercial 0 18) Commercial or industrial type incinerator
30.00
Additional information or description of work: 19) Repair units
fiL /5Y i /V w/( ° A5 FC — 4.50
20) Wood stove
NOTE: For Commercial projects only; Units over 400 lbs. require 4.50
structural gas caics. 21) Clothes dryer, etc.
Type of fuel: oil 0 natural gasPG 0 electric 0 4.50
22) Other units
I hereby acknowledge that I have read this application, that the information 4.50
given is correct, that I am the owner or authorized agent of 23) Gas piping one to four outlets
the owner, that plans submitted are in compliance with Oregon State laws. See footnote 1 / 2.00 -
/ 24) More than 4 -per outlet (each)
Sig1- u . er/A
"2_ -nt Date .50
e
' — 1 -t e7 Minimum Permit Fee $25.00 SUBTOTAL
Con •: ct • erson Name Phone
5% SURCHARGE
PLAN REVIEW 25% OF SUBTOTAL
Foonotes for commercial projects only: Required for ALL commercial permits only
1. Provide full schematic of existing and proposed gas line and pressure. TOTAL -
2. Provide drawings to scale showing existing and proposed mechanical '
units. *State Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
I:\rnechperm.doc rev 02/4/99
6/8/00 Activities for Case #: MEC99 -00068
2:40:50 PM t XPIR
�®
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MECA007 Application received 2/17/99 GEO RECD DST 2/17/99
MECA008 Create Permit • 2/17/99 GEO DONE • DST 2/17/99 •
MECA799 Final Inspection 3/2/00 RB FAIL AKJ 3/2/00 no one home left note to
arrange insp
MECA705 Gas Line lnsp 2/17/99 DST 2/17/99
MECA725 Heating Unt Insp 2/17/99 DST 2/17/99
MECA060 (F) Issue permit 2/17/99 GEO PASS DST 2/17/99
MECA845 Request inspection research 3/24/00 JMT DONE No Hold JMT 3/24/00 still over 180 days. no contact
with owner. no inspection made
MECA880 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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