Permit ` CITY OF TIGARD MECHANICAL PERMIT
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DEVELOPMENT SERVICES PERMIT #: MEC2005 -00421
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/13/2005
PARCEL: 2S 112CA -13000
SITE ADDRESS: 15566 SW 76TH AVE ZONING: R -7
SUBDIVISION: RENAISSANCE WOODS NO. 2 LOT: 054 JURISDICTION: TIG
Project Description: AC unit. Permit created to get final inspection.
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: 1 DOMES. INCIN:
ELE 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: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
HUTTON, BRIAN D + DEBORAH A Description Date Amount
15566 SW 76TH AVE [MECH] Permit Fee 7/13/200` $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 7/13/200E $5.80
Total $78.30
Phone:
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397 REQUIRED ITEMS AND REPORTS
TIGARD, OR 97281
Phone: 503 - 624 - 2704
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: 041 444 Permittee Signature ,
( • 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.
.1
1 I0 hanical Permit Application " ` � , ' FO ROFFICE USE t -a
503.639.4171 Fax: 50 Rec eived
City of Tigard (11 [t L; It u v i /6)5 r ,
s Phone: SW Hall Blvd., Tigard, OR 97223 Date/By: Pe"
! mtNo. fir Cd-f�F 6
Plan Revi• J
'. 359,8.1960- / �, , Other Permit. C6685j
2005 .. 1 i,x Date/By: l�r���v 1 �/(�
inspection Line 503 JUL ;�, • Date Ready/By: Je � ® See Page 2 for
Internet: www.ci.tigard.or.us ` = ="� ""
CITY OF TIGAR® Notified/Method: � CA Supplemental information
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P..; ":4 � %-: �t »a d i rC fi y V;t 'Mists '+'1�?i .R:�" Kt`r 4 y i i 1 14'y '' (5 v_ { ' ' COMN1'EROx eki bfri. D OL • - 'USE C HE C Kt 1sT
11 New construction &CAddition/alteration/replacement Mechanical permit fees' are based on the value of the "or!;
performed. Indicate the value (rounded to the nearest dollar) of al
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
tt y �Q / � ] yg �Q�$i�ry� [yc�gv r a } 1�Q p�, 5/ IV�s , /SS�,ina ✓s�l}4' t,t ai,�� r I�Er tNf Value $
'I g ifeeAatA . :L C�f'W1.SkJ �..e Jh�.s.. 11 .� � a. e [ i S ... ,
f amily dwelling ❑ Commercial/industrial ∎ r? y' r „, � ° QU' !,. - :
l and 2-family / "SY FEES
❑ Accesso building —
For special injormnrion use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Description I Qty. I __ I Total
r t sl', �g{'yrirll i �� k t7r v'rn r u � � ,��,c��a�rysrr i J c il,e � s r � � � rt
G., . , #a:�t , i��,��i , 'I ,�a ,� 9 f.f�'rv'.M ONE':' i'',u _. i ., '"t Heating/cool1ng
Job site address: / 5 5 - 6 ' 1 6' J 7t f w Air conditioning or heat pump 0
slj / (requires site plan showing placement) 14.0
City/State/ZIP: Furnace 100,000 BTU (ducts /vents) I 14.00
Fumace 100,000+ BTU (ducts /vents) 1 7 90 I
.. Suite/bldg./apt. no.: I Project name:
Gas heat pump I 14.00
. Cross street/directions to job site: Duct work I 14.00 I
Hydronic hot water system I 1 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Flue /vent for any of above I 10.00 I
Lot no.:
Other: i 1 0.00 I
Tax map /parcel no.: Other fuel appliances
r a' m `, fir; tiyY _bi h q., �r ..+er g to 4“ p .. yt; it I I t�r ! ' Water heater 10 00
m. �i. 6, ela� f U `' -�.
Gas fireplace 10.00 I
/4/3 L.. _ /e1.-e-- Flue vent for water heater or gas
fireplace 10 00
Log lighter (gas) I 10.00 j
Wood /pellet stove 10.00 I
Wood fireplace /insert I 10 00 I
yy '�.k
Ir''t�� i C).7 !yzx, 1 IFy' i 4r 5, 4 , .�,,�; y7 '^ M G. C t t r a /liner /flue /vent 1000
�y Chimney/liner/flue/vent !`��1 i1£ ' J, � '. 5 Qa, `, ;� t 4 s 4 s',..4 , W}.1 ; r ; :. r. 1? r t r. 73 i 6 - ± . OW !- Other: y I 10 � 00 I
Name: 4,9-40a./2 �Lf � � Environmental exhaust and ventilation
J/ Range hood /other kitchen
Address: /55 G Sr u 7c ' _ equipment - 10 00 1
Ciry/State/ZiP: 7 ' a Clothes dryer exhaust 10.00 I
/ .7 Single -duct exhaust (bathrooms,
Phone .? ) 4 a 4 / 6e Fax ( ) toilet compartments, utility rooms) 6 80 ,
f$ ?, ` ONVi ��s - i h uts V a t� , ,ry� ., �a� l ig.TW , A 4 Y yr � /m 4 r,1; u d A ttic /crawlspace fans i 10.00 '
�tia wi .Y:•& tItti'.i[=T4 [T -: o ilvi4t4 /C'tri'�lt5- s .. ur:'�= t•marel u° is &
Business name: Other: I ! 0.00
Fuel piping
Contact name: Agvte O/1-/6 V 95.40 for first four; 51.00 for each additional
Address: / Furnace, etc.
— Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phonei ( 3 �O42 y 0 2 ,,7 U , (' �ci d 7 Water heater
T j Fax:: '� ,70 Fireplace I
E -mail
b/ y+(rw?(n��Sn� , r,,wrr a�s,.rcrx +n a �; , ;y a p y} Range
s t a 1-7 f : a YY � ' 1• m�k�` to `y, '',�". r Gfi7 f ��r ra2 1 Barbecue I
��� yr '+ , 1 r� tRA'tF�+ ��`� `:' a5� �sa.�,r����r�
4� 4f-� r a. n �n.«'i. y rynn? :: ,�a +• ) , !(_D n i ri;:
Business name: ( ,.-f 6 , 7/-c -Al 77 -I-- a /! ti 4 Clothes dryer (gas)
Othe 1
Address: 0 3 b y 7 :er; ��^ c_ r
k ; li n , n , i 'I E , HAI;IIC PEVO4:16 =:
•
Ciry /State /ZIP: 4 �Q- �/--. ? 3 Subtotal
Phone: ./ � ) c., a ci d ?P -03) O d f74 Minimum permit fee (x72.;0}
eJ 'T Fax: sp Plan review (25% of permit tee) I
CCB lic.: 7 3,5 ? State surcharge (8% of permit fez) 1
TOTAL PERMIT FEE
Authorized signature:
a.-2 This permit application expires if a permit is not obtained within ISi.
days after it has been accepted as comple(e.
• Print name: )i c/4 ,q - O/ //) Date: /3, OS • Fee methodology set by Tri•County Building Indso . Ser: icc 3oa:a
is\ Building 'Pernits\MEC- PermitApp, doc 12/03 T � 440 -46 17T 1! I /02 /COM/WEB) •
t^ .,J._
CITY OrGARD
BUILDING DIVISION PERMIT #: MEC2005 00421
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/13/2005
Phone: (503) 639 -4171 /�m�� i � h l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 66
SITE ADDRESS: 15566 SW 76TH AVE CLASS OF WORK:
SUBDIVISION: RENAISSANCE WOODS NO. 2 LOT #: 054 TYPE OF USE:
PROJECT NAME: HUTTON
DESCRIPTION: AC unit. Permit created to get final inspection.
OWNER: HUTTON, BRIAN D + DEBORAH A, PHONE #:
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503- 624 -2704
Inspection Request Scheduled For: Date: 7/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 011385 -01 503- 624 -204# N
Corrections /Comments /Instructions: /
e l 4/e6,-, 7 6 G .I t - ' /i its/i' U / (90)
1
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ' ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • � Date: - 'hone #: (503) 718-
1•
et , •
• /
HEATING & COOLING, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503)624-2704
SITE PLAN
ADDRESS: e,60/0 gtr