Permit 41 CITY OF TIGARD MECHANICAL PERMIT
NI COMMUNITY DEVELOPMENT
PERMIT #: MEC2007 -00659
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/9/2007
PARCEL: 25111 CC - 16700
SITE ADDRESS: 10130 SW HIGHLAND DR ZONING: R -
SUBDIVISION: SUMMERFIELD NO.4 LOT: 218 JURISDICTION: TIG
PROJECT: NOTTINGHAM
Project Description: Replace gas line to fireplace.
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:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS: 0
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
ROBERT & HALLIE NOTTINGHAM Description Date Amount
10130 SW HIGHLAND DR.
TIGARD, OR 97224 [MECH] Permit Fee 11/9/20W $72.50
[TAX] 8% State Surcha 11/9/20W $5.80
Total $78.30
Phone: 503- 968 -5785
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: o e_____ Permittee Signature: Q// /91 ie/9770'fk
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.
.•• ,
...
. 1.....1,
Mechanical Permit Applicatio . • , FOR OFFICE USE OM.) . , ..
1, Cit SW Hall gar 131vd of Tid Tigard, OR 97223 Received irr
1 0:'• ! Dare/By: / 7 o" P 14
ennit° I t ieeeZ00 7 - 70659
. 13125 ( - \ \I - ?, - -
, ,, Plan Review i
' 3 - Phone: 503.639.4171 Fax: 503.598.1960 1 / 4 . 1 ' i‘t,.. t ow' . k ke ig y: Other Permit:
Inspection Li 503.639.4175
3-tGARD Line: Gviy %.P. _.kils ID:N Ready/By: Juric Fil See Page 2 for
Internet: www,tigand-mgON GDW NotifieciNethod: Supplemental Information
0 014 •
• • • •
'' ' •• • • ' ‘. ::, TYPE OF *ORK - --:. : "1 . -':::: . ...COMMERCIAIIFEE* SCIIEDLBLE.--. USE CHECKLIST
•
Mechanical permit fees' arc based on the value of the work
El New construction E Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
•
'CATEGORY. OF.CONSTRIICITONi,::'•:i'::-,.E;2..'--1,:**..:';:3;4---..-' Value: $
• - : RESIDENTIAL EQUIPMENT. /SYSTEMS FEES*
0 1 - and 2-family dwelling D Commercial/industrial 0 Accessory building . .
For special information use checklist.
0 Multi-family 0 Master builder El Other:
Description Qty. j Ea. Total
' JOB SITE INFORMATION' AND LOCATION' ' ...:. .. -- I. - " • Beating/cooling
Job site address: Mit3 e _c5 /74,//44 d 404 Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/StateiZ1P: Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) '17.90
Suitc/bldg./apt. no.. I 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 I
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc, 10.00
ue/vent for any of above 10.00
Subdivision: Lot no Fl
.:
Other: 10.00
Tax map/parcel no.:
Other fuel appliances
• DESCRIPTION OF WORK' • . *. .*. ..". --... ' • .., .. . Water heater 10.00
Gas fireplace 10.00
ir c .-_ .7-..- /, .-v zi ./2.--L.4-,/-<...-' ' Flue vent for water heater or gas ' 1
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
mneylinerfluevent , .
r1ROPERTY - OWNER. - Chi / // 1000
,
Other: : 10.00
Name: g,-Ah Aj , / /09 - Environmental exhaust and ventilation
!
i Range hood/other kitchen
Address: /6913 n „Cal i-//6 hio9 7 te.6 2w . equipment I 10.00
City/StatefZ1P: 77C-4L-41 'Clothes dryer exhaust .•
. 10_00
Single-duct exhaust (bathrooms,
FhoneL(" 7; ) (67 5 - ,7f .5 Fax: ( ) toilet '
compartments, utility rooms) : 6.80 .....
CI APPLICANT ". . ' • * la CONTACT 'PERSON :-. . • . Attic/crawlspace fans 10.00
Other 10.00
Business name:
Fuel pining
Contact narne:" pri rt/.1) $S.40 for first four; SIAM for each additional
Address: Furnace, etc.
Gas heat pump
•
City/State/ZIP:
Wallisuspended/unit heater
Phone: ( "n7 ( ,;,)... Li — .., 0 Fax: :,51) 3) 3f— ( 52„ -- 7 a Water heater
Fireplace /
E-mail:
Range
. .
•
• ' CONTRACTOR; --- ,.. . : .. • - .1..- .. -... . . . - -.. ... Barbecue
- - - .
• .
Clothes dryer (gas)
Business name: . .
4 ....-Afi A . / . e ■ . Ci- ., II O
I / 42
....._ Other
Address: n .0 x '-. 3 0 Sh • .... .
.' . - .MECHANICAL PERMIT FEES' . * • ' -. '*'..
City/State/ZIP: - . - '7 , ,, . ..,. 0/E. ■ - 7,--,F I , Subtotal
Minimum permit fee ($72.50) 9a t se,
Phone: (50) Z -- Fax) 51, -027D Plan review (25% of permit fee)
CCB lie.: ' 2 - -.-- • State surcharge (8% of permit fee) .....c. YO
TOTAL PERMIT FEE _ 0
Authorized signature:
This permit application expires if a permit is not obtained ithin 180
6 ....... 28 ,2
days after it has been accepted as complete.
Print name: /4
7 I Date: // , /ey ..) • Fee methodology set by Tri-County Building industry Service Board
Catulding,Pennal1NIEC-1 04/06/06 440.4 / 177 04 102/CIIM/W7R1
Z . d OLZ0 ONI1V3H visininioo eoc:eo LO 90 AN
-
CITY ��N��������
��mn m �n�m��nn��
BUILDING DIVISION PERMIT #: MEQ2007-00659
| 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1102007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 839'4175 ��W■ ^7 11.
INSPECTION WORKSHEET FOR DATE: 11/19/2007 TIME: 7.01AM PAGE: 41
SITE ADDRESS: 10130 SW HIGHLAND DR CLASS OF WORK:
SUBDIVISION: BJh8W1ERp|ELQM0.4 LOT #: 218 TYPE OF USE:
PROJECT NAME: NOTTINGHAM
DESCRIPTION: Rep gas line to Eireplac.
OWNER: Nam NGHAhA. ROBERT &HALL|E PHONE #: 503-968-5706
CONTRACTOR: GOL1]K80A HEATING & COOLING INC PHONE #: 503-6247704
Inspection Request Scheduled For: Date: 11/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 069868'01 603-624'2704 Y
Corrections/Comments/Instructions:
.
.
.
.
�PASS 7 PARTIAL APPROVAL 0 CANCEL E NO ACCESS
7 FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
|nepector: � � �y ~k Date. / /-- 1 q -- c> �7 Phone #: /503\ 718-