Permit 'CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00600
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/16/2007
PARCEL: 1S134CA-07300
SITE ADDRESS: 11630 SW BURLCREST DR ZONING: R - 4.5
SUBDIVISION: BURLWOOD NO. 2 LOT: 013 JURISDICTION: TIG
PROJECT: GODOWSKI
Project Description: Replace 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
GODOWSKI, MARY Description Date Amount
11630 SW BURLCREST DR
TIGARD, OR 97223 [MECH] Permit Fee 10/16/20C $72.50
[TAX] 8% State Surcha 10/16/20C $5.80
Total $78.30
Phone: 503 -590 -2613
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.
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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.
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Mechanical Permit Application i:c >It c)rhlc E I' I? ON IN
City of Tigard a Received
' ti Dat1�B y . o /(O O7 ��
Permit No. A./K 7iv
' 13125 SW Halt Blvd., Tigard, OR 9722' �`ttt���777 ° W� " T��
- Plan
I Phone: 503.639.4171 Fax: 507.598.1' =0 ate/Be�itw other permil
'T 1 LT A R O Inspection Line: 503.639.4175
r� r. DairlRy:
Internet, ww.> igatd or,gov T 1 6 2007 Date Ready/Bye rails: S See Page 2 for
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NotiflecUMetbod: 4 - Supplements{ Information
CITY O FIG1 D
rYrE OF wt M®9AifaC9WiSi COM RC1al. FEE* SCHEDULE — USE CHECKLIST
1 ❑ New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of die work
performed. Indicate the value (rounded to the nearer: dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
j CATEGORY OF CONSTRUCTION Value: $
RESmENTIAL EQUIPMENT I SYSTEMS FEES'
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
❑ Multi - family - ❑ Master builder For special information use checklist,
❑ Other: Description Qty. Ea. I Total
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JOB SITE [NEORMAT[ON AND LOCATION . Heating/cooling
Job site address:
14 4) , J /1 f fL Air conditioning or heat pump
_ G l�' U � (requires site plan showing placement) 14.00
City /State/ZIP: Furnace 100,000 BTU (ducts/vents) f 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldgfapt. no.: I Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronie hot water system 14.00
Residential boiler (radiator or
hvdronic) 14.00
Unit heaters (fuel -type, not electric).
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Flue/vent for any of above 10.00
Lot no.:
Other: _ 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORT{ Water heater 10,00
Gas fireplace 10.00
I' ,./ . 1 — _ Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) I 0 - 00
Wood/pellet stove 10.00
Wood fireplace/insert _ 10.00
1PROPERTY OWNER . j] TENANT Chimneyllinerlftuelvent 10.00
Other: 1 1C.00
Name: c_- - 4 - Q �p f ,, ./54 Environmental exhaust and ventilation _
Address: Range hood/otherkitchen
equipment 10.00
City /State/ZIP: Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone : � I 5 ) , 0 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT • . • ❑ CONTACT PERSON Afc/crawispace fans 10.00
Business name:
Other: 10.00
Fuel piping
Contact natne:� / 11 Y $5.40 for first four; SI.00 for each additional
Address: Furnace, etc.
i
Gas heat pump
City /State /ZIP: WalUsuspended/unit heater
Phone: 3 4 l.f __ y " 7 0 ` . Fax:: 3) 51p _-02:76 Water heater _. .
E -mail: O Fireplace
Range
CONTRACTOR ' ' ' Barbecue
Business name: j // pp //�� // Clothes dryer (gas)
T� GtIYa GtJ # Ooi "!n Ci - trrs `! xt5 Other
Address: ! 4) X f3 -3 D I IIA
. MICNICAL PERMIT FEES*
City /State/ZIP: V d o 9 7?_- I Subtotal
Phone: V
VV ) -c7 i Fax: ( - j,�2j -. 9 — U 2 7D Minimum pLtulit fcc($72.50)
Flan review < 2. 5a /01 }f permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE a
Authorized signature: `
This permit application expires if s permit is not obtained within rSEI
days after it has been accepted as complete.
Print name: A9' 4°14 Date: /0�/6 l •� ` Fee methodology set by T:i- County Building Industry Ser .ce Board
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CITY Q .,,. .__
BUILDING DIVISION EC207-00600
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/16/2007 //�
Phone: (503) 639 -4171 mnv l
Inspection Requests (24 Hrs.): (503) 639 -4175 °'__..
INSPECTION WORKSHEET FOR DATE: 11/2'2007 TIME: 7 :01AM PAGE: 50
SITE ADDRESS: 'M() SW I3URLCRE ST DR CLASS OF WORK:
SUBDIVISION: BURL000 NO. 2 LOT #: 013 TYPE OF USE:
PROJECT NAME: GODOWSKI
DESCRIPTION: Replace gas furnace.
OWNER: GODOWSKI, MARY, PHONE #: 503 - 2613
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 5O3- 6242704
Inspection Request Scheduled For: Date: 11/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 058899 -01 5a 624 -2704 Y
Corrections /Comments /Instructions:
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PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL A CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date://— -- - c9 ? Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION
, .....
PERMIT #: MEC2007-00600
4 -
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/16/2007
Phone: (503) 639-4171 Niveilif / O (3
11.
Inspection Requests (24 Hrs.): (503) 639-4175 ....,_14-
INSPECTION WORKSHEET FOR DATE: 10/29/2007 TIME: 7:01AM PAGE: 45
SITE ADDRESS: 11630 SW BURLCREST DR CLASS OF WORK:
SUBDIVISION: f3URI.WOOD NO. 2 LOT #: 013 TYPE OF USE:
PROJECT NAME: GODOWSK1
DESCRIPTION: Replace gas furnace.
OWNER: GODOWSKI, MARY, PHONE #: 603-590-2613
CONTRACTOR: COLL/1\461A HEATING & COOLING INC PHONE #: 503-624-2704
Inspection Request Scheduled For: Date: 10/29/2007 Pour Ti -:
Code # Inspection Description . Confirm # Contact # Me : ge
699 Mechanical final 058474-01 503-624-2704 Y
Corrections /Comments/ Instructions:
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Vkl ,,
_, 416i- a/P 1 ' e t,
I _.
. ) A . . - th•("r-
. ,
' . I PAS*. \ kJ() 1 PARTIAL APPROVAL n CANCEL Li NO ACCESS
-..;
a FAIL 0 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: A/
Date: 11\1 Phone #: (503) 718- ? IA A
_ . .
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CITY OF TIQARD
BUILDING DIVISION PERMIT #: MEC2007-00600
13125 SW Hall Blvd., Tigard, OR 97223
DATE ISSUED: 10/160007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/24/2007 TIME: 7•00Am PAGE: 96
SITE ADDRESS: 11630 SW BURLCREST DR CLASS OF WORK:
SUBDIVISION: BURLWOOD NO. 2 LOT #: (313 TYPE OF USE:
PROJECT NAME: GODOWSKI
DESCRIPTION: Replace gas furnace.
OWNER: GODOWSKI, MARY, PHONE #: 503-690-2613
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 603-624-2704
Inspection Request Scheduled For: Date: 10124/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
6f.g Mochanical'final 068098-01 503-624-2704
Corrections/Comments/Instructions:
ei-eOrTzte 6 2.
411 1116" -a . _ Ar: •
•
•
I IP S pi PARTIAL APPROVAL n CANCEL n NO ACCESS
VA FAIL I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
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Inspector: Date: /e Phone #: (503) 718- 2qA(