Permit ht ,
CITY TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00241
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/30/2007
PARCEL: 2S109DA -11400
SITE ADDRESS: 12994 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 103 JURISDICTION: TIG
PROJECT: GJOVIK
Project Description: Installation of an a/c unit.
CLASS OF WORK: OTR 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
TINA GJOVIK Description Date Amount
12994 SW BLACK WALNUT ST
TIGARD, OR 97223 [MECH] Permit Fee 4/30/2001 $72.50
[TAX] 8% State Surcha 4/30/2007 $5.80
Total $78.30
Phone: 503- 684 -6980
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 : ti / / / 1 ' / Permittee Signature: ) 0 , 4, 4,Kk a /%sail Call 503.639.4175 by 7:00 a.m. for inspections that busine 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.
Vlechanical Permit Application tim i5COVE I . •
Foa orFicE um.: ()NEI.
- .., ' . City of Tigard riA6°"-- , Received ,
ch 'NI.) Date/By: Permit No.: 1 j i c 2 _ 00 2
1, -• 13125 SW Hall Blvd., Tigard, OR 97223 P'Y 3 " r .I.DIan Review
Phone: 503.6394171 Fax: 503.598.1%0 O.ther Pencil:
..lt tbalte/11 y:
I IOARD Inspection Line: 503.639.4175 CN'So
I
WI re Reerly(By: lurk. F21 See Page 2 for
• Internet: www.rigard-or.gov *en MI' Nolificd/Nfothod: Supplernentar Information
BUILD
•
• .
. . .'• • TYPE OF WPRK •.: .,. . :..;i::'.1:•::::.. .: COMMERCIAL FEE*: SCHEDULE -• USE CITECIa1ST
] New construction i< Addition/alteration/replacement Mechanical permit fees+ are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of al:
3 Demolition 0 Other: mechanical materials, equipment, labor, overlicad, and profit.
• . • . CATEGORY OF ::- : .... . .:.:.-'..,,:. Value: $ _-. . . ..,
.....!.RESIDENTIAL EQUIPMENT I SYSTEMS FEES'
)g 1- and 2-family dwelling 0 Contrnereialiindustrial 0 Accessory building
For special Information use checklist.
Multi-family 0 Master builder 0 _ Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION': • : . .:: s .. . • . • . Heating/cooling •
.b site address: / 2. 9 Q si g/# i/o) h ,,,,--1 yl- Air conditioning or heat pump
(requires site plan showing placement) / 14.00
Ity/State/ZIP: - der) Furnace 100,000 BTU (duets.Nents) 14,00
Furnace 100,000+ BTU (ducts/vents) , 17.90
uite/bIdgJapt. no.: I Project name:
Gas heat pump 14.00
!ross street/directions to job site: _ Duct work . • 14.00
Flydronic hot water system 14.00
Residential boiler (radiator or
I hydronic) 14.00 _
Unit heaters (fuel-type, not electric).
in-wall, in-duct, suspended, etc. 10.00
i Flue/vent for any of above 10.00
ubdivision: Lot no.:
Other: 10.00
'ax map/parcel no.: Other fuel appliances
. DESCRIPTION OF WORK : • .• •'
: Water heater .
. „ 10.00
Gas fireplace '
. . 10.00
in g -1 1 Pi e, (or% 0 147 C Flue vent for water heater or gas
fireplace 10.00
i Log lighter (gas) 10.00 i
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimne iner/flue/vent 10.00
0 PROPERTY OWNER - . : •. 0 'TENANT •
Other: 10.00
lame: 77 ro -- 4 .J 0 V' ks Environmental exhaust and ventilation
Range hoodiother kitchen
,ddress: / 2,--_.- 9 if/ ,-/- _co fitzili ,LLIi,i) a, fi .r . equipment 10.00 1 l
Ity/Stater212: - 7 i i C.. ) f(j) Clothes dryer exhaust 10 00
.
'hone: (S le 11--‘ a gb
r Fax: ( ) Single-duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80 i
•El APPLICANT • - - .. ; ..:. : - 0 CONTACT PERSON ... : . Atticicrawlspace fans 10.00
Other: 10.00
lusiness name:
Fuel piping
:ontact name: 7?-71/ I]? t $5.40 for first four; $1.0() for each additional
ddress: Furnace, etc.
i.
• Gas heat pump 1
:ity/StateiZ1P: Wall/suspended/unit heater
'hone: 6 ()-z-/ - 7 0 . Fax : 6 1 3 C --' C 7� Water heater
Fir
;.-mail: Range
CONTRACTOR • . . . , - • . ' Barbecue
•
lusiness name: Clothes dryer (gas)
../ Ar 0 .. ., A . Cii . „,, b A
--- -
# Other:
tddress: )/ 0 K ,3 1 o e •. - • - , MECHANICAL PERMIT FEES* • -
• -
:ity/State.IZIP: -7 . 40.4. , c 1 0 r q 7 c ?-i / : Subtotal ,
1 tvlinimum permit fee ($72.50) 7 1-2_ .50
'hone: (51)3 f .- -- d- - 24) y I Fa3 q57 1 ) '?:, - 0 27)
Flan review (25% of permit fee)
:CB lic.:
State surcharge (8% of permit fee) 5 . go
t TOTAL PERMIT FEE _ Igi .30
a uthorized signature: 67') •-e.--e----e'- ,,,... • This permit application expires if a permit is nOt obtained within ISO
days after it Ins been accepted as complete.
?rint name: ,,. /... - :-4 77 : ,_....?... . Date: .4447/,--7 * Fee methodology set toy Tri-County Buildinp, indrstry Service Board
t.T3
: C4I06/06 / • e 11 Cr2iCOMAYEB) 6171'1 • -
.----
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ar
HEATING & COOLING, INC.
P.O. BOX 230397 - TIGARD, OR 97281
(503)624 -2704
SITE PLAN
I-
ADDRESS: /7 S41 g/46 G114-Aiaf ,57
8'd OLZ0 DNILV3H VI8Wf11OO o9Z :L0 LO 08 ady
. 1
CITY OF TIGARD . •.
BUILDING DIVISION PERMIT #: MEC2007 -00241
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/30/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 , , , ... ( 1: 041( r
INSPECTION WORKSHEET FOR DATE: 5/21/2007 TIME: 7:02AM PAGE: 52
SITE ADDRESS: 12994 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 103 TYPE OF USE:
PROJECT NAME: GJOVIK
DESCRIPTION: Inetaliatii.on of an a/c unit.
OWNER: GJOVIK, TINA PHONE #: 503 -6184 -6980
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503 -624 -2704
Inspection Request Scheduled For: Date: 5/21 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 048583 -01 503 -624 -2704 Y
Corrections /Comments /Instructions:
C .____ ) cf...._....e. 00/
. /
*---- - ,
/
7( PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 0 G ik � Date:-- 7 A Phone #: (503) 718 -
l
CITY OF TIGARD.
BUILDING DIVISION
t i PERMIT #: MEC2007 -00241
13125 SW Hall Blvd. Tigard, OR 97223 D ATE ISSUED: 4/30/2007
Phone: (503) 639 -4171 "v�
Inspection Requests (24 Hrs.): (503) 639 -4175 --a
INSPECTION WORKSHEET FOR DATE: 5/15/2007 TIME: 7:00AM PAGE: 111
SITE ADDRESS: 12994 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 103 TYPE OF USE:
PROJECT NAME: GJOVIK
DESCRIPTION: Installation of an a/c unit.
OWNER: GJOVIK, TINA PHONE #: 503 - 684 -6980
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503- 624.2704
Inspection Request Scheduled For: Date: 5/15/2007 n� Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 048164 -01 503- 624 -2704 Y
Corrections/Comments/Instructions:
I I PASS P TIAL APPROVAL I I CANCEL NO ACCESS
❑ FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
/4 Inspector: Date: SS - --/S - ---a? Phone #: (503) 718 - Z