Permit v CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00711
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/6/2007
PARCEL: 1S133AD-06200
SITE ADDRESS: 10935 SW SUMMER LAKE DR ZONING: R -
SUBDIVISION: AMART SUMMERLAKE LOT: 106 JURISDICTION: TIG
PROJECT: NEWTON
Project Description: Furnace replace.
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:
NAT 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:
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
NEWTON, DALE A AND LINDA L Description Date Amount
10935 SW SUMMER LAKE DR
TIGARD, OR 97223 [MECH] Permit Fee 12/6/2007 $72.50
[TAX] 8% State Surcha 12/6/2007 $5.80
Total $78.30
Phone: 503 - 524 -5240
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -557 -2220
FAX 503 -557 -0919
Reg #: LIC 72623
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 Permittee Signature: z, Q�j� -� • (4#
Call 503.639.4175 by 7:00 a.m. for inspections that business day.
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.
...)r DEC -6 -?007 10:00A FROM: TO:5035981960 P.1
. ,(I I
Mechanical Permit rclii OFFICE use ONLY
City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 97223 DEC 0 q 2001 P e e°1- 6 e i i j Permm ' ., ^ 4/A D ,
Phone: 503.639.4171 Fax: 503.598.196a._ ya , Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGAR 0 1 Date Ready/By: saris. ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DtVIS 1 Notilled/Method: Supplemental Information
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❑ 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.
' ^Xt A' ! 'r r:; ', c a s.: : k _ . ; r Value. $
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3 ,. ,rrs r .!.,,•.r ' C'!4T ,., : .,. :.. -' : , _ -. 4"T 'I; r ° ': ', ri M pP..l',14i..Q., AMEN /•SYSTE_ MS FEES*
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building : "''
Multi-family Master builder For special information use checklist.
❑ y ❑ ❑ Other: Description I Qty. I Ea. I Total
l i 4 > ITE 16( i1VjATl (Qlr' : I .' Heating/cooling -
Job site address: (DAN �1CW'' �eor i v o Air conditioning or heat pump
�J�/' r (requires site plan showing placement) 14.00
City/ State/ZIP: Tigard £11223 Furnace 100,000 BTU (ducts/vents) 1 14.00
Suite/bldg. /apt. no.: I Project name: Furnace 100,000+ BTU (ducts/yenta) 17.90
Gas heat pump 14.00
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
Subdivision: Lot no.: Flue/vent for an of above I 1 0.00
Other: 10.00 ,
Tax map /parcel no.: Other fuel appliances
„� n I r ny,, !.,:;a O• 10.00
I
j �hv y.i ? a+. y' 'p 4' 11mS " u''. `13 Wate heater
` u }l •M'f `'} : ge ;1r 0 sf• { i ' " • + :'t]�y d , p I� + 31 : t' : :i
fi ,4i:. o. t r : x. -: . . C , -J •xsal 1'41;�ta. .t' ,i,' Y .i' ..krie' .a: y. ,
Gas fireplace 10.00
Flue vent for water heater or gas
e A „ n/ i,p fireplace 10.00
1 -�i ,l�J 1 lldJl3.> Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
�,', : N ,;.; Chimney/liner/flue/vent 10.00 0 4,117 0
Other: 10.00
T
Name: C
� O Environmental exhaust and ventilation _
Address: 6W r io Range hood /other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
52-4-b240 Fax: ( ) toile m p exhaust utility rooms) Phone: ( ms) 6.80 _
It � ) i toilet compartments, ti i'3mi �a <n. n tl , a�,t , .. i ��lgi a !, .;, a .. = a' '• i' : • y'•:( 10.00
VI 4 +t''� •,,, Auic/crawlspace fans
Tr! � Ye lp CO I rim 1 Other: _
CetU 10 00
Business name: Ebel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: 4 I t) (3 0 laCktti N ,"c'r JN7Ul.! Furnace, etc.
Gas heat pump
City/ State/ZIP: C atioi 1 (.1'q ( (( 704.5 Wall/suspended /unit heater
Phone: ( J)) S5 ` 7- - - ' O Fax:: ( 13) 5 5 7- Cl VI Water heater
Fireplace
E -mail: Range
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`rqKtjr '' n � " � r . i 7 ` n /.• Y fit} T n• d x - ; ∎ q .. ,at� ! • !i ,, Barbecue
S � ti. � � ' u � q. "t'� 1• ,° 1 .
dn,rslFl i1 ..: 7"t,;i:'i �a.. "nubN, . a � r� � - „ • d e ' I M;'., 3'. ■t, -,,. ��tw :+ 'tK•�r� s, I'U � • t ...v.;.....,
Business name: Tr, CCILu r , -en) aA :)
ii Clothes dryer (gas)
{{ ` L t Other:
Address: V ?) "J C ) t -ICLC i i rx13 1; /C.(" t' ' C., s , I ;' 'j ! 1 ;;:.: Edk i rrE .
ry Subtotal
City/ State/ZIP: C tt . (,I 1 C � C•; _ ` T
rx '3) 55--r Z �r I (IJ 65.7.-011g Minimum permit fee ($72,5)
Phone: (, Fax: Plan review (25% of permit fee)
CCB lic.: ' 7211 23 State surcharge (8% of permit fee)
/� /� �r1 ClL�� TOTAL PERMIT FEE 1t�
Authorized signature: ' "F / f Thls permit application expires if a permit It not obtain d within 180
gn r • days attar It has been accepted as complete.
Print name: N ail( /1 '0.5(1 {) Date: 1 (i ' Fee methodology set by Tri- County Building Industry Service Board
CITY OF TMARD
BUILDING DIVISION PERMIT #: MEC2007 -00711
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1276/2007
Phone: (503) 639 - 4171 +1 fl
Inspection Requests (24 Hrs.): (503) 639 -4175 `'-.
INSPECTION WORKSHEET FOR DATE: 12/12/2007 TIME: 1:00AM PAGE: 57
SITE ADDRESS: 10935 SW SUMMER LAKE DR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 106 TYPE OF USE:
PROJECT NAME: NEWTON
DESCRIPTION: Furnace replace.
OWNER: NEWTON, DALE A AND LINDA L, PHONE #: 50 5245240
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503 -557- 2270
Inspection Request Scheduled For: Date: 12/12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
599 Mechanical final 061334 -01 503 - 557 -2220 Y
Corrections /Comments/ Instructions:
0 ELE . L _ L.1 # - -
ASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
.--V
Inspector: ' , Date: I ' 2 - - - - / - , . . . . . . - 7 Phone #: (503) 718- __.11,-41,