Permit 1, v
CITY OF TIGARD MECHANICAL PERMIT
°' ` COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00616
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/24/2008
PARCEL: 1S133DD
SITE ADDRESS: 12573 SW WINTER LAKE DR ZONING: R-4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT: 101 JURISDICTION: TIG
PROJECT: RANDALL
Project Description: Install furnace.
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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
DAVID & SHAWNA RANDALL Description Date Amount
12573 SW WINTERLAKE DR
TIGARD, OR 97223 [MECH] Permit Fee 12/24/20C $72.50
[TAX] 12% State Surch 12/24/20C $8.70
Phone: 503 - 521 -8121
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.
gYri ?.____
Issued By: Permittee Signature: OA./ 19"72/ 6/ e (.52.y-to ".J
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.
DEC/22/2008/M0N 04:09 PM FAX No, P. 002
Mechanical Permit ApplicatRECEIVE I 1.1) I( OFFICE USE ()NIA
City of Tigard Received . •
q ll B„
111 DEC 2 2 2008 may: / . • o is
Plan Review Perrilit Ho es iff411:„ . fj ° - .
• 2 13125 SW Halvd.Tigard, OR 97223 . ph one; 503,639,4171 Fax 503.59812e- Date/13y: Other Permit:
1 . ; c:; A rc T . ) Inspection Line: 503.639.4175 UTY OF TIGARD Dare Ready/By: INE la See Page 2 for
Internet. www.tigard gov BUILDING DIVISIO NotifecVMethod Supplemental Information
4 c ! . . 7 4 121-4 V-W i ; 4 ■4 . ; : i`Vikr tr Velil 4I ngrt*-Ttieffilll'= r :',.'1Fihry.T-T-i;;• 1 4,, ,, i■FialT. r . 7 1. 7 ailyiarditiVifiltitiiy(W*Sitkedteii:St;
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Mechanical
0 New construction Addition/alteration/replacement permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
"
..-; .KT100/1, iF41`0"gir,OVT10011110-41;1:1 , Value: $
le- -' "‘ - - - - - - --- ' ' - . - ''''-'' ' ' " ' ' ' '.." . :' .'"iigaizaktsWielfigai4'.i'ktOttertitt,.
.- _ and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-family 11 Master builder 0 Other: Description I Qty. 1 Ea. I Total
ii ; .:.',.T .: - Heatin g /cooling
, Air conditior heat pump
Job site address: 1 L 1 (....,..) L ,-\ -Ity 1 cn4‹..c tl , (requir ning o es s ite pla showing placrment) 14.00
' 1
City/State/ZIP: e-- . 13 r2 . 6 1/ 2-L-3 Furnace 100,000 BTU (ducts/vents) ( 14.00
•
Furnace 100,000+ BTU (ducts/vents) 17 90
Suite/bIdgJapt. no.: I Project name: -
Gas heat pump 14 00
Cross street/directions to job site: Duct work 10.00
Hydronic hat weteraystem 1400
Residential boiler (radiator or
hydronic) 14 00
Unit heaters (fuel not electric),
in-wall, in-duet, 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
:77:7;:i Water heater 10.00 _
10.00
Flue vent for water heater or gas
-C--(A-dCdt-J fireplace
10.00
Log lighter (gas)
10.00
Wood/pellet stove 10,00
Wood Ereplace/insert 10.00
Chimney/liner/flue/vent 10.00
- 77.7774:..t: Ili,":1 m:;d.;..r,i11;A is .:1f#‘0,*: 10.00
Name: -Vs)c-A.,,),E V AAr A A Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( ) S - 4- \ ^ S'' I 2_,, I Fax: ( ) toilet compartments, utility rooms) 6.80
r:'11:trkilg AttidGrawiSPaGe farIS 00 10. ,
Other: 10.00
Business name: — Fuel piping
Contact name: SS.40 for first four; $1.00 for each additional
Address: - Furnace, etc.
Gas heat pump
City/State/ZIP; Wall/suspended/unit heater
Phone: ( ) Fax : ( ) Water heater
Fireplace
E-mail: Range
V:7 i ,' .t;:a!:.:;!.' Barbecue
Business name: Specialty Heating and Cooling, Inc. Clothes dryer (ass) '
Other:
Address: 7500 SW Tech Center Drive Suite #130
i;i:e4
City/State/Z1P: Tigard, Or. 97223 Subtotal
Minimum permit fee ($72.50) 72 , S 0
Phone: (503) 620-5643 Fax: (503) 681-0793
Plan review (25% of permit fee)
_
CCB lie.: 66578 State surcharge (12% of permit fee) ircro
_ TOTAL PERMIT FEE t ej
a permit applicadon expires If a permit is not obtained within 180
Authorized signature: (:)),‘,..GLI.. Thi
, CX, _ says after It has been accepted as complete.
- 1 ...,
Print name: Andrea Dripps Date: t •-•.-1 a. ?,./ n r , • fee methodology set by TriZoluity Building Industry Service Board
v r
muildinstPeruitmEc-FenritAro do' 01/19/07 440-4617T (11/02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MFC200B -00616
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/24/2008
Phone: (503) 639 -4171 Ao l
Inspection Requests (24 Hrs.): (503) 639 -4175 .'1J1.
INSPECTION WORKSHEET FOR DATE: 1/8/2009 TIME: 7:00AM PAGE: 28
SITE ADDRESS: 12573 SW WINTER LAKE DR CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT #: 101 TYPE OF USE:
PROJECT NAME: RANDALL
DESCRIPTION: Install furnace.
OWNER: RANDALL. DAVID & SHAWNA PHONE #: 503 -521 -8121
CONTRACTOR: SPECIALTY HEATING & COOLING PHONE #: 503.620 -5643
Inspection Request Scheduled For: Date: 1/8/2009 Pour Time:
Inspection Description Confirm # Contact # Me s e r
Code # Ins
p p Co r g ry51
699 Mechanical final 079402 -01 503.521 -8121 Y ) ( /
Corrections /Comments /Instructions: )
1
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I 7
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
v I-� o Q Inspector: Date: �/ Phone #: (503) 718 - 2"'(
Ci�