Permit , S ,
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00249
, . � 1
4 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/1/2006
PARCEL: 2S110DD -13800
SITE ADDRESS: 15495 SW 109TH AVE ZONING: R -25
SUBDIVISION: SUMMERFIELD NO.14 LOT: 708 JURISDICTION: TIG
Project Description: Replace furnace, ad AC unit.
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: 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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
STERRETT, DOROTHY P Description Date Amount
15495 SW 109TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 6/1/2006 $72.50
[TAX] 8% State Surcha 6/1/2006 $5.80
Total $78.30
Phone: 503- 620 -3371
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: 46 X14 ,1j Permittee Signature: G, /�I
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 Ap ti ` ?
t r•cm (>,hrlrE 1 se ()NIA
City of Tigard
Date/By. O/ I PernritNo. e
13125 SW Hall Blvd., Tigard, OR 97223 Plan Ity. �� -
Phone: 503.639.4171 Fax: 503,598.1960 Plan Revie
,''*•; " ' Other P ermit:
Inspection lane: 503.639.4175 . 1- 'lis I, Dat e
Internet: www.ci.ti _ Date Rea S p 2 for
gard.or ■ , `
t Notified/Method.
, � 1 `Y 3 i , rt y t i �► ►6 SupplemeaUl Information
1 ; - 17t:0* WO RK :COMMERCIAL FEE*,.
SG'HEDULE' = : 'IJSE CHECKLIST
❑ New construction Addition /aItecation / replacement Mechanical permit fees* are based on the value of the work
❑ Demolition performed- Indicate the value (rounded to the nearest dollar) of all
❑ mechanical materials, equipment, labor, overhead, and profit.
CA 3 ;'.EGORY 'OFr'4`ONsTrUCTION Value: $
`g 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDEN I IAL EQUD'MENT: /sYSrEMS FEES Commercial/industrial
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description 1 Qty. I Ea. I Total
JOB SITE INFORMATION :AND'. LOCATION . - Heating/cooling
Job site address: 4.5 - 5- -5-A-1 7 Air conditioning or heat pump
�D (requires site plan showing placement / 14.00 ,
City/State/ZIP:
Furnace 100,000 BTU (duets/yews) / 14.00
Suite/bldg. /apt no.: I Project name: Furnace 100.000+ BT13 (ductslveats) 17.90
Cross street /directions to job site: Gas heat pump 14.00
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: 4 Lot no.: Flue/vent for any of above 10.00 ,
Tax map/parcel no.: Other: t 10.00
Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
f /J/ � S .7 Gas fireplace t for 10.00
j �` 4 c - tom Flue vent for water heater or gas
r� �5 /7 - fireplace 10.00
t
Log lighter (gas) 10.00 ,
Wood/pellet stove 10.00 '
Wood fireplace/insert . 10.00
ItOPERTY OWNER , Chimney/liner/flue/vent 10.00
,
l .. o TENANT
Name: .6P/1--in Other 10.00
17/) ` -- G Environmental exhaust and ventilation
Address' ' Range hood/other kitchen
City/State./ZIP: equipment 10.00
Clothes dryer exhaust 10.00
Phone v�) ? /7/ Fax: ( ) Single -duct exhaust (bathrooms,
�J toilet compartments, utility zooms) ' 6
0 APPLICANT • ... ', - CONTACT PERSON Attic/crawispace fans 10.00
Business name:
10. 00
Contact name: 1j) nil /i Fuel piping
77 �f/Y1 / (� 35.40 for first four; $1.00 fo r each additional
Address : Furnace, etc.
City/State/ZIP: Gas heat pump
Wall/suspended/unit heater
Phone i4 :] ) q 9 ?Q I Fax: 5 q) 595 , z27
E -mail: cc J a9 �f )S •,! Water heater
Fireplace
Range
/ - L CONTR A ACTOR / , / _ , Barbecue
Business name: (1Q 1fIM b. e !rL ?TT2l7 7e- W/��j.tl Clothes dryer (gas)
Address: Q� /) 9 Other:
f 17 y r,,9 Q? MECHANICAL PRRMIT FEES*
CityiState/ZIP:
7
Phone: � 97 O?r/ • Subtotal
) Gail �oei I Fax: �Z) �- g 70
Plan review (25% of permit fee) Minimum permit fee ($72.50)
CCB Litz: / l4 S 9 �JJ
State surcharge (8% of permit fee) . 3
O TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not abtaioe within 180
days after it has been accepted as complete.
Print name: a te: q • Fee methodology set by Tri Building Industry Service Board
i ABuildinglprnritAME6perrtitApp .doe 17/03
440- 4617T (1 lrovCOMnvaB)
Z'd OLZ0969£09 6uque uigwnloo e£l i. L 90 L£ ADW
ar axin a a
HEATING & COOUNG, INC.
P.O. BOX 230397 • 11GARD, OR 97281
(503 )6242704
SITE PLAN
1
ADDRESS: ���5 Sci / 9 > -
£'d OLZ0869£09 6uneeH eiquan1 e171 90 6£ AeW
CITY OF TIGARD -• ` J 01.-et
BUILDING DIVISION PERMIT #:a0Q6 j[
13125 SW Hall Blvd., Tigard, OR 97223 " � DA E ISSUED: 7
Phone: (503) 639 -4171 µ ul�Ht �I lJ
In Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: I cc( q / 6 q `A 11'0 . CLASS OF WORK:
SUBDIVISION. / ( LOT #: TYPE OF USE:
PROJECT NAME: 1
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: (.p v / \" 6 `P Pour Time:
Code # Inspection Description Confirm # Contact # Message
6 2o -337
Corrections /Comments / Instructions:
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IFS PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
i� � ,�A I Inspector: V Z (/ _ - Date: 6 Phone #: (503) 718-