Permit CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00148
4.00.,„,,,t 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/5/2005
PARCEL: 2 S 103 B D -00400
SITE ADDRESS: 11850 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Replace gas furnace
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:
LPG 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
EDITH HANSEN Description Date Amount
9894 ROAD 18 NE [MECH] Permit Fee 4/5/2005 $72.50
MOSES LAKE, WA 98837 [TAX] 8% State Surchar€ 4/5/2005 $5.80
Phone: 509 765 - 3816 Total $78.30
Contractor:
A -1 AIR CONDITIONING CO INC
2038 NW ALOCLEK DR # 225 REQUIRED ITEMS AND REPORTS
HILLSBORO, OR 97124
Phone: 503 645 - 5900
Reg #: LIC 62102
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 -
Issue By: Q a jyyt jajo, Q Permittee Signatu ,`� - vim
Call 503 - 6394175 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.
•4/04/2005 15:20 5036907435 Al -AIR PAGE 02
•1 (a, - 24. - .2
Mechanical mit A► ® I ( 1 ONLY
City of Tigard l�wta
D av e y : 4, i� A �e PcmotNo.: ,�
13125 S W Hall Blvd., Tigard, OR 9 N� � S Q O �•
Phone: 503.639.4171 Fax 503.598.19 0 4 � *I ° r, _ Plan Review
inspection line: 503.63 5 I ' � \ Dat�1" Other Paoli:
Internet: www.ci.tigard -onus ZkGP . 1 Nara ed/M rho S sae Pane for
G, . ` N Q �`v1M ltotifled/trtethod Supplemental information
yV 4.( ' r1 i' , I 1 ,a ,, ts n I y 7 et r ! .l ; r r ' : 11`y s. 1 I V'' p ,'' ,,
i Mill : I i•,r�;.,,.'1 • at..,� 1 ei,.Y :a'•',. i{}.!d mod,,,.,t(li1 1.4i .'.. r. Id fit 11'.'t''4
• ; .
. � �. ' - •�15�'�JSECKL[S'1'
❑ New construction RI Addition /alteration/replacement Mechanical permit fees* are based on the value of the work -
❑ Demolition Other performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
''Li
:. A- .... 1, : _.s :!'.''''',..,,-0,-., .. , . v ; l'- .` I Y 1 ?.._ 'ti'. 1 F :.. it" 71. 4. ' `1 � ValUe_�
a.r mdh.. 0 , , i I . iS $ S FEES*
1- a nd 2-family dwelling ... ,... . � <: ?, 4 �.,
® y g ❑ Commercial/industrial Q Accessory building r
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist,
Description J Qty. I Ea. l Total
'`t1wfl1;,, a t , f ,,14' , ' , i • 1 1' , . ,1 , l Y \ 'E I n i•' ' 4Ir, . Vl :. .��I f `,lF l
ti , S
t t t.... < . .. .. ‘1-.,,, , s :, . ? t. y a .�r.:f�.,. t Heating/cooling
Job site address: / / S S O 5w 4•CJ/QL/U ti T S / Air conditioning or heat pump
(requires site plan sho+viagylaeeoeeaq 14.00
City/State/ZIP: 7" j G.e9 2 U 0 /Z cl - 2 Z- Z 3 Furnace 100,000 BTU (duets/venes) ) 14.00
5uite/bl a t no•: Furnace 100,000+ BTU (duets/nab) 1 7.90
p PCOjeet frame: Gas heat pump 14.00
Cross street/directions to Job sites )( I Z I S T Duct work 1 4.00
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 Flue/vent for any of above I 10.00
Tax map/parcel no.: Other: 10.00
r. , { ; t, ; ,, - Other fuel appliances
.t =sly
';'...,'''.• � , .' - ,
'1-� :: i ' t II ., r . t4 i I . ,i' jrr ` ' ' t water heater
... __ . .. L,..,.._ 5 + c - t,i 5�,. .,...,.v.. 10.00
r ■... -.. Gas fireplace [0.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) W.00
Wood/pellet stove 10.00 _
Wood fireplace/insert 10.00
`; . :4- , ti , r - ; " ` if y' 1- I ' + ? t: 1 I g r, 1 s � 71,1 Chimney/liner/flue/vent 10.00
Other: 10.00
Name: E. D 1 T' 1 4 1-i /9ti S &N Environmental exhaust and ventilation
Address: Range hood/other kitchen
9 8 ' C/ i A.) equipment , 10.00
City/Stater/JP: M o a 2-se_a. W lo. 3 clothes dryer exhaust 10.00 - _
Single -duct exhaust (bathrooms,
Phone: (J o) '7 ( S--- 3 • I - Fax: ( . ) toilet cotrtpartments, utility rooms) 6.80
, ..... (. .. . F ... ' , .. ' . l u, . `', ' . s ;, . .� .. +. j •i: Y ti . -, :,'; �f i ,&atl1 „j' i 7.l! i
I�t r h5 Attic/crawlspace fans _ 10.00 -
13tis1oaat1mmelo: T CA.14dt) 7' Other: 10.00
Fuel piping
Contact tee: r L / L r4 t M 0 /Z, i 50 I✓ $5.40 for first four: 51.00 for each additiona
Address: / / & S4 3 W w /9 C , ill i S T' Gas heat pump
Gas heat putrtp
City/State/ZIP: 7- J 649 /2/D are_ 4 7 Z "Z 3 Wall/suspended/unit heater . -
Phone: (,S S 74 - 9� y/ Fax:: ( ) Water heater `
Fireplace
-
Range
-, e.� {.., t .. _. ' ' _. i , . l∎ Barbecue
I �, t 1 i
A / A i Clothes er )
Business name: 2 C O Nl� / r / A /LI 1 ti 0- .) • other, d'Y
Address: Z O 3 if ,(it,( 4 L O C G t /C. Z. Z S 7' v I `., ', "k , •
'`' t ''d ( 1 Jt:2 t lJ,u 11 ! 4 l--
, Ii11 i:Ur ��11 �1[,' � . 0 �, . _ ,� I , � , I �
City/State/ZIP: /4 , L L. .. /3 U' se-0, - -2 / Z _ Subtotal _
Phone: (.5"0.3) (, 4'5 • S''OO Fax: (SQL (Q - ^7 y 3 S a n revi (25% of r mit fee)
7 Z . 5Q
Pla review {ZS% of permit fee)
CC13 lie.: 6 /p e.. State surcharge (8% of permit fee) 5' : $ b
TOTAL PERMIT FEE 7 g .3 0
Authorized signature: /2, _ ` // L- / o days l0 Thus p ermit application after tzpirea If a permit b not obtained within 180
ys after It has been accepted as eomptets.
[ Print name: !7\Q 5.5 ".7 /3,_ / /} I Date: 4 /- Le p S • Fee methodology act by Tri- County Building Industry Service Board
e‘Bul PanttakapOC- ranprtAPPdoC 12/05 140461 rr(ttro?1c0Mfwsn)
CITY OFTIGARD
BUILDING- DIVISION PERMIT #: MEG200500149
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/5/2005
Phone: (503) 639 -4171 1
Inspection Requests (24 Hrs.): (503) 639 -4175 � �..
INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 86
SITE ADDRESS: 11850 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HANSEN
DESCRIPTION: Replace gas furnace
OWNER: HANSEN, EDITH PHONE #: 509 - 765 -3816
CONTRACTOR: A -1 AIR CONDITIONING CO INC PHONE #: 503 - 645.5900
Inspection Request Scheduled For: Date: 6/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 009935-01 503 - 590.9141 Y
Corrections /Comments /Instructions: •
•
•
•
PA ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ��✓ Phone #: (503) 718-