Permit CITY TIGARD MECHANICAL PERMIT
`, DEVELOPMENT SERVICES PERMIT #: 4 1j. II DATE ISSUED: 12/7/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S111 CC -05000
SITE ADDRESS: 15940 SW CENTURY OAK CIR
SUBDIVISION: SUMMERFIELD ZONING: R -7
BLOCK: LOT: 073 JURISDICTION: TIG
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: 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace.
Owner: FEES
MILLER, BERYL Description Date Amount
15940 SW CENTURY OAK CIR [MECH] Permit Fee 12/6/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 12/6/200 $5.80
Phone: 503 639 - 6680 Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
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.
Issued By: � u Permittee Signature: Alir _ _
• Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
• Mechanical Permit Application FOR OFFICE US E ONLY
R Received _
City O ,.Tigard DateBy: -7 .•y koa-, Permit No. 6 UAL/ �Oi1
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review V
Phone: 503.639.4171 Fax: 503.598.1960 //avr il\ Date/By: Other Permit:
Inspection Line: 503.639.4175 r I
Internet: Notifieed/Metho www.ci.tigard.or.us ` .. Date d /Metho d: - -i/ Jars, H See Page 2 for
-- Supplemental Information
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t) EE FIED
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Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
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;;;z'' IDEIV TA ,E'QUIPI LENT = /S FEES
WI and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
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,w. nR/coolinQ
Job site address: / ,//0 ,s-A,.) 6 -4/ it O ItIL �� Air conditioning or heat pump
(re s ite plan showin placement) 14.00
City/State/ZIP: Fumace 100,000 BTU (ducts/vents) / 14.00
Furnace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14 00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
'in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
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.. ;, . IT. =fin's ; ..�;._.. -�' 1,6, ,.,,, y =a l: W. ,,.< ir.� .` r r Water at
, 1 .itN".ra?r" tiirii-: 4%: s ; �, AESCI�IP . , WO •i ..4. #; W heater er 10.00
4
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Gas fireplace 10.00
2 /4cr . 7 "LS' -Pc..it,,.r -!1 6., 4-.. e-___... Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Y,;4 p=.. t5' s ,�t4.:..:x+:te",isc;rs^_�t*k'.. is ».zz ? ' z :ti ;� qr.:. , -, t r K - :3srs. =fit " >i.Ss'ii: "v,;:�,..x, Chimney/liner/flue/vent 10.
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Other: 10.00
Name: 8 Y // / �, 7/ t-.-
/� / / Environmental exhaust and ventilation
Address: , _ J I Range hood /other kitchen
9 y SK Ce A. 40 IL. equipment 10.00
City/State/ZIP: Z a1�c Clothes dryer exhaust 10 00
Phone. Y° 4� -0 Fax: Single-duct compartments, utility rooms) 6.80
exhaust (bathrooms,
�� ) ( ) toilet compar
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` ?;t 0 -4 a w Xii 4 i SIG T ;tea 4 t"„ A f ;, ; y;.:;. t' �: Attic /crawls ace fans 10.00
Business name:
Other: 10.00
Fuel piping
Contact name: / U/1- fb V $5.40 for first four; $1.00 for each additional
Address: / • Furnace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended /unit heater
Phone: Fax: C Water heater
( �rJ 3) h.„2 h.„2 y , '2 0 F ( ��J ) J / 6 > 0.� �0 Fireplace
E -mail:
T . , sr c; : s '.> . ^ i,n.H q Range
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RAC-� Te X 3'�' - i '1 * Z'.N' �]if.
xt ' "-: n ?, ,4 . " R ;+' ti, ,, ,,mi r,W1! 7 Barbecue
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6 1a- -
Business name: �u /`'f 4 1 �� „- e ev
Other:
Address:
Clothes dryer (gas)
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D 60y, 0 33 5 3 9 7 ;,F w ay E.CHA1�tTCAT " +PERMTT4.EEES: *'
City/State /ZIP: 7 / G »-4.- 0/2-. 9 ?ArR '3 Subtotal
Phone: g ) G a � oz ' L Fax: o 3) o d 7e Minimum( permit fee ($72.5 e )
,� T ` S 9 Plan review 25% of permit fee
CCB lic.: 7 4- .3 s 9 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: � This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ) e %g 4. Q,■• 7 Date: ,'i / -7,Q v ` Fee methodology set by Tri- County Building Industry Service Board
is\Building\Permits\ EC- PermltApp.doc 12/03 440 - 4617T (I I /02 /COM/WEB)
CITY OF TIGARD
BUILDING DIVISION .,..Ai PERMIT #: MEC2004 -00797
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/7/2004
Phone: (503) 639 -4171 4 ii
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/23/2005 TIME: 7:08AM PAGE: 120
SITE ADDRESS: 15940 SW CENTURY OAK CIR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD LOT #: 073 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Replace gas furnace.
OWNER: MILLER, BERYL, PHONE #: 503.639 -6680
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503- 624 -2704
Inspection Request Scheduled For: Date: 6/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 007308 -01 503-624 -2704 N
Corrections /Comments /Instructions:
CA) vi,o-yla/U 5 `)1 '13 :/.4.weiti)40 otAli - ria
7r. c_:___ - ,,,,,
L PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CA FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ) 1 Phone #: (503) 718-