Permit CIT OF TIGARD MECHANICAL PERMIT
4lj DEVELOPMENT SERVICES PERMIT #: MEC2005-00804
.f I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/6/2005
PARCEL: 2S1 11 AC -05800
SITE ADDRESS: 15010 SW 92ND AVE ZONING: R-4.5
SUBDIVISION: LAUNALYNDA PARK LOT: 026 JURISDICTION: TIG
Project Description: Replace furnace new ac
CLASS OF WORK: OTR 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: 1 DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
DIANNA HESTON Description Date Amount
15010 SW 92ND AVE
TIGARD, OR 97223 [MECH] Permit Fee 12/6/200E $72.50
[TAX] 8% State Surchar€ 12/6/200f $5.80
Phone: 503 639 - 9576 Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397 REQUIRED ITEMS AND REPORTS
TIGARD, OR 97281
Contact #: PM 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: 5,1 /Aj) 514 (4CIS -- Permittee Signature: SCE APP./ C•}7 /0 A.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.
Mechanical Permit Application . FOR OFFICE USE ONLY
13125
City SW Hall Bi of Tird r c '''A
evqs7:-.4 Received .
I Date/By• 24 443 s
5- 1 PUT'll I No.necloos--oo8oy
ga vd., Tigard, OR 97ZikE,C :ew /
Plan Rev
Phone: 503.639.4171 Fax: 503.598. 4,4t,04114610% Date/By Other Permit:
Inspection Line: 503.639.4175 - Ni Date Ready/By: /Luis l23 See Page 2 for
Internet: www.ci.tigard.orus
0 Tir,,...... ......
N.3inaimethodibl.003 rid. Supplemental In formanon
\ )g'
• 1 •'.; . 1% 1 . • : i" ,,..::':.‘',):- ...-i .ebiqkOietu, i -s CH:MULE — USE 011ECKL IS
_
Ej New construction (p,--- --: i-i '
Q*Ad<0 - Mechanical permit fees• are based on the value of the work
.3. I, perfernied. Indicate the value (rounded tc the nearest dollar) of
E) Demolition 0 Orp mechanical maierials, equipment. labor, overhead, and prof:
Oalgtitli4tiltitN:1 - ': ';;;- 1.:':,..:1;;,; Value: S
i .:. lt.g§,Dji■i#AT.,.E:QUIPMEENT / SYSTEMS FEES •
lEn 1- and 2-family dwelling 0 Commet'cial/ind'ustrial 111 Accessory building
For specia? inforrnatart use c.ieckiist.
1:1 Multi-family 0 Master builder 0 Other:
D es cripti on Qty. Ea ! Tote
f:.3::,.,,,:,:::;•.41;z;-.-,-:1:?p'cl,!;:$.:rritii0:41*#Ciri■444i:.::0-t 0 .-:::: , :: ..;,.; Heating/cowing
A:r conditioning or heat pump
Job site address: /1/45-7)/0 ,_5•J Y40,2 .e•LfiZ9
(requires site pia 3 showing placement) i 14 00 i
City/State/ZIP:
Furnace 100,000 BTU (duc tsivents) / 14 00
Furnace 100.000-t- BTU (doctsivents) L 17.90 :
Suite/bldg./apt. no.: Project name:
Gas heat ournp
i . I 4.0C
Cross street/directions to job site: Duct work 14.0C
Hydranic Ito: water system 14.0C
1 Residential boiler (radiator or
i hydronic) 14.0
Unit heaters (fuel-type, not electric), ! I
m-wall, M-duct, suspended, etc. ! 10 2C
' , Flue/vent for any of above 0.00.
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.:
Other fuel appliances
';g - w ater heater
1 , 10.00
Gas fireplace 10.00
- yg0t-e5 24e-/f....")- , • Flue vent for water heater or gas
fir:fp I ace 10 00
1 '
Log lighter (gas) , 10.30
Woodipellet stove . 10.30
Wood fireplace/insert 10.00
10 00
*-':'- ' 4f ri.q : NX4.4.4X0**:,-eitP: :. :Ila' ; :4: - :41:: : : , ;i:it:.:: : : i CI--irrineY/linerlilue/vent
. Other: 10.00
Name:
,,7-- I 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: 3 , c , 3 y 9i-.5--7. Fax: ( ) toilet compartments, utility rooms) 6.80
. -
:i21.t.W.:4:;;-:i•ittf 4*::C.::•:.;:r..;y:47,I,,4.: .,-i:t:';,iirA;A:ik:A.6:ip;i.:,0:t,f'c':it:1t.f.t.,.i.,,..,; Attic/L wlspace fans 10 00
Otner: , 10.00
Business name:
Fuel piping
Contact name: / C; 1 44 ■Ol y i S5.40 for first four i 51.00 for each additional
Address: , Furnace, etc. I
Gas heat pump
City/State/ZIP:
Wall/suspended/unit healer
Water heater
Phone -: ) & ,2 4/ D ",... 2 0 Li l I Fax: : ( )
Fireplace 1
E-mail:
Range
-741:')..I.•Vii;.:,:•i'itE: ii. T. 2 6pe0ii . A -44. 1 ialW:•;. ::: ''.`i?.i
•::4 :■: ' ' - .:iiii!-....75',44:... : ',=;,...., ,..7„ : . - 2 - ,:. , '-, .4,-. Barbecue
, Clothes dryer (gas)
Business name: C 4, . ".i incl.,. W.c....ettl -770.....ic,, .4-- C...., et , /, 4/ 4,
Other:
Address: /.° D 6 o x , Th34 5 ,3,?' ' : . ''': .. , !: : ...MECHANICAL . Pg121tilft
Cizy/State/ZIP:
Subtotal !„,,,,
-
7
9 7, - 3 i
Minimum permit fee (372.5C) ;"r" S
0
, *"'""
Phone: 1% ) c c 7 v ale:, „../z. Fax:(5-: ) 5 ... 9 ir 6 a 7
Plan review (25% of permit fee)
• 540
•
COB lie.: 740,57 State surcharge (2% of pe - rrnit fee) •■••••••"
TOTAL PERMIT FEE aip JO
Authorized signature: ,(2:2„---?-7 This permit application expires if a permit is not obtaitA Whin 1Se
day-s after it has been accepted as complete.
[ Print name-
• ".42ife Date: / I • Fee methodology set by To Building M•cls:ry Servize Board
■.\11u ildmacrmits \ NC-C-PcrrdlAco.dat 12:03 . . - -... ,.......-- . .... ___ .
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aragnaz
HEATING & COOLING, INC.
P.O. BOX 230397' llGARD, OR 97281
(503)624-2704
SITE PLAN
•
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ADDRESS-
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: X005-0 gO
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ho ll
Inspection Requests (24 Hrs.): (503) 639-4175
WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 5O / / a -1164 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: ` 2 6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
5
// •'
Corrections /Comments /Instructions:
M/t.I? 3a iOq
C i ll.;
•
•
PASS / A L APPROVAL ❑ CANCEL I NO ACCESS
r
FAIL / [ FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
.'"-
Inspector: _ Date: /! Phone #: (503) 718-