Permit MI CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00031
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/17/2008
PARCEL: 2 S 110A D -01000
SITE ADDRESS: 10617 SW CANTERBURY LN ZONING: R -12
SUBDIVISION: LANG HILL LOT: 010 JURISDICTION: TIG
PROJECT: POWELL
Project Description: Gas furnace replace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SFA 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: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
POWELL, JACQUELINE S Description Date Amount
P 0 BOX 23322
TIGARD, OR 97281 [MECH] Permit Fee 1/17/200E $72.50
[TAX] 8% State Surcha 1/17/200E $8.70
Phone: Total $81.20
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 624 -2704
FAX 503 -598 -0270
Reg #: LIC 76359
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 4.j it_ ` Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
VIL
•
Mechanical Permit Application Fois.orrICl USE: ONLY
Received Permit No..
City of Tigard Eiji, Datcl0y: 1 17 0 -6 :r I a-Co$ — 00031
III 13125 SW Hall Blvd., Tigard, OR 97223
C Phone: 503.639.4171 Fax: 503.598. y r D 7 O Date/By:
Permit.
1 on Line: 503.639.4175
1 1 G ARE) Internet: www.tigard- ur.gov [) °S L it t Dade Ready/By: ]ar 0 See Page 1 for
�� . i L \UU Notified/Method: Supplemental Information
TYPE OF C�'
• WOR ,T L� �� ��� t COMMERQAL :FEE' SCHEDULE — USE CHECKLIST
�. 1 11Fir,'�� 9S ' 1s ^ 6 � Mechanical pemtit fees' are based on the value of the work
❑ New construction El Additianlalterah m n performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, . ui. mcnt, labor, overhead, and .rofit.
' CATEGORY OF CONSTRUCTION- Value: $
. RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
❑ I- and 2- family dwelling ❑ Commercialindustrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea_ Total
. . 4OB SITE INFORMATION :AND, LOCATION , . . _ . .. Hearin: coolin_
Air conditioning or heat pump
Job site address:
/6 L l o;,t ��/ t ,p�p 1A �e/ /� ",,,, r :. wires site .tanshowin:.lacement 14.00
City/State../ZIT: f J Furnace 100,000 BTU ductsivrrts) we 14.00 Furnace 100,000+ BTU (ducts/vents 17.90
Suite/bldg. /apt. no.: Project name: Gas heat .um• 14.00
Cross street/directions to job site: Duct work 14.00
' H drone hot water tem 14.00
Residential boiler (radiator or
h dronic 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, sus .ended, etc. 10.00
Subdivision: Lot no.: Flue/vent for any of above 1 0.00
Other: 10.00 -
Tax mapiparcel no.: Other fuel a . liances
DESCRIPTION OF WORK . . Witter heater 10.00
' Gas fire.lace 10.00
..�fJ / r c- tf c,0 74.44-/fut-e-- , , Flue vent for water heater or gas
fire •lace 10.00
Lot li: ter :as 10.00
Wood/. - filet stove 10.00
. Wood fire .lace/insert _ 10.00
Chimn • /liner /flue/vent 10.00
. PROPERTY OWNER • I • ' • ❑ TENANT Other: _ 10.00 __
Name: f ( ., f fr Z?) 1 / Environmental exhaust and ventilation
Range hood/other kitchen
Address: ..ui. ent 10.00
City/State/ZEE': Clothes . er exhaust 10.00
Single- duct exhaust (bathrooms,
Phone: ( G t) — ! 9, Fax: ( ) toilet corn.artments utili rooms) . 6.80
❑ APPLICANT ' ❑ CONTACT PERSON Attic/crawls.ace fans OM 10.00 .
Other: 10.00
Business name: Fuel .i. in
Contact name J 'D / b y $5.40 for first four; $1.00 for each additional
Furnace, etc. _
Address: 1
Gas heat .um.
City/State/ZIP: Wall/sus• nded/unit heater
Phone :,c63 )»t{ .' PIQLi I Fax : : )S q 4''- 6D,7 6,) Water heater Fire __ IIIIIIIIIIII
.lace
E -mail: - Ran:e
CONTRACTOR . Barbecue
/ f / Clothes . - r ::
Business name:
l b 6 , I't 2.4. i tt+ �Q-(7 C Other:
Address: (F 10 o X .2 3 0 3 5 7 U MECHANICAL PERMIT FEES*
City /State/ZIP: - / ! G /7 227 d it. 7 7 2 i/ Subtotal .
Minimum permit fee ($72.50) MIMI
Phone: ( ) T o / ?- y -?O c e Fax: ( 93 ) ,cg? "/- d >."- Plan review (25% of permit fee)
CCB lie.: 74, 3 5-- / q ' State surcharge (12% of permit fee) / •
0171 tII11� lIFBMIIP
This permit application expires if a permit is not obtained within 18U
Authorized signature: GZ ., t•�se--7' days after it has been accepted as complete.
• Fee methodology set by Tri Bud sing Industry Service Beard
' ^ Date: /
� ✓!
Print name:
aen.ae,1 (1 1 /02C. b1/WEBt 1 619e
z'd 0LZ0 969 DNIlVBH V181A1f1100 dZj7:Z6 80 L6 uer
CITY ,®F, TIGARD
BUILDING DIVISION PERMIT #: Pr1F_C2I108 00
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/7/7008
Phone: (503) 639 -4171 64 �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 21//2008 TIME: 7:02AM PAGE: 85
SITE ADDRESS: 10617 SW CANTERBURY I.N CLASS OF WORK:
SUBDIVISION: LANG HILL LOT #: 010 TYPE OF USE:
PROJECT NAME: POWELL
DESCRIPTION: Gas furnace replace. •
OWNER: PHONE #:
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503-624-2704
Inspection Request Scheduled For: Date: 1 112008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 064304 -01 503-522 -6952 Y
Corrections /Comments /Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
❑ FAIL ti CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: -�� a" Phone #: (503) 718- Z,�
CITY OFTIGARD
BUILDING DIVISION PERMIT #: milt 0(8.00O31
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/17/2000
Phone: (503) 639 -4171 Am P�iiu'
Inspection Requests (24 Hrs.): (503) 639 -4175 _��
INSPECTION WORKSHEET FOR DATE: 1/2312008 TIME: 7:00AM PAGE: 26
SITE ADDRESS: 10617 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: LANG HILL LOT #: t110 TYPE OF USE:
PROJECT NAME: POWELL
DESCRIPTION: G furnace replace.
OWNER: PHONE #:
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 703 -524 -2704
Inspection Request Scheduled For: Date: 1123/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
099 Mechanical final 063700.01 503.624 -27(14 Y
Corrections /Comments/ Instructions:
n PAS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / f Date: / — g--c: Phone #: (503) 718-