Permit C ITY OF TIGARD _ MECHANICAL PERMIT
I ' ` COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00610
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/16/2008
PARCEL: 1 S133DD -02400
SITE ADDRESS: 12887 SW VILLAGE PARK LN ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 LOT: 063 JURISDICTION: TIG
PROJECT: MIDDLETON
Project Description: Replace gas furnace and venting.
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:
Owner: FEES
ANDREW MIDDLETON Description Date Amount
12887 SW VILLAGE PARK LN
TIGARD, OR 97223 [MECH] Permit Fee 12/16/20( $72.50
[TAX] 12% State Surch 12/16/20( $8.70
Phone: 503 -590 -2606
Total $81.20
Contractor:
SPECIALTY HEATING & COOLING
7500 SW TECH CENTER DR #130
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503 -681 -0793
PRI 503- 620 -5643
Reg #: LIC 66578
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: �„ / ��� Permi' -e �' // fern?./ /
Call 50 "'175 by 7:00 a.m. for inspections that busine s ay.
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.
, DU/16/2008/TUE 07:41 AM FAX No. P.001
Mechanical Permit Applicati!■; FOR OFHCE USE °NIA'
City of Ti 4175 639
gard tikb - keeeived
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ale/BY- , ■
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13125 SW Hal1131vd., Tigard, eii: , I ..\.t. v. .• . - Review --
Phone: 503.639.4171 Fax: 51 ,' 'N : .0 4 0 4,0eV , 9 ,telBy: Other Permit.
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- 1 1 6 A It 1:, Inspection Line: 503,639.4175 c V 4\ Date Ready/By: J El See Page 2 for
Internet: wmv.tigard-or.gov ON "t■ Notified/Method, r7-774 Supplemental Information
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1.'''': .;.; -. IT:i**V#ON ' 7 ' ,',- .';',2:i'1. ..-:;'-' -j:,:!'nfaiiiil :1!:,e1tadt**:14:***WW..fi.*:PrilOr.**
Mechanical permit fees* arc based on the value of the work
CI New construction F4 Addition/alteratiO•:•" p acement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition p Other: mechanical materials, equipment, labor, overhead, and profit.
*ibioNgfictotio , 1::i.:..,,4014 vi'dr, .. ,,. .., , Value: s „.,,,
1 - and 2-family dwelling 0 CommerciaVindustrial El Accessory building
For special information use checklist.
p Multi-family 0 Master builder 0 Other: Description J Qty. r Ea I Total
4/,,AttE,A10i5:1:*;,:,,,,itsl; l49;i4lcOte ',:':_i•. Heating/cooling
• I., Air conditioning or heat pump
Job site address: ov 50 i j Iim ( I r_
v r ? , (requires site plan showing placement) 14.00
City/State/ZIP: Ti • ctr ct oe 9-7 .1._ Furnace 100,000 BTU (ducts/vents) i . 14 00
. Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg./apt. no.: Project name: arnitlehlAMMI
Gas heat pump 14.00
Cross strect/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
Flue/vent for any of above 6.80
Subdivision: I Lot no.: -
Other. 10.00
Tax map/parcel no.: Other fuel appliances
. ilk(OItell ei■li:.4* .. ‘r -1; r.; '''. Water heater 10 00
- ' -,- .15i . , .-!,'_ .0; .. ■ , i , , t 1 . , 4 ,.,., .1, ',. , lw:i'; -1-,,. .1, L'".
Gas fireplace 10.00
-- R 1 914..te 3 irs uutrute a L), • . Flue vent for wat heater or gas -
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove _ 10.00
Wood fireplace! Insert 10 00
. ...
0,0Iti,1 „ Chimney/liner/flue/vent 10.00
„i,; ' ;:„!:.1f:”, ',:'.1;411i9I oti 10.00
Name: . itnidli&I a Environmental exhaust and ventilation _
Range hood/other kitchen
Address: tai. e .--7 si ij -, entigimm e 10.00
..
city/swear-1-i , 6 re- 97 ao-3 Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( b3) ' D _. , , Ot„ Fax: ( ) toilet compartments, utility rooms) 6.80
; ::;,:.;• ;, ;•:‘, .4 (;*114 - Attic/crawlspace fans 10.00
Other: 10.00
Business name: / e. • 1 • - Cr. Fuel piping__
Contact name: (+ee i MA. kl. i $5.40 for first four; 51.00 for each additional
Address: 1 75 - 0 50 7 demuie( nr. Sid 130 Furnace etc
2 •
Gas heat pump _ —
City/State/ZEP71 • a CAZ . Wall/suspended/unit heater
Phone: p ) , Fax::663) g c ie - 67 i 8 water heater
—
Fireplace
E-mail: Range
,.....::.• ■I' j Y= ,-'.441'•1.!;:;,i,l':: !
:- ; Barbecue
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-1 , :,5L'..-! , ..-■ r :r ,,,, I-■ -.'' r,o . ' , , 1 1,.. , •'• 9 • 1 . —
Business name: Specialty Rearing and Cooling, Inc. Clothes dryer (gx)
— Other: I I
Address: 7500 SW Tech Center Drive Suite #130 '''!40...j..11el,iO47.710;:-
City/Statc/ZfP: Tigard, Or. 97223 Subtotal
Minimum permit fee ($72.50) ^b.,1, )
Phone: (503) 620-5643 Fax: (503) 681-0793 Plan review (25% of permit fee) _
CCB lie.: 66578 State surcharge (12% of permit fee) d.., '7 1)
TOTAL PERMIT FEE S. I ..2c,
This permit application expires if a permit is not obtained within 180
Authorized signature: days after It has been accepted as complete.
Print name: Andrea Dripps Date: b.--1 • Fee methodology set by Tri-County Building Industry Service Board
BsinimeaPamile\a/PC-PermilApp doe 01M/O7 4413-4617T (I I /02/COM/WEB )
CITY OF TIGARD
* ..... A
BUILDING DIVISION e & PERMIT #: MEt 100is iTG6'10
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/16/2008
Phone: (503) 639- 4171:VI el
Inspection Requests (24 Hrs.): (503) 639 -4175 �
INSPECTION WORKSHEET FOR DATE: 12/220008 TIME: 7 :00AM PAGE: 10
SITE ADDRESS: 12087 SW VILLAGE PARK LN CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 LOT #: 063 TYPE OF USE:
PROJECT NAME: MIDDLETON
DESCRIPTION: Replace gas furnace and venting. f'''` `'t
OWNER: MIDDLETON, ANDREW .,. E #: 503590 -2606
CONTRACTOR: SPECIALTY HEATING & COOLING PHONE #: 503 -520 -55/13
Inspection Request Scheduled For: Date: /2122/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Me ge
699 Mechanical final 079119-01 503-590-2606 Y
Corrections /Comm nts /Instructions: •
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4 pAss [1] PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL El CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 2 Phone #: (503) 718- 2-1