Permit CITY TIGARD MECHANICAL PERMIT
l" DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00619
e � l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/4/2005
PARCEL: 2S1 10 D C -90231
SITE ADDRESS: 15565 SW 114TH CT 23 ZONING: R -25
SUBDIVISION: FOUNTAINS AT SUMMERFIELD CONDO LOT: 023 JURISDICTION: TIG
Project Description: Fireplace insert.
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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
HELEN BIRD Description Date Amount
15565 SW 114 CT. #23 [MECH] Permit Fee 10/3/200f $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/3/200`. $5.80
Phone: 503- 684 -2982 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: 06(�1.4,L) 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.
I.
' chanical Permit Application FOR OFFICE USE ONLY . .
City of Tigard ,� Receives Q A
13125 SW Hall Blvd., Tigard, OR 97223 r �� ® ► DatetB /05.... D - ��`' �vOs�rri
Phone: 503.639.4171 Fax: 503.596.1960 Plan Revie
kiesitti t Date/By: Other Perm t
[nspec.:on Line: 503.639.4175 ��� t dli ` (
Internet: www.ci.tigard.or.us
Noti
n Date Ready/By: rur' . ' ;' S upplemental Information fil See Page 2 for
p fted/Methcd . S
"sr�' ' }�' r�F• 111aay'� T§ i' �_ . ;r " y e -. a•. t ,,,
s 1Zi R W0 : :41 Nt : r :4 + »0 :7:04 l4'}'�E -•:S:'ly'HE66.6 - 13it'C17k'CicusT
Mechanical permit fees* are based on the value of the work
❑ New construction ,pL1 Addition/alteratiorvreplacemen[
0 Demolition ❑Other: performed. Indicate the value (romded to the nearest danar) of
ry�� [- !,� _ mechanical materials, equipment, labor, overhead, and rofit.
.d ` r M fi ,,,l,EF r r JP W ji" �:,5k -.At.", d s 1 :.• .: •,i :.. I s •.;e• 4. J!., p
s .. - �.t ; :4 0 1 . • . ? : L`- " :i? $^?i Value: $
1 - and 2- family dwelling [] Corr.mercial /industrial 0 Accessory building
1i 4: ;M3 ',• r k :WPAT1'ly gNT r 2 -FE
For special i
❑ Multi nnforrnatior: use chec.Klist.
Y ❑ Master builder ❑ Other:
a kh ,t 3't r • „• Description : Qty. I Ea. / Total
V c.S..:; �t'L P - 1 - ; N �. ?t , -'� ®La Il34 55.1,', AI G? :O � .� »� :•• � .- •;' . i ,
ar. .: ll o �,�to • ; .a.: :ai(i}i Reatingko°11ng
Job site address: /-5- -.5 5) //9 ¢ ! Air conditioning or Feat pump
(requires site plan showing placement) 14.00
City/State/ZIP: a Furnace 10O,0C0 BTU (ductsivents) 14.00
Suite/bldg. /apt. no.: Project name: Furnace 100,000-1- BTU (ductslvetue) 17.90
Gas heat pump 14.00
Cross streer/directions to job site: Duct work 1400
Hydronic hot water system 14.00
Residential ooi :er (radiator or
hvdronic) 14.00
Unit heaters (fuel -type, not electric),
1 in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flueivent for any of above 10.00
Other: 10.00
Tax snap /parcel no.: Other fuel appliances
ki LG?t``1��a a rla3. dll( O
0 l u , a ry „ �
t i . 1..,• s 1, . ' f s L *.: i t .3 ' Water heater I 10.00
//17-57-e---,--"---' tG� L T ,0 C�Yte4e./1. Gas fireplace 10 00
Flue vent for water heater or gas
fireplace i 10.00
Log lighter (gas) 1Q.00
Wood /pellet stove 10.00
Wood fireplace/insert / 10.00 ,
' }a'. ". i p *LI`^'� ' r n .t> ' Chimney /lineriflue /vent 10.00
/,�
Other: 10.00 I
Name:
<,. its //1 /) Environmental exhaust and ventilation
Address:
Range hood/other kither • t
equiamer,t 10.00
I
City/State/ZIP: Clothes dryer exhaust 10.00
Phone: ( 03 ) i �y�a Fax: ( ) Single -duct exhaust (bathrooms,
t „ g,,, t: �- -fl- to`.letcompartments, utility rooms) 6.80
.�
P� lA�', rt' � .,,® r ; i is"; ..k ,a Attic /crawlspace fans I 0.00
Business name: Other: 10.0C •
Fuel piping
Contact name: / 6 /b/ $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
City/State/ZIP:
Gas heat pump
Wall/suspended/unit heater
Phone (, 3 ) b,2 y c 6"/ l Fax:: (., 3) 5?( O,7 go Water heate-
E - mail: Fireplace
g era'
ins' 44 Range
NE t;r'�'`•.y?���t?..'. a. r, ... w� + s i
` ' d � .•' t ���� Barbecue I
Business name: CQ / � �� 11 4 -r7 0.1 ( -I- O ther: dryer (gas)
Address: ,01 I �J e, �r � Other. •
b e r $-sit x, v ,� •.
City/5tateJZCP: 7 /‹...et--4241 op y, 0 3 3 . 3 e /�f ; , ,,` ,,y_ :7WO -41: e rTER34Ii *-:i.$*
�/.Z. 97�, Subtotal
Phone: �) „210 ,../
permit fee ($72.50)
G t72 7 a Fax-. ) ,5-9 Jr 8 °Z 76 Plan review (25% of permit fee) I
CCB lie.: 7 .9 s 1 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Author -zed signature: �4iy 2..,i,fsC-- 0e 4.ei This permit applicarion expires if a permitis not obtained within ISO
J days after it has been accepted ns complete.
Print name: )044,l � /� 4- f/_ G q / a� Date: 9 ty j�,� :, � Fee methodology set by Tri- County Building Industry Service 3oard
� ! 7
is +ffiC- PermitApp, doe 12/03 [a11.46 ) rr n vnvr•r...,...vo.
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CITY-.;.OE TIGARD
BUILDING DIVISION PERMIT #: MEC200&00619
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2005
Phone: (503) 639 -4171
Ap4,1400 l �QI,L - � u11`° yu Sw�r/ nc�6fd
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/3/2005 TIME: 7:06AM PAGE: 72
SITE ADDRESS: 15565 SW 114TH CT 23 CLASS OF WORK:
SUBDIVISION: FOUNTAINS AT SUMMERFIELD NDC LOT #: 023 TYPE OF USE:
PROJECT NAME: BIRD
DESCRIPTION: Fireplace insert.
OWNER: BIRD, HELEN PHONE #: 503 - 6134 -2982
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503624 -2704
Inspection Request Scheduled For: Date: 11/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 020160-01 503 -624 -2704 N
Corrections /Comments /Instructions:
PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
U FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Q� lV 6\1 Date: U " Phone #: (503) 718 -
P c