Permit t :# CITY OF TIGARD MECHANICAL PERMIT
,
A : COMMUNITY DEVELOPMENT Permit #: MEC2010 -00004
1? Date Issued: 01/05/2010
TIGARD: 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S103CB06200
Jurisdiction: Tigard
Site address: 12263 SW HOLLOW LN
Subdivision: Lot: 0
Project: Khellah
Project Description: Install gas furnace and NC. Unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
KHELLAH, MUHAMMAD M & Description Date Amount
12263 SW HOLLOW LN
TIGARD, OR 97223 Air Conditioning 01/0512010 $46.75
Furnaces < 100K BTU 01/05/2010 $46.75
PHONE: 503 - 970 -0280 12% State Surcharge - Mechanical 01/05/2010 $11.22
Contractor:
COLUMBIA NW HEATING
PO BOX 622
SCAPPOOSE, OR 97056
PHONE: 503 - 543 -3624
FAX: (503) 543 -6285
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $104.72
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC j by calling 503.246.6699 or 1.800.332.2344.
Issued By: ' t d Permittee Signature: a/r /e, / (P,9-7--7
Call 503.639.4175 by 7:00 a.m. for an inspection 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.
"C,1/04/2010 12:36 5035436285 PAGE 02
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on r RECEIVE � y ° � � = `
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` �' . City of Tigard
I Recei , j
. 13125 SW Ball Blvd„ Tigard, OR 97223 Date/By: Q 4 � Pun" l - CeoZ e
6 Phnnc: 5(13,639.4171 Fax: 503.598.1960 P1zn Rev' w �@ ~ �
`'1 rt , ,_. Tnspcction Line: 503.639,4175 JAN 0 4 201 D arc/By: OrherPCrmic
lnlCMef: www.tigard-or.gov
Date Rcady/ny; -- Jur♦
CITY OF TIGARD Nonfierl/M� Sec !'nRC 2 for
I - � pP entnT Information
TAP !V Or W e ' ' . .
New construction [ Additian/alttration/ lacement CiST
rat Mechanical permit frees" arc based on the value of the work
❑ Demolition
111 dther: performed. indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment_ labor, overhead. and profit
CA1 • ORY .a? COlvsy- U tJQN .
value
1- and 2- family dwelling Commercial /industrial ❑ Accessory building ` /SYSTEM FEES"
❑ Mu lti family ❑ Master bur Idet
Far special inform/ion use cjrecldfsr.
❑ Other:
JOB $ICE 1t +[1fR11r(b1IIOIY AND )<,OCi17 ptiN ,,: Description
_ Qty. Ea, 'Polar
Hearing/cooling
Job site addr c Air conditioning
!� r .uires site .ran shenrin placement) / 46,75 1 /6. 25
City /State /ZIP: ` ducta/
���� F urnace 100,00013TU ( vcnts ) / 46.75 4 /6
Suite/bldg. /apt, no.: Project name: Furnace 100.0004- nu (ducts /veins) 54.91
Cross street /directions to,job site Heat pump 61.06
Duct work 23,32
H dronic hot wafer system 23.32
Residential boiler (radiator or
hydronic) 23.32
- Unit healers (fuel -typc, not electric).
in -wall, in - duct sus ended, etc. 46.75
Subdivision: iot nn.: Flue /vent for any of above 23,32
Tax map /parcel no.:`� _ 23.32
Other fuel appliances
rastiarriox t11F'Wduc Watcr heater 23,32 I
/(J a 1 Gas fire lace 33.39 J
�1
Flue vent for water heater nr gas '
CD/U4.Z7 iF, fireplace — 23.32
Log lighter (gas) 23.32 .
Wood/ diet stove 33.39
Wood fireplace/insert 23.32
_
'1IRIDittx OWNER 23.32
0 ' 1'E NAiNT Other,
Narne: tai - 23.32
x Environmental exhaust and ventilation
Address: 10 /_ 2 � � , 1 L J_ _ y� A , r, Range hood/other kitchen
� !� _ �'� — Bu 33.39
City /State/ZiP: Z y j .
d Clothes dryer exhaust
Phone: ( -!2)L 2 )60 Fax: ( ) Single'duct exhaust (bathrooms, 33.39
. J( M1"L / I , �k d' riR ` w toilet compttroncnts, utility ± 23 32
till , rooms
0 'COI'Ai( PERSON Atticlttawlspace fans 23,32 _
Tusiness name: t C'1 / Cat) Other: 1 23.32
��``77 Ca-J_� Fuel ipis
Contact name:
514.15 f lint four; $4,03 for each additional
Address: Furnace, etc.
L.
City /State/T.TP: Gas heat .0 ..
WalUsusLrcndcdjunit heater
III
Phone: ( ) Fox: ;
( ) Water heater
E-mail: — Fircytace MO
CONTRACTOR .. _
Ram
Business na �_� j� Clothes dr .e _
addres f --� rnh
Cr:
p 1� MECRA C.A1L 1' Tli& Fetg+
CrtylStatc/ 7_I fiY" /�nn °�
Phone: ( (JC 'L'� _-` �
Subtotal Awe
53-36.-?Li Fax: ( ) 7 3_ Minimum permit fie ($90.00) --
CCB lie.: 67,7 q7 Plan review (25% of permit fee)
'7 Ctde surehorpe ( fee) C,..2a
.-____, [
I 3 /
Authorized signature: 1 � 1 I ! ! j(111 . 4 � TOTAL PERMIT FEE 04
' r -mi. p application expires If a
permit is not obtained Within IAO
" permit li V
Print name: 7 ds after it has been accepted as complete.
L - 1 J " 4 ; 0 Date: „ ,� 1 0 0 Fce methodology set by '1 Building Industry Service Board
I ^Buildi1 \r . \, c.perrnitnpn dnc in /al/09
110.4617T (11/07./COM/WFT)
Z1/04/2010 12:36 5035436285 PAGE 03
I\ l U . 20 0 q
J08 #10K130H
KHELLAH, MUHAMMAD
12263 SW HOLLOW LANE
TIGARD, OR 97223
503 -970 -0280
Installation Property Information
pj,RECTION; NN I
!v
Property Line
G c-fa , e
Fr:
Z o
Property Ltne
(F= FURNACE)
(X= OUTSIDE UNIT) STREET
Columbia NW Heating, Inc.