Permit CIT OF TIGARD MECHANICAL PERMIT
1 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00686
I - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/2/03
PARCEL: 2S 110AD -05800
SITE ADDRESS: 14900 SW 106TH AVE
SUBDIVISION: LANG HILL NO.2 ZONING: R -12
BLOCK: LOT: 051 JURISDICTION: TIG
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:
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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace
Owner: FEES
LUMPKIN, FRED B + ESSIE M TRS Description Date Amount
14900 SW 106TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 12/2/03 $72.50
[TAX] 8% State Surcharl 12/2/03 $5.80
Phone: 503 620 - 3600 Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223
Phone: 503 624 - 2704 Final Inspection
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 -00
Issued By: �� �y Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Received FOR OFFICE USE ONLY
/� Mec
Date/By: J 4 - - cy) if Permit an ical No.maL 3 'eV 6g
City of Tigard Planning Approval U Building
Date/By: Building
No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Internet: www.ci.tigard.or.us �,L w Contact Case No.:
24 -hour Inspection Request: 503- 639 -4175 - Juris.: Su See Page 2 for
Name/Method: Supplemental Information.
. TYPE OF WORK :?'COMMERCIAL FEE* SCHEDULE - USECHECKLIST. -
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
... Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2 Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi Family RESIDENTIAL; EQUIPMENT /SYSTEMSFEE SCHEDULE
al Master Builder Description Qty Fee(ea.) I Total
❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** / 14.00
Job site address: /Y7& $ ,,i ,, 6)6, ." Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Cross street/Directions to job site: Residential boiler
_ (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Tax map /parcel #: Other Fuel Appliances
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
4 _ _ _ . � _ . , ........e Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue/vent 10.00
PROPERTY OWNER . . '1, 0 TENANT Other: 10.00
Name: Lu /7/ , rt.1 Environmental Exhaust & Ventilation
Address: Range hood/other kitchen equipment 10.00
/ 9 va __.<4.,) /d C "--
City /State /Zip: ^ o/ .0,1— Clothes dryer exhaust 10.00
Single duct exhaust
Phone: / , 2,0 , ..3A.:7 4 ;. Fax:
0 (bathrooms, toilet compartments,
APPLICANT !CONTACT PERSON . : utility rooms) 6.80
Name: Pkm 4n/by Attic /crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: ,_3L„„7y .2 70 471 Fax:5435970.z Furnace, etc. **
E -mail: Gas heat pump **
WalUsuspended/unit heater **
. CONTRACTOR Water heater **
Business Name: 614,04/a. Az% 4-604y9 =loc.. Fireplace **
Address: Pe, s 43 Range **
City/State/Zip: BBQ **
y p: T G A DR Q Clothes dryer (gas) **
Phone:So3 4,2y I Fax: Sp3S92 o a ?o Other: II
CCB Lic. #: 1435 9 Total:
Authorized Mechanical Permit Fees*
Signature: Date: /Zj 'o3 Subtotal: $
et
A Minimum Permit Fee $72.50 $
A 1p■ect4 A Oiv j/ Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: . (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Receive — Date Requested C.) AM PM BUP /
Location `4 ( ® 0 Suite E 411 f(,
Contact Person CT/YYl 6r / Ph ( ) 6 2 —2 - Z PLM
Contractor ■ • iiI .L� IF Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing --/eAr-e246-, �//L� r�=, CA 1 - i A NC
Insulation /
Drywall Nailing ' , 6: 77 2 e 6L / / ti O, %; -4 : , 5"8 5
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
mpers
(PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final n Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please call for reinspection RE: n Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date Z! 3` O f�- Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL