Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00606
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/18/2007
PARCEL: 1 S133CD - 11500
SITE ADDRESS: 11765 SW WILTON AVE ZONING: R -25
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT: 147 JURISDICTION: TIG
PROJECT: GUTIERREZ
Project Description: Furnace install.
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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
FRANK GUTIERREZ Description Date Amount
11765 SW WILTON AVE
TIGARD, OR 97223 [MECH] Permit Fee 10/18/20C $72.50
[TAX] 8% State Surcha 10/18/20C $5.80
Total $78.30
Phone: 503- 624 -6236
Contractor:
SPECIALTY HEATING & COOLING
7500 SW TECH CENTER DR #130
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503 - 598 -0718
PRl 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: , � „ ' � i Permittee Signature: /74 ��lv
all 503.639.4175 by 7:00 a.m. for inspections that business a .
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.
�O�CTi18 /2007/THU 12:15 PM FAX No. P. 002/002
• -- t .,
Mechanical Permi . A. ... _ cam 4 FOR OFI:1C:E USE ONLY
City of Tigard 1 ,y
n `� Received ] �
13125 SW Hall Blvd., Tigard, OR '7 ! "" Me/B is 4 I 1 Y. l/ -ol' :r /
Pion • Other Permit:
Phone: 501639.4171 Fax: 503.596.1960 el .9e,, ;.. . tti b � ;,\ a�g
�� = Inspection Line: 503.639.4175 j 1 0 2 oo Ali ' j l i D ate
Internet: www.ci.tigard.or.us •. .�. -- N Ready/By: $ pent l I for
n , 4J otliled/Method; Supplemental
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FR;: F 1 �,cJi c , �, cl5 � a : I - �. i` a
hs 1 1 "ura ,1�7 ,. .ri s
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V ' ` T Mechanical permit fees" are based on the value of the work
❑ New construction •' on/alteration/replacement
pertbrmed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other: mechanical materials. equipment, labor, overhead, and profit.
77 Wa-'el,u� o `T ^n77 t ;= s,r-_t :._ .. -
.. .. .. fe s ' 3, II ,O�:.f*y= �-�'�.�->.°!'.I,e.1: r ilr,A y e. d i 7 , _,',v,Z4 ,''•'.
ell--a"'- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
0 Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
R 7;., -, t.tl� l.ti. { 0� i !\ tr `B � : �'�� ,. fni, • • ; 1� ;:i::. : Ir Heating /cooling
Job site address: Air conditioning or heat pump 1 �" t o �_ � kp . � 1 , .,-� Sreat fires sirejlan showing placement) 14.00
City /State/Z)P: Furnace 100.000 BTU (ducts/vents) r 14.00
Suite/bldg./apt. no.: I Project name: Furnace 100.000+ BTU (duets/vcuts) ' 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
hydronlc) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10 00
Subdivision: I Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map/parcel no.: Other fuel appliances
1 '�F fF.�. r J 'C M � �' r- it ~ ; ;C ,1 .�. '� �- 7',•; .4 ,: Water heater - 10.00
�;>r.:. >. -r, � i a� t' • ;- Sl ri fir 1 ,,:ra. y a : t z t. .._ a -1-6-',1--
1 te ,_. .. ., :t Fs : . Gas fireplace 10.00
Flue vent for water heater or gas
d p fireplace 10.00
J5�~ Log lighter (gas)
10.00
IP Wood/pellet stove 10.00
Wood fueplace/insert 10.00
;7;1 S ,r�-' :v. ■ i1�ru Y %�r'::�_'c_' "`�':''' ,- ,J 1 ;: -. .� - � - �e,, Chimney/liner /flue/vent 10.00
° - 7- �` 'J~ .' I1 - .. '..Z. 47 + : +,l�r. ,. Jr 10.00
Other:
Name: Gutierrez, Frank R07442 Environmental exhaust and ventilation '
Address: 11765 SW Wilton Ave. Range hood/other kitchen
Tigard, Or. 97223 equipment 10.00 _
City/State/ZIP: g r Clothes dryer exhaust 10.00
(503)524 -6236 Single -duct exhaust (bathrooms.
Phone: ( ) toilet compartments rooms) 6.80
^*+ ' „ !iy ;' r;' r. ,, : N ` ;?r "1sp ;:. =' ;rs - _j "::ic:E': 'r Attic /crawls pace fans 10.00
.H },,. .. li41,r - � {._ ._ -,:.. .1. ,..I ., . : ; ,�Q _ ,. , hl'�� l ' i :C...,,N p
Business name: • Other: , 10.00 + Fuel piping
S pee 4 a- ti N>� (,n i 4 &Dh1 ai 1r ,
Contact name S5.40 for first four; SI.00 for each additional
Address: 7566 50 -r - 4, - Furnace, etc.
T V" n r 1 �� Gas heat pump
City/State/ZIP: I l /L4 i '1c-3 Wall/suspended/unit heater -
Phone: ( ) S 4 Fax: : ( ) . Water heater
Fireplace
E -mail: Range
z ', 51 .:, am ,.. '.; t/ _ i :: :;. � f-r : ° J [°... i4r:�i� la:''. ;.
. eFr�• I; .. ,,., ` .j .; 'y. -r „1: P17 Y � _ ,1
9� .c . - `
: , _ '• - Barbecue
Business name: d, . s . i Clothes dryer (gas) . • Address: e ,, 5u) M i _ p Other: ..,- - -1;Th A S SGliri 565 , 91; ° i'6t 7.A J ' ,
City /State/ZIP: Ti ^ a �,,� Olt g 7 Subtotal
Cwt pax; o Minimum permit fee ($72.50)
Phone:
V 67) t . - 5 � 43 I ( 65) 57 Cri i Lf Plan review (25% of permit fee)
CCB lie.: / 512 State surcharge (8% of permit fee)
o f TOTAL PERMIT PEE b
Authorized signature: V3"�� Thu permit application If a permit is not obtained within 1
days after r It bas bas been accepted as complete-
Print name: A ? & - , a_ 4 �7 I Date 1 d' 4 , 81 C • Fee methodology set by Tri -County Building Industry Service Board
'r utuiiaanglPerm ;u»eaC- rermhApp.doe 12/03 440.4612T (1 I/a'JCOMN/EB)
i , . ✓
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: MEC2007 -00606
13125 SW Hall Blvd., Tigard, OR 97223 �� DATE ISSUED: 10/18/2007
Phone: (503) 639 -4171 ,III
Inspection Requests (24 Hrs.): (503) 639 -4175 +1 r:_..
INSPECTION WORKSHEET FOR DATE: 12/31/ 07 TIME: 7 : 0 0AM PAGE: 46
SITE ADDRESS: 11765 SW WILTON AVE CLASS OF WORK:
I I
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT #: 147 TYPE OF USE:
PROJECT NAME: GW1ERIRE
DESCRIPTION: Furnace install.
OWNER: GUTIERREZ, FRANK PHONE #: 503 - 6236
CONTRACTOR: SPECIALLY HEATING & COOLING PHONE #: 503. 620 -5643
Inspection Request Scheduled For: Date: 12/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Messae
699 Mechanical final 062150-01 503.524 -6236 a)
Corrections /Comments /Instructions:
M 11 '( OR i_per 5 i t/VI 5'' f
'PASS' / 1a PARTIAL APPROVAL 111 CANCEL 111 NO ACCESS
❑ FAIL / ` rA CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
b/t/
Inspector: Date: I /b 7 Phone #: (503) 718- 26