Permit ;,
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q CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/5/2007
PARCEL: 1 S133DA -04900
SITE ADDRESS: 12660 SW GLACIER LILY CIR ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT: 071 JURISDICTION: TIG
PROJECT: DU VAN
Project Description: Furnace replacement.
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:
GAS 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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
NGUYEN, DU VAN Description Date Amount
CO, HOANG YEN THI
12660 SW GLACIER LILLY CIR [MECH] Permit Fee 10/5/2001 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 10/5/2001 $5.80
Total $78.30
Phone: 503 - 524 -6174
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: 410 . A ` 11:., �I A Permittee Signature: L
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.
Mechanical Permit Application ' ' . FOR OFFICE 1'51 :t xia
City of Tigard P arent
t 13125 SW H al l B l vd., Ti gard, OR 97 Plan Review D � Ods�
1 u Phone: 503.639.4171 Fax: 503.598.I96l T Other Fermis
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inspection Line: .639A 175 C 4 200 / Ba te R /B I kris: ® Se Page 2 for
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CITY TI ® r1Md}knd: cntel information
• 1 T OF a 'i 1 ;AiGz i3iviuioN 7&): MMERCIAL' FEE* SCHEDULE -USE CHECKLIST
❑New eoastivetion M'chanical permit fees* are based on the value of the work
❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all 1
El Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION ' I Value' $
•
E' • RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
El I- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building
I For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: I Description 1 Qty. Ea Total
JOB SITE INFORMATION AND LOCATION Re k
p j Aii conditioning or heat pump
Job site address: 1 f l
:�[aJ � U Lr G (requires site plan showing placement) 14.00
City/State/ZIP: Fuinace 100,000 BTU (ducu/vonts) ` 14.00
Futnace 100,000+ BTU (duotv'veots) 17 90
Suite/bldg./apt. no.: Project name: Oas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Re boiler (radiator or
hydronic) 14.00
Uriit heaters (fuel -type, riot electric), 1
in-Wall, in -duct, suspended, etc. 10 00
FItue[vent for any of above 10.00
' Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no : Other fuel ppliances
DESCRIPTION OF WORK Water beater 10.00
I Gas fireplace 10.00
ile z l c 9 4 )4*' Fltie vent for water heater or gas
fireplace 10 00
Log lighter (gas) 10 00
I WOocVpellet stave 10.00
I i Wood fueplace/tnsert 10.00
0-PROPER'TY OWNER j ❑ TENANT . Cliimney/liner /fluelvent 10.00
Other: 10.00
Name: fieltoW Environmental exhaust and ventilation
Address: I Range hood/ather kitchen I equipment 10.00
City /State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: 3) S34f / 0 7 V Fax: ( ) i toilet compartments, utility rooms) 6.80
❑ APPLICANT - / ❑ CONTACT. PERSON Attic /crawlspace fans 10.00 I
Business name:: 10.00 _
�'"') Fuel piping
Contact name: f7 �, j $5.40 for first four; $1.00 for each additional 12-1
Address I Ftunace, etc.
I Ga_a heat pump _
City /State/ZIP: I Wall /suspended/unit heater
Phone: c 3 6 . (j — 27 V /r Fax: : 3 • S - 9F -- 6 � "7 A I Water heater
[! 1 Fit+eplace
E -mail: I Range --
CONTRACTOR 1 Barbecue
'' I Clothes dryer (gas)
Business dame: itLiwiii, rx 1 �`1 n auk / Other:
Address: x 3 D • - : : MECHANICAL PERMIT FEES*
•
City/State/ZIP: � t? a� / e ore.... '�'� 11 L) , I i Subtotal
Minimum permit fcc ($72.50)
Phone: (5)3) 6, . -) 7 L Fax: O , 5-1 L' J 0 2,7 Plan review (25% of permit fee)
CCB lie.: / State surcharge (8% of perm it fee)
— — TOTAL PERMIT FEE 7p D
Authorized signature: /J /J This permit application expires if a permit is not obtained within 8
," - / �� J h }/ days after it has been accepted as complete.
Print name: z, O - , /j l Date: /o /9r 1/77 ° Fee methodology set by Tri- County Building Industry Service Board
If lncit3in ¢1POrniitsl_41EC- PermIIAoo doe 04.'O6/06 440 -461 TI' l 1/0:,CDiIS'WEB'k
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CITY OF TIGARD � -
BUILDING DIVISION c o ti j.1 PERMIT #: MEC2007- 00664
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: • 0/5/2007
Phone: (503) 639 -4171 / i �p�6P'1 I+ 1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/10/2007 i TIME: 7:01Am PAGE: 70
SITE ADDRESS: 12660 SW GLACIER LILY CIR CLASS OF WORK:
SUBDIVISION: /MART SUMMERI AKE LOT #: 071 TYPE OF USE:
PROJECT NAME: DU VAN
DESCRIPTION: Furnace replacement.
OWNER: NGUYEN, DU VAN, PHONE #: 503'5'46174
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: X5;.03. 6247704
Inspection Request Scheduled For: Date: •l0/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical Final 057183•.01 503.624 -2704 Y tei ^" 2 V
Corrections/Comments/Instructions:
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X PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
I II FAIL n CALL F!1R INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: , ( Date: #: (503) 718- .
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