Permit a CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 - 00061
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/9/2009
PARCEL: 1 S125DB -03802
SITE ADDRESS: 09600 SW 74TH AVE ZONING: R - 4.5
SUBDIVISION: BOULEVARD HEIGHTS LOT: 026 JURISDICTION: TIG
PROJECT: MOORE
Project Description: Replace gas 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:
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
WALLACE MOORE Description Date Amount
9600 SW 74TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 2/9/2009 $72.50
[TAX] 12% State Surchai 2/9/2009 $8.70
Total $81.20
Phone: 503- 380 -8175
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 OU NC by
calling 503.246.6699 or 1.800.332.2344.
r
Issue. By: 0 -4 a/ AA , Permittee Signatu e: ; , a
Call 503.639.4175 by 7:00 a.m. for inspections that b ness Id ay.
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.
may
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Mechanical Permit As e le 7:4 , � �
f7 l' 1K E S L ° q 1 l 1 G' //� � � •1 , ,q � � , � ,,
fir City of Tigard :pit-, ' _ , .,. ` ENEE Date elBy D/ 7" Permit No.: Ui1pWe97.0e00/
, , • 1 31 25 S W I 0 � Q O n Plan Review
Phone: 503.639.4171 Fax: 503.398 J DateJBy: Other Permit
TfI, - , ' • Inspection Line; 503.639.4175 Date R y /g y , m El See Page 2 for
r: • -'''' . Internet: www.tigard- or.gov GI B OF �' D VI TIGARD SION Notifuaktvle:hod: � Supplemental Information TYP E
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COVIhIEEtCIAL FEE` SCHEDULE - USE CHBCKLEST
❑ New construction ❑ Add it/on/alteration/replacement Mechanical permit fees'" are based on the value of the work I
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
•
'RESIDENTIAL EQUIPMENT 1 SYSTEMS FEES"
❑ I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. i Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address: 4' !!/� O/) b (requires site plan showing placement) 14.00
City /State/ZIP: Furnace 100,000 BTU (ducts /vents) / i4 -00
10---.(0, Furnace 100,000+ BTU (ducts/vents) • 17.90 •
! Suite/bldg./apt. no.: Project name: 2 - , Gas heat pump 1 4.00
Cross street/directions to job site: Ductwork 14.00
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
Flue/vent for any of above 10.00
Subdivision: Lot no. Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00 i
Gas fireplace 1 10.00 _
77 41,-/--e---"' _ 6.0-4_4 79 rr,��. Flue vent for water heater or gas
�7 fireplace 10.00
Log lighter (gas) 10.00 I ,
Wood/'pellet stove 10.00 •
Wood fireplace/insert 10.00 I 1
Chimneyllinerfflue/ ent 10.00
PROPERTY OWNER ❑TENANT Other. 10.00
Name: ( 4 Environmental exhaust and ventilation
■
Range hoodlother kitchen
Address: equipment 10,00
C ity'StateJZIP: Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: Tit j,`/)' 5 V Fax: ( ) • toilet compartments, utility rooms) _ . 6.80 '
v
❑ APPLICANT ❑CONTACT PERSON Attie crawlspace fans • 10.00
Other: _ 10.00
Business came: Fuel piping ,
Contact nantei." l t 1 b y S5.40 for first four; $1.00 for each additional •
t
Furnace, etc.
Address:
t Gas heat pump
City/State/ZIP: ' Wall/suspended/unitheater
•
S7:13 Phone: `1vJ ,�2 )6 - p.7 Fax: :I )S c%- 6 D76 Water heater Fireplace
E -mail: Range
• CONTRACTOR • • Barbecue
Business nm
ae: e.,0 l 07 b / G,./ P,.e.ej/ (? a - o f l C, Clothes dryer (gas) `
Other: i
Address: g � e 2J ,..... ) 3 p 3 9. 1 MECHANICAL PERMIT FEES*
City /State/ZIP: " // c; el re,40 2 7721 -/ Subtotal
Minimum permit fee ($72.50)
Phone: (.51 6 2- Li - ) -)% V Fax: (553 ) S'y f -' C):Y"7p . Plan review (25% of permit fee)
CCB lie.: 1 State surcharge (12% of permit fee)
TOTAL PERMIT FEE i
This permit application expires if a permit is not obtained within 1B0
Authorized signature: `�
' if n i 7 days afterithas been accepted as complete.
: ' Fee methodology set by Tri -ounty Building Industry Service Board
Print name: z /'" fJ C date: rr.FinR 440 -46;TT (11 /O21COM1WEB)
d OLZO - 009 DNILV3H VIBWl1OO 0 1.9:90 60 60 qe
CITY OF TIGARD
BUILDING DIVISION A PERMIT #: MEC200810061
13125 SW Hall Blvd., Tigard, OR 97223 f n5 DATE ISSUED: 2/9/2009
Phone: (503)' - 639 -4171 �u°�9p i
�1
Inspection Requests (24 Hrs.: (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2117/200 TIME: 7 :00AM PAGE: 16
SITE ADDRESS: 09600 SW 74TH AVE CLASS OF WORK:
SUBDIVISION: BOULEVARD HEIGHTS LOT #: 026 TYPE OF USE:
PROJECT NAME: ' MOORE
DESCRIPTION: Replace gas furnace,
OWNER: MOORE, WALLACE PHONE #: 503 - 380 -8175
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503- 6242704
Inspection Request Scheduled For: Date: ?1 17/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 080547 -01 503- 330 -8175
Corrections /Comments /Instructions:
S l 1bz— S
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PARTIAL APPROVAL ❑ CANCEL 7-NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Ins actor: D
ate: tit • 770/ Phone #: (503) 718- f 6 �
P , ( )