Permit CITY OF TIGARD MECHANICAL PERMIT
114
s , COMMUNITY DEVELOPMENT Permit #: MEC2012 00340
T [GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2012
Parcel: 1 S133DD14000
Jurisdiction: Tigard
Site address: 11935 SW 127TH PL
Project: Kociemba Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 177
Project Description: (1) furnace - replace
* *REPRINT 7/2/12 Correction of Description of work **
Contractor: COLUMBIA HEATING & COOLING INC Owner: KOCIEMBA, RICK
PO BOX 230397 11935 SW 127TH PL
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 971- 533 -4165
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 07/02/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/02/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/02/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
_____AAp
Issued By: Permittee Signature: v -n j4 ppu DLj
Call 503.639.4175 by 7:00 a.m. for the next available inspection d ate.
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.
CITY OF TIGARD MECHANICAL PERMIT
II s COMMUNITY DEVELOPMENT Permit #: MEC2012 -00340
T [GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2012
Parcel: 1 S133DD14000
Jurisdiction: Tigard
Site address: 11935 SW 127TH PL
Project: Kociemba Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 177
Project Description: (1) furnace - replace Must be within minimum 5' side yard setback and approved rear yard setback
Contractor: COLUMBIA HEATING & COOLING INC Owner: KOCIEMBA, RICK
PO BOX 230397 11935 SW 127TH PL
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 971 - 533 -4165
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 07/02/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/02/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/02/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: J te__.. Permittee Signature: Oki pictievir/Q`' silliketti
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. [ '
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.
06/ 29/ 2012 12:50PM 5035980270 COLUMBIA HEATING PAGE 02/02
RE CEIVED
mp o
RECN t
. ..
Mechanical Permit AisplieetiOti JUL 2 2012 Fin: 01.11( 1- ■ .,,), ON! 1
CO of Tigard . CITY OF DGARD RN/MM. Pmnlmt.L1 I' _ . . -003 1
11 .---- 'I 13125 SW Rail Illvd., Tiiard,.019 Ma r. 1 5 ,,,, plan gaial,
• Phone: 503,718,2439 Fa k 5 o3 9 6 el r L i . V i.. ON DICAY: Other Pamir
• .
r ,7„, inspection Line: 503.639.4175 Date Mbr Wk. lil : : . raas Z for .
ledernail wc.ov.tigard-or.rrd I o NonficeUraokol; ' 1 - 1 c s . . . . rata! tofarroodon
9,-- _
. .
.v:-7, -7-,,;!,:ni,7wF4,F,"4--7-*"7 .2._-
ENENMI#F4tgett::: LtadkAet?. ,-):::J:q ...(::-:::2111:., ivic • lil arc wed. on value onto wott
0 New construction IN Additionialteration/retilacement *farmed. Indicate:the value (row .. - .; t0 the nearest dollar) of ail
0 lac tnelltion El other: mechanical materals, . - ment,labo Overhand, end Term
.
iue: $
,::1'.7g.':-t A'k-i1'...,,..4MT:Lt.:MTEL,70--L-71MY:atiZEIY ritr---17Liez'7195F-NEIA
'' 2' . ) ::;4-i.LI . " .' '.;2;klk4.,..J. A.4g,
Lg and 2-family dwelling El dommercialfIndusuial 0 Accv.ssory building rot weria/Mfornrogen . . chtritlik. .
El Multkiimily 0 .Master builder ri Other: Deireripfithr 4W.
i'...* ...71Wira,37,-Z171Z1L'7745.,sgaira ttidrbuin " .
Job site address: OSIMIF-P11111WIL t: OirOSSRO . n .4 own] : • .. • - out 46.75
121=201.111T15.M. 0 &.. i .... ..... Funia.t00000.sru cmilyent. iii 46.75 111
NM= 100 000+ gni dualsAhont%) 54,01
r
5Uite/bItigJapta10.: 0 Pioject name: .... t .. o ii !Zile= 1.1 . 0 !m 1 2 . ,..: . 6i
Crass strestAlirectitirts to job sift: 1 . Duet ‘orlt . 23.32 11111MI
Hydronis boomer-system Z332 .
Residential boiler (radiator or . ill
3.32
. h Un . lc 6n li ic . type. anteinnot" 0.. 46:8
iit-Nnst on-clugt.stiapendecketb.,
• 23.32 •
Subdivision:
MM. Fladvent lbr *my& above
•
2332
Tax map/pan:el no.;
cithei- fvelappliances:
LW•W:•.:EUET Wutirt heeler =I 23.32
Sias fireplace 33.39
,Fi tie vent YIN orelOr healer Or was
fireplace .... II 23.32
Lc. 11.: - FAS 23.32
Wood/pellet stove
Wood fireplaseldsert
Ch etill
:':g t: lbgieVilidikienr .
c 23.32
:: , ..--; 7 :'. my, P '' -., .: -- i■tv ,;.2124.44"E 1-. :t•ti - u:it.":i4:4 ,... RegfAaali.
2332
122/11•1642311gkeirfariNINI Ed4iruilmrntill 'exthitssisidd ventila r“
Address: OX,W.WWW51112171/71 R eZ c rit @tik thicliezhen • 33.39
City/WOW: 010 -- - . Clothes dryer exhaust'
- I—
ingle-duet axhamt (bathrooms.
Eri L7.115 S
7 42 d
C ) , fait com_partuiems, utilnv rooms) 23.32
2s ,32
-
' -ait' ia- .,, Attic/ crawl $P a cellms
2332
Other.
•
llusittess name; Colombia Heating t‘l COW,. Inc-
Aid 11
Contact name: %ulna Matdors • . - 314;15 for first tow; $4.63 fb secs *Miriam
.,,
Address: PO HOE 230397 .
rusiface, etc.
• •
&sheet pump
City/St *02P: 9=1 , WallistisimndedittuR heater
•
Phone: (503) 6244704 } ax : :(503) 5904270 • Water irtaisr
Fireplace
,
E-Mail: solorslibt@teltparl.coar , . Ranee .......
2asisreue
e f)
Uusiness name •Columbls
laeating and Coating, Ear Cloths drver ps
• . I .
Other
Address: PO Mix 230397 :
ri42F271.
City/State/21P: Ti Ii:
gard, OR 97281.
l'illinienurn permit ^, • 0
Phone; (aaa.) 6Z4-2704 • Fwr: (503) 598-02?0 Kan inviEW.(25% of ,* it fee)
Stitt . .- y .(I2% o r mit fee
WULF DI' IT FEE s7.#
_ t1/4111.1wrizeci si ‘..A.kithilil iiiidfinov• Tb Permit a POliell Oxfili0e if a ... • . fie not oburdAvirliis Ise Si
days after it has been • • .. . aa complete
Print name: MaKkaa A Wedeln i Date: ti gt.1 1 * FEE Oiciftedology st.1 liy Tri-Councy BLit. ; . ladasiry &treks 80010
I Wit.ILII....111....i.A.Vra~0 "... 4 " 6"."141 ettwirt ninornwwon