Permit M. CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00712
TIGARD . 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2007
PARCEL: 1 S133DA -03400
SITE ADDRESS: 12605 SW GLACIER LILY CIR ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT: 056 JURISDICTION: TIG
PROJECT: VANHORN
Project Description: Install 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:
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:
Owner: FEES
RALPH VANHORN Description Date Amount
12605 SW GLACIER LILLY
TIGARD, OR 97223 [MECH] Permit Fee 12/10/20C $72.50
[TAX] 8% State Surchar€ 12/10/20C $5.80
Phone: 503 - 579 - 5350
Total $78.30
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 OU NC by
calling 503.246.6699 or 1.800 332 2344
Issu By: / ��/' l Permittee Sign- ure: ,�� J ,
Call 503.639.4175 by 7:00 a.m. for inspections th 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 Applicati Int: -WED ilit( oil: Jut:
,,- .. Reeeived .„
City of Tigard h t. y Permit No : H 10 7
13125 SW Hall Slyd , Tigard, OR. 97223 r 1 0. '1Ali°' Date/By /X /0 0
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one; 5.639.4171 Fax: 503.9.1960 U-- Other Permit;
inspection Line 503.639.4175 clePAD Datenity,
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Internet: rmn non
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' • ' . • ;• , • • • . • ,.• - ' - '.' : TYPE 'OF'WORK.,:, •, ,,„•,: .; ' OAMeITIR,..., OWE'. WEI Ul E - USE CI ft kl . t s1'1
Mechanical permit fees* are based on the Valtle of the ykoo,
n New construction ID Addition/alteration/replacement
performed. indicate the value (rounded to the nearest dollar) of all
El Demolition El Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
V.417:4460:0,t4EQi1eviENT I SYSTEMS FEES*
0 1 - and 2-family dwelling El Commercial/industrial El Accessory building
For special information use checklist
El Multi El Master builder D Other:
Description Qty Ea Total
. JOB SITE INFORMATION AND LOCATION - ' " ." "-: Heating/cooling
Air conditioning or heat pump
Job site address: / 6 0 S - (4 6 ft= c;e4 1, LL y (requires site plan showing placement) 14 00
Ci ty/StateiZIP: — 7',,0,...c 0 a.....) q -2 2_:2------1."..., Furnace 100,000 BTU (ducts"vents) i . I 00 '
Furnace 100,000+ BTU (ducLsivents) 17.90 ,.
Suite/bldg./apt. no.: 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
hydronic) 14 00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. [ 0,00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other. 10 00
Tax map/parcel no.. Other fuel appliances
DESCRIPTION OF WORK ' ':. - ':. ZgeArial Water heater 10 00
s fireplace 10.00
/ 0 3 "-/- 4 I t --C Ga
(41 1_... 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
ROPERTY OWNER - - - 0
Name: p H i/44, A / a... g_fit
/ ' TENANI g`
oth Chinut er: ey/liner/flurivent 10.00
Environmental exhaust and ventilation
Range hood/other kitchen
Address' / ,C, 0 S 5 1 .,,) ( / a e e ... J--) LL7 equipment 10.00
City/Slate/ZIP: ---r G - p. 1:742 ° ( 4 ? 7 2___-2,-% Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone,' 63 ) S 7g — S 3 So Fax---)----- toilet compartments, utility rooms) 6.80
0 APPLICANT ':- - - ' Er CONTACT PERSQ11;';', '';.`,'".'i:.., Attiercrawlspace fans 10.00
' , Other: _ 10 00
Business name:
Fuel piping
Contact name: ''' .."'.......7- 9 , ,, in 7;..)- 1; y 55.40 for first four; $1.00 for each additional ,
Address: Furnace, etc.
Gas heat pump
City/State/ZIP; WallisuspendecVun it heater
Phone: 13 / )_q _ - 0 f Fax :Ell g - 6 .. d Water heater
Fireplace
E-mail' . I
Range .
CONTRACTOR .. -- - ' .:',- Barbecue . I
Business nam . .4: 5 )A 2 _ ,m 4, ' if 1 1 - e_ /
I ri i Zo 1 , fa 01 '').) / (1- Clothes dryer (gas)
Other: I
Address: D X p 3 0 5
Y, '',...;:-'4:! rEamrr FEES* . " i
City/StatelZIP -- o 7 di? / Subtotal
141inimum permit fee (S72.50) 7g -
Phone: 67)13) /, .....- Fax:{57), ' qi -- 27D Plan review (25% of permit fee)
CC/3 lie.: Iii e'/ .
.
' . State surcharge (8% of pennit fee) , 8
TOTAL PERMIT FEE 7. '3o
Authorized signature Z.;,---2.-Zotre-,f--.-/ This permit application expires If a perrait is n ot obtained wItbm 110)
clays after it has been accepted 25 corn p lete.
Print name: , 4 /0 ,41.ay Date: /01 4 A. • Fee methodology set by Tri-County Building Indusuy Server Bourn
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~�~°,~~�°,.~~° ~~.°.~,"~,.~ . PERMIT #: kNEC2007'OO712
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/ ion Ow
Phone: (503) 639-4171
Inspection Roqua�o(24Hroj:(6U3)G3Q'4175 v��m�� '
INSPECTION WORKSHEET FOR DATE: 12/12/2007 TIME: 7:00Am PAGE: 50
SITE ADDRESS: 12605 SW GLACIER LILY R CLASS OF WORK:
SUBDIVISION: AKXART5K)Mk0EpLAKE LOT #: 056 TYPE OF USE:
PROJECT NAME: VANHORN
DESCRIPTION: ipodcdi f urnace.
OWNER: YANM0R#.RALPM PHONE #: 503..579_5350
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 603-624'2784
Inspection Request Scheduled For: Date: 12/12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 061339-01 � 603-6242704 N
Corrections/Comments/Instructions:
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.
— G n PARTIAL APPROVAL EI CANCEL U NO ACCESS
I FAIL CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
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7.
nspector: ��:� , ` Date: --12--a7 Phone #: (503) 718- '-