Permit 1 4
`' CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00620
rf 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/4/2005
PARCEL: 2S 103BB -07300
SITE ADDRESS: 12532 SW 123RD AVE ZONING: R -4.5
SUBDIVISION: LAKE TERRACE LOT: 001 JURISDICTION: TIG
Project Description: Gas furnace replacement.
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: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
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GAS OUTLETS:
Owner: FEES
WHITWORTH, PERRY R AND BONNIE J Description Date Amount
TRUSTEES [MECH] Permit Fee 10/3/200E $72.50
12532 SW 123RD [TAX] 8% State Surchar€ 10/3/200E $5.80
TIGARD, OR 97223
Phone: 503 - 590 - 1862 Total $78.30
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: 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.
, ,. 6 •!
4 . •
Meedanical Permit APPli IV ED FOR OFFICE,,USE ONLY
City of Tigard r.R w - - Received
DatetBy: i l agnim Pcr711 A Er, o - Z
S ,.(,
! 3125 SW Hall Blvd., Tigard, OR 97223
?Ian Review
Phone: 503 639.4 l 503.598.1960 2N
7 I Fax:
S 2 4 vo'lvol'''
N
v _,,,,,j,,,,.., 1 Datelly.
Date Ready/By: 01let F emet
:
he . s 0 See Page 2 for
In3peclion Line: 503.639.4175
Inte.rnet: vi....-w- ci.tigard.or.us Notified:Method: Supplemeu cal le:•ormail
( IGAR
TD
011 .....,. 15 0,4
[ - * ::::: • . - • .....: _. .:••.:.- : - ... ::: '`. ".'.• -. :" ' ' . 1.- • .• 1 •:.'-'• ' - • : COMMERCIAL FEE* SCHEDULE - USE C BECKLISI
Mechanical perm:: fees are based on he vlitue of the
11] New construction Icl ditionialteration/replacement
performed. Indicate the value (rounded to :he r.eare: J:..i..1:*
D Demolition 0 Other: mechanical materials, eq:::pment, lahu u:ernead, and prof::
1; --- , ' • -:::: . :. :- .:'-- :li .-- '1 :0FONSTRLICTION .- .--. . • . - 1 '•• . :': . Value: S
. • -RESIDENTIAL EQ LlIP NIENTI SYSTEMS FEES*
U 1 and 2 dwelling 0 Commercial/industrial 0 Accessory building
For specia; ulforauzift;r: use checl:
1:1 Multi E Master builder 0 Other:
Description (...-: 1 a
. 1 ... • .:.. .. H *
JOB $I , •-- • Heatinpcooling
Air condit:oning or heat purap 1 .
, •
Joo site address: /a7_57 32 , 54ti A77,3 - I (requires site p:anshowia placenitra) • 14 ,a_. :
i
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City/Stare/ZIP: Furnace 100,000 BTU (ducts•Reots) 1
Furnace 100,000+ BTU ducts/. outs;
: SuiteibIdg.lapt. no : Project name:
Gas heal pump 14 :
Cross street/directions to job site: Duct work :4 -,:
. . -
Hydronic hot water system •
Residential boiler (radiator or 1 1
1
hydronic) J 14 : 1
Unit heaters (Ps:el-type, not elective:,
I :n-wal:, in-duct, suspended. etc. I 10..)::
Flue/vent for any of above 1 It
Sabdivis•:on: Lot no.: -
Other: . 10 Or .
Tax map/parcel no.:
Other fuel appliances
•-• ris04 ,.. r-,,, • -..:_:.....' ::.•:. Wa:er heater 10 V,
Gas fireplace 10 C.0
.." 4,,y7,..
-.A....L.... . Flue vent for water heater or gas /4
• fireplace 10 I.:C.: '
Log lighter (gas) 101.:(
'Wood/pellet stove 1000
Wood fireplace/insert 1000
•
, -. Chimney/ I iner/flueiven t 10 Cc_
: -':::* qlWPgITY .-PNYNgli-:. . ': •;..'.: :,.:.:-._:--. -i • •......!.f 0 : TgrIANT .-.:- „ '• ::;.,. .i:
other:
Name: l ' , / - 7 1 71./.c7/2 7 Environ:nental exhaust and ventila ion
Range hood/other kitchen
Address:
equipment 1000
C:ty/S tate/ZIP : Clothes dryer exhaust 10 -:t,-
. Single-duct exhaust (bathrooms,
Phor.e:*e; 9 ... "--yr /42... Fax: ( ) . , toilet compartments, utility rooms) : o.S0 .
i2iiiICA14i . 3 - : ,,.. ..'=.:,' :,'.'; ;tr alitTAc17 s O ise' r ' . .
A.E.icl'orawlsoace fans I 10...:JO :
Other: I IC 00 1
Business name:
Fuel piping
Contact name:
/ 0,9-thy S5.40 for first four; Sl .00 for each
addit.unal
Furnace, etc. . .
Address: •
: Gas heat pump •
City/State/ZIT': • I Vv'allisuspended/un it heater _
Phone: - c.. 71 - 2 ) V. I Fax: : (3" ".1 5j( Wa:er heater 4:7 ,i g
Fireplace
E-mail: " - . •
• Range
.:.-.;:::::: ::E - -:,,.- . .: : ;.. " 6 " N.i4L'Irt*_. , .:.1,;::, 7 '.; . :::t.'el :; :' . ": . . 1 :' . ..s . :! :.;... • - ,...^:::,:.. ' • :::` Barbecue ,
---
Clothes dryer (gas) :
Business name: cc, 7 ,,,, 6 /.,; izie...4- -4.-- C_AD e. f .01,40. 1 :
Other
Addrs: i 0 Aci 3 4 :' ..../ , . , . . .
" - .
. :• - - , - MECELANI CAL PERMIT PEES*
Cit Subtotal '
7 "4-4-1.1 0 /J-. 5 7 cp• S
M inimunt permit lei- (S ... _. _ ...._
Phone: ... ) 4 „? „ , a el % Fax:- ) _ f 6 a .2
Flan review (25% of perm:: i
COB tic.:
7 (-- -2„....1 9' State surcna• (8% of perrri:1 fee:
TOTAL PER2uI1T FEE
Authorized signature: Ge...2.--,1-/.-e-t-e---se:::941.--4-21-y This permit application expires if a permit is not obtained ..1 c r. 1S.:
days af ter it has been accepted as complete.
Print name: 7 4- :6/.9.765/ Date. e) ' ALS' • Fee methodology set ay Tta•Couoty Buedmv lt•.:...:Ty Se. iee 1.;;:s
1 13 - ■ I d ogs.P L-rm icsIME C-?erratAnv doe 121C3
z OLZ0969C09 6uReeH eqwnioo etZ:0l. SO CO 100
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005-00620
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2006
Phone: (503) 639-4171 401 NOilt
Inspection Requests (24 Hrs.): (503) 639-4175 I •
INSPECTION WORKSHEET FOR DATE: 10/11/2005 TIME: 7:08AM PAGE: • 98
1,.M SITE ADDRESS: 12532 SW 123RD AVE CLASS OF WORK:
SUBDIVISION: LAKE TERRACE LOT #: 001 TYPE OF USE:
PROJECT NAME: WHITWORTH
DESCRIPTION: Gas furnace replacement.
OWNER: WHITWORTH, PERRY R AND BONNIE J, PHONE #: 503-590-1862
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503-6242704
Inspection Request Scheduled For: Date: 10/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 017809-01 503-6242704
Corrections/Comments/Instructions:
f'u t(( S 6
oar::
PA PASS 0 PARTIAL APPROVAL 0 CANCEL n NO ACCESS
fl FAIL • ALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
/11111
Inspector Date: (0 05 Phone #: (503) 718-
w
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