Permit ail
'CITY OF TIGARD MECHANICAL PERMIT
0 DEVELOPMENT SERVICES PERMIT #: MEC2006 -10067
DATE ISSUED: 6/27/2006
.�_�I
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S134DB-04600
SITE ADDRESS: 11080 SW 109TH AVE ZONING: R -4.5
SUBDIVISION: CARNAHANS ADDITION LOT: 008 JURISDICTION: TIG
Project Description: Heat pump install
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:
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:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
ALICIA LONEY Description Date Amount
11080 SW 108TH
TIGARD, OR 97224 [MECH] Permit Fee 6/28/200€ $72.50
[TAX] 8% State Surcha 6/28/200€ $5.80
Total $78.30
Phone: 503- 684 -5214
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: B Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business da .
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.
P . r
ei
Mechanical Permit Application ron o l'F1 V t SE ONLY
City of Tigard Received ; a., 2 �, Kg 13125 SW Hall Blvd., Tigard, OR 972
D ECEIVE® Davy: D. Permit No.: ,,, fo p & I
Phone: 503.639.4171 Fax: 503.598.1 60 Plan Review
� 1I "• Date/By: Ocher Permit:
Inspection Line: 503.639.4175 •l � I - /By: D Read tun , •
Internet; www.ci,tigard.or.us JUN 2 7 2006. u y a1 Sele Page .for
NotifiedPMethod: :/ t. / Supplemental Information
CITY OF TI(,ARD
SUCED191 MOMS SON I COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction A ddition /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
❑ I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQlTIPMENT! SYSTEMS FEES*
❑ Multi-family [] Master builder ❑ Other;
For special information use checklist.
Description I Qty. Ea, Total
JOB SITE INFORMATION AND LOCATION Heatio
lob site address: / / /))? S&} jD rj/6 Air conditioning or heat pump
J (requires site plan showing placement) / 14.00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) 14.00
Furnace IOO,000+ BTU ( ducts /vents) I ?.9U
Suitc/bldg./apt.no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 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
Subdivision: Lot no.: Flue/vent for any of above 10.00 '
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
7.?1S /! 6 r � Gas fireplace 10.00
e,,,,-7 Flue vent for water hearer or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 1000
Wood fireplace/insert I0
4ROPERTY OWNER I 0 TENANT • Chimney /liner /flue/vent 10.00
Other . Name: / / 10.00
�/ r�7/ / 4 7. Environmental exhaust and ventilation
Address: Range hood/ other kitchen
equipment 10.00
City /State/ZlP: Clothes dryer exhaust 10.00
Phon O 3) 494,/ . / toilet compartments, exhaust (bathrooms,
Jam/ </ F ax: ( ) toilet compartments, utility rooms) 6.80
0 APPLICANT Et CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Other: 10.00
Contact name: /n► �l / - Fuel piping
Ca
�r7 D A �6 y 55.40 for first four; $1,00 for each additional
Address: Furnace, etc.
City /State /ZIP: Gas heat pump
Phone: /� ` /��1 Wall /suspended/unit heater
E -mail; hone43 ) 4 t �" ! 0 I Fax:: �� , 5 ) _ !, D 27 ,, Water heater
tf �,! Range
CONTRACTOR Barbecue
Business name: /T /� G �/ n / �¢ �Q Clothes dryer (gas)
2,4 b/ / 4 / T r! 12//4./ ? Other: -
Address: P P 4 ox r 3O ,� 9 7 J ,
r MECHANICAL PERMIT FEES*
City /State /ZIP: � ~ D /! 97 a8 , / Subtota
� '1I Fax: Minimum permit fee ($72.50)
CCB lie.. vi '? c`•CJ �� Plan review (25% of permit fee)
7 S 9 State surcharge (8% of permit fee) - a1
TOTAL PERMIT FEE I L/
Authorized signature: ( ate: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 01�01, _ .4 ' 1 . 4 , * Fee methodology set by Tri County Building Industry Service Board ■
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HEATING & COOLING, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503)624 -2704
SITE PLAN
ADDRESS:
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CITY OF TIGARD ,�
BUILDING DIVISION PERMIT #: MEC2006-10067
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2006
Phone: (503) 639 -4171 AvitiO l
Inspection Requests (24 Hrs.): (503) 639 -4175 „Al ':_..
INSPECTION WORKSHEET FOR DATE: 8/1/2006 TIME: 7 :02A1v1 PAGE: BO
SITE ADDRESS: 11080 SW 109TH AVE CLASS OF WORK:
SUBDIVISION: CARNAHANS ADDITION LOT #: 008 TYPE OF USE:
PROJECT NAME: LONEY
DESCRIPTION: H pump install
OWNER: LONEY, ALICIA PHONE #: 503..684 -5214
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503-624-2704
Inspection Request Scheduled For: Date: 6/1/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 034099 -01 503-624-2704 N
Corrections /Comments/ Instructions:
'" «c d a -- itz-2-,...07v 0' 6 $ Qd' 754- .t & , -7' r
1
ASS PARTIAL APPROVAL I I CANCEL I I NO ACCESS
n FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
r
Inspector: -4 Date: - ;/"' 6 '. 7 Phone #: (503) 718 - .L4