Permit • �h a x CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00005
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/5/2009
PARCEL: 2 S 114 BA - 03600
SITE ADDRESS: 09675 SW SERENA WAY ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.2 LOT: 104 JURISDICTION: TIG
PROJECT: THOMPSON
Project Description: Replace gas furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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
LAWRENCE & NANCY THOMPSON Description Date Amount
9675 SW SERENA WAY
TIGARD, OR 97224 [MECH] Permit Fee 1/5/2009 $72.50
[TAX] 12% State Surch 1/5/2009 $8.70
Phone: 503 -620 -1097
Total $81.20
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 624 -2704
FAX 503 -598 -0270
Reg #: LIC 76359
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: 4-voinsi ^ / J Permittee Signature: APPhect � 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.
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Mechanical Permit A fica " E ' FOR OFFICE USE O \1.1
Mechan pp
City- of Tigard JAN 0 5 Zoos Received .. . •il._.
1. G • `i _ ► ' Permit No
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
D J
Phone: 503.639 4171 Fax: 503.598. err Other Permit.
Y FTIGARD
T I GAR D Inspection Line. 503.639.417' Q Date Ready /By. ]urns, If See Page 3 ►or
Internet' www- tigard -or. gov 3UILDI� G DIM* NotiticdlMethod: 1 I I . Supplemen i.l Information I
TYPE OF WORK • • COMMERCIAL FEE* SCCUEDULE - USF CAF,CKL'ST
❑ New construction ID Addition /alteration/rep acement Mechanical permit fees* are base on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit.
•
CATEGORY OF CONSTRUCr[ON Value: $
1
RESIDENTIAL EQLIPMI:NT / SYSTEMS FEES*
❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
Forspecral information rise checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description i Q fy. Ea. Total
JOB SITE INFORMATION AND .iOCATION Heeting/cooling ■
1 � 1 Air conditioning or heat pump
lob site address:
'7.5 ( 4f ) �yY j� ) l/(1 / ii r wires site ]en shu�+in hicement 14.00
Ci ty/State/ZIP: -✓ (` Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct 14.00
Hydronic hot water system 14.00 ,
Residential boiler (radiator or
hydronic) 14,00
Unit healers (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue /vent for anv of above 10.00
Subdivision: Lot no.: l G 00
Other: -
Tax map/parcel no.: I ! Other fuel appliances
DESCRIPTION OF WO4){ ' Water heater 10.00
Gas fireplace 10.00 i
11 `�„/ , ,g 4,0 j�� i Flue vent for water heater or as
_271/0--1---a--
`" ` I j lr - fireplace 10.00 I
Log lighter (gas) . 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00 1
ROPERTY OWNER ❑TENANT Other. , 10.00 ,
Name: 2 1.,-r,y's „ Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 1 0
City/State /ZIP: Clothes dryer exhaust _ 10.00
Single -duct exhaust (bathrooms,
Phone') I b /7 Ct q Fax: ( ) toilet compartments, utility rooms) 6.80
0 APPLICANT q t] CONTACT PERSON Attic /crawlspace fans 10.00
• Other: 10.00
Business name:
Fuel piping
Contact name' s ' R i b y $5.40 for first [our; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone:57y3 )62.LI - ?7h) Lf Fax: : 653 ) ey--c) D. Water heater
•
Fireplace
E-mail: Range
CONTRACTOR Barbecue
(}
Business name: (2,.0 /bur 6l e" p�eL/t // tr E(7 1 /1 y 7 c�'Y Clothes dryer (gas) .
Address:
U IT FEES* 1 `// Other.
' MECHANICAL PERM
0 /� rD 6,x ✓ 2 3 0 3 9 � Subtotal I /-1 . 0 0 C i t y / S t a t e / Z I P : ! / 6, rA , a40 t ) 2 (9 - a/i
�t Minimum perm foe. ($72 Si)) 72 -C
Phone: (} u ! ' �p Fax: { ) �y, 4 '.- - 76 Plan review (25% of permit fee)
CCB lie.: 7e, 3 S 9 r State surcharge (12% of permit fee) ZS L �. 70
TOTAL PERMIT FEE • ZQ
Authorized signature! This permit application cipira if a permit is not obtained within 180
'`�� T } days after it has been accepted as complete_
Print name: � - 0 f �' � 1 arc: r / [j :1, Fee methodology set by T,i -Cuumy Building Industry Service Beard
i.. a..: i a,......--- ,,,kAre_o....,:.*.., an, ramurd; 1 / 440-41.71"(1 1 /01/ ) I b) H)
Z OLZ0 869 - E09 ONLLV3H vietm moo E617:0 60 90 uer
CITE( OF TIGAR®
BUILDING DIVISION PERMIT # MFC2009.OtJ0O6
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1J517039
Phone: (503) 639 - 4.171 " nilpu ���°
Inspection Requests (24 Hrs.): (503) 639 -_4175 ° ut �' I
INSPECTION WORKSHEET FOR DATE: 171!" 0 09 TIME:, , 7 :01Am PAGE: 24
SITE ADDRESS: 09676 Est SERENA WAY CLASS OF WORK:
SUBDIVISION: PICKS LANDING N0.2 LOT #: 10 • TYPE OF USE:
PROJECT NAME: 1THOMPSON
DESCRIPTION: Replace gas furnace
OWNER: THOMPSON LAWRENCE & NANCY PHONE #: 503 -620 -1097
CONTRACTOR: COLUMk3IA HEATING & COOLING INC PHONE #: 503-6242704
Inspection. Request Scheduled For: Date: 1/1€/2009 Pour Time:
Code # Inspection Description Confirm # " Contact # Message
699 Mechanical final '07973401 503-6201097 iNivi
Corrections/Comments/Instructions:
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„A n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
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FAIL ill CALL FOR INSPECTION_ ❑ ADDIT ONAL. FEES
L 6) 7
Inspector l.�l•. Date: � v � 1. Phone #: (503) 718-