Permit I • ' � r�
1111 v CITY OI C TIGARD MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00511
TIGARD DATE ISSUED: 10/16/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S1036A -00103
SITE ADDRESS: 11950 SW ANN ST ZONING: R -4.5
SUBDIVISION: LERON HEIGHTS LOT: 003 JURISDICTION: TIG
PROJECT: ANDERSON
Project Description: Install gas furnace.
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:
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:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
EDWARD L. ANDERSON Description Date Amount
11950 SW ANN ST
TIGARD, OR 97224 [MECH] Permit Fee 10/16/20( $72.50
[TAX] 12% State Surchai 10/16/20( $8.70
Phone: 503- 984 -4882
Total $81.20
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.
r _
Issue By: / Permittee Signature: 4, A jiff / J J —
Call 503.639.4175 by 7:00 a.m. for i •usin- -.. day.
This permit card shall be kept in a conspicuous place on the j.ob site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1‘16.., I
Mechanical Permit AAQlicatio� �,0�� [ Oil ill rIC`�:'tL;Oi.l'
City of Tigard L� • ♦ %Received ® Pam t N o .: £, e - ����
° 13125 SW Hall Blvd., Tigard. OR 97223
• �G P t, I y. � of i
r V` All. • an Reviw e ether Perm][: '
P 503.639.4171 Fax. 503.598.1960 C, ,�1 �`G ,``�t Dat&By:
T 1 GARD inspection Line: 503.639.4175 �11` Date Ready/By. luris• RI See Page 2 for
Internet: svww.tigard or_gov $� Notified/Method. Supplemental Information '
• ] TYPE OF WORK 'F
COMMERCIAL FEE* SCHEDULE - USE CIIEC:KLIS
❑ New construction [f AdditionlalterationJreplacement Mechanical permit fees' are based on the value et the work
performed. Indicate the value (rounded to the nerJest dollar) or all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overheat, and profit.
CATEGORY OF CONSTRUCTION Value: S
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
anti 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use check! sr.
❑ Multi ❑ Master builder ❑ Other:
1 Description I Qty. Ea. Total
1 JOB SITE INFORMATION AND LOCATION Heatingcooling .
C Air conditioning or heat pump
Job site address:
7/ 7 v (L� a J! r? (requires site plan showing placement) [ '4.00
City /State/ZIP: j ' I !f Furnace 100,000 BTU (ducts/vent / 4 .00 f �
• �� -� r�t�, �.
Suite/bldg.la t, no.: Project name: Furnace 100,000+ BTU (dues
en 7.90
p Gas heat pump 4.00 _ ,
Cross street/directions to job site: Duct work 4.00
Hydronic hot water system 4.00
Residential boiler (radiator or
hydronic) 4.00
- Unit heaters (fuel -type, not electric),
, in -wall, in -duct, suspended, etc 0.00
Subdivision: Lot no.: Flue/vent for any of above 0.00
Other: 0.00
Tax map /parcel no.: Other furl appliances
DESCRIPTION OF WORK • Water heater 0.00
nn J Gas fireplace 0,00
` .- .4 (1-172 - 96 / {[ - e.4 -iiii r ; .t J Flue vent for water heater or gas 6.00
(! �f fireplace
Log lighter (gas) 0.00
Wood/pellet stave 0.00 _ _
Wood fireplace/insert 0.00
Chimney/liner /flue /vent 0.00
❑ PROPERTY OWNER ❑ TENANT ! Qther. 0.00
Name: / - ff in.,--e 4 . .L G d -,o� Environmental exhaust and ventilation
Address: F --� Range hood/other kitchen i 0.00
equipment
C ity/StatelZ I P: Clothes dryer exhaust i 0.00
{� Single -duct exhaust (bathrooms,
Phone: ( (16S ) 9' g --4/L, , Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact nanter ') d it I b " $5.40 for firs) four; 51.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: WalUsuspendedrunit heater j ,
Phone: ,03 j3 ) 6 2. l _- 2,') D y Fax: : 93 >9' 6. 7 v Water heater
Fireplace ,
E-mail: •
Range
CONTRACTOR Barbecue
Business name: (?..,0 1 e t P !J J C. 1 / D f / (J C' Clothes dryer (gas)
�lSj Other:
Address: e /D 0 X ..23 d 3 1 (� MECHANICAL PERMIT FEES .
City/State/ZIP: 6 T } , f ,7 / .2 . , / .2 . , 9 7 2 j// Subto al T
Pl (25% Phone: (511) b } ' " - -- 2 1 0 V Fax: ) c d y �d Minimum permit fee ($72.f. 57) 0) 7 .
_ J f 9 z1 � Plan review (25 of permit fee)
CCB lie.: Y � � --7 5 9 State surcharge (l2 %of permit C:e) 70
TOTAL PERMIT FEE gy. U .
signature: {,,� ,/ J This permit application expires if a permit is not cblaiaed within 1 80
Authorized si
1 G ��. Y , P i 1 oy, A, days after it has been accepted as con plea. ._
Print name: 4 /k.1.__ 7 4 /. / fr e l f 0 /� .� Date: jC, _ 4 , f - - " • Fee methodology set by tri- County Building tedu, try service Hoard
t `T uildino, ermitA 4FC.Pe ,eitAoo.doe 04,06/06 440-46177 (': IN2'COtvI WEB) .
'd OLZO ONI±V3H VIeWf1100 d90:ZI. 20 9 l 100
Ctr OF TIGARD
,) BUILDING DIVISION PERMIT #: MFC200B 00511
I 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/16/200
Phone: (503) 639 -4171 ' ��p�ypil ,I
Inspection Requests (24 Hrs.): (503) 639 -4175 ''' �..
INSPECTION WORKSHEET FOR DATE: /003/2008 TIME: 7 :00AM PAGE: 33
SITE ADDRESS 119E00 Sw ANN ST CLASS OF WORK:
SUBDIVISION: I ERON HEIGHTS LOT #: 1103 TYPE OF USE:
PROJECT NAME ANDERSON
DESCRIPTION: Install gas furnace.
OWNER: ANDERSON, EDWARD PHONE #: 50:1- 681 -4882
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503-624-2704
Inspection Request Scheduled For: Date: . 10/23/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 076964-01 503 - 624 -2704 N
Corrections/Comments/Instructions: ?
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PASS _ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
/ /
,Inspector: Date���� Phone #: (503) 718- -2-q-4--