Permit CITY TIGARD MECHANICAL PERMIT
° ' COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00352
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/14/2007
PARCEL: 1 S133DB -00500
SITE ADDRESS: 11576 SW SHEFFIELD CIR ZONING: R -12
SUBDIVISION: BRITTANY SQUARE NO. 2 LOT: 029 JURISDICTION: TIG
PROJECT: FORNER
Project Description: Replace gas furnace and install a/c unit.
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: 1 DOMES. INCIN:
NAT 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
FORNER, HENRY E JR AND Description Date Amount
BARBARA J
11576 SW SHEFFIELD CIRCLE [MECH] Permit Fee 6/14/20W $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 6/14/2007 $5.80
Total $78.30
Phone:
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 c . l/ 4/1 i Permittee Signature: S Q !Jp f cal;
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 As 'cation l'OR 011 T. USU. ONLY
Ci ty o T igard .M1". - I V E R« d 6 i ' : 0 � Z V Permi1No.: .1 g 0' - 4, ,A 2.
lL 0an8
1� ti 13125 SW Hall Blvil, Tigar•, � o •� "•�'� �t
Plan Resew
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: ,
I
l'li;Altl)
Inspection 503.639.4175 D siaB d suns: H S.s Page Zfur
Internet: , r , �,,,.tiga<d- ar.Bov JUN 14 2007 ter:
Notificd/Melhod: 11 b- Supplemental Information i
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...,: , ., .. ,. ,. .. a 7,5 =t-,.�tcr l S , - _ ;,.. .: a • . `'r' ►' E • -' L` S E .cHECKLLS 1'
� a �` r � ticr;:F.,..c�vuz:
❑ few eons[TUCLion 7 y _' Mcchartical crmit fees' arc based on the value of the work
.. ❑ A i i. L. .af/ a .,I.._ P
❑ Demolition Other. performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment. labor, overhead, and profit.
6 c,. EGQ47IYt ;;OG.Q us'at V;'''` k value: S -
I- and 2-family dwelling ❑ Commercial mdust ial D Accessory building S N .. . • ISYST BLS FEES • ] Multi -femil For special ixjormoriox use checklist.
Y ❑ Master builder ❑Ot her. Description 1 Qty. I Ee. [ 'fora
:JOB sr* : IIYFORMITION <AND :.iLOCATIQIte 14, :' .:1 ,';' t .4. Heating/coolln
Job site address: ,_ .. ,re- - / ' , • _ (requirres g showing p I 14.00
City/State/ZIP: Furnace 100,000 BTU (ductsrvcnts) f 14.00 -
SuiterbldgJapt. no.: Project name: Furnace 100,0001 BTU (duets/vents) 17.90
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
bydronic) 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 i
Tax map/parcel no.: Other fuel appliances
• • DESCRIPTIO.N or WORK;':''.' •' "^ "''' ` t " fi . e Water heater 10.00 •
%y 1e, Gas fireplace 10.00
' ✓ � Q� 4A /Z'7/. _ Flue vent for water heater or gas
e4-1 7,i� � 7,4--, fireplace 10.00
I Log tighter (gas) 10.00
Wood/pellet stove 10.00 •
Wood fireplace/insert 10.00 •
• ' $PROPERTY OWNER : . . . . ..: ', i Chimney/liner/floc/vent 10.00
❑T ENAN T i ,t
Omer: I ! 0.00 i
Name. i.... 1461 / -4- _iJ._ Enviroameotal exhaust and ventilation
•
Address: Range hood/other kitchen ,
equipment 10.00
City/State/ZIP: Clothes dryer exhaust I 10.00
�
Single -duct exhaust rooms,
Phone.
3 ) - See 4. 3s/d Fax:( ) toilet compartments, utility rooms) 6.80
• ❑ APPLICANT . . v , :;'a si ❑i ERSON ; v ? ' r: Anic/crawlspece fans 10.00
Business name: Other: 10.00
� -
S540 for first f� _ Fuel piping ;
Contact nacre first four; 51.00 for each additional
Address: Furnace, etc.
Cos heat pump
CirylState2lP: � Wall/suspended/unitheater
Phone: (` ?3 4, , .,--- / L ) Fax .S�9 p 6 2- / 7 a Water heater
E-mail: T O Fireplace
Range ,
• .• CONTRACTOR'` W ? 1; °s ; 1 "y e., " •,, ' 7 .;; - ' :-. 1 :' : Barbecue I
Clothes dryer (gas) I I
Business name: j -,-.04, Address: r (Other:
,/ 1 6 c2.3 o 6 r :
MECHANICAL PERMIT FEES
City/State/ZIP: I 0p 1 L/ / Subtotal I
Phone: a3 6 e �d..?D 9 I Fmo ``J it� t) 5q j 0 27 Minimum permit fee ($72.50) -77 •
' ! v Plan review (25% of permit fee) o '
CCB tic.: , w 1 Slate surcharge (3% of permit fee) 5. D', i
TOTAL PERMIT FEE -1g,30 I
Authorized signature: (7e This permlt application expires If a permit is not obtained within ■80
days after it has been accepted as complete.
Print name: /. Date: / y ' Fee methodology set by Tri- Cowimy Building Ludustry Service Board
IA BoildiagsPermicAMEC- Permiup Na6 p.doc oam 4404 rr p 11 2 /COM wen)
Z 0L 3O - 969 ONII.V3H V181A1f1100 d£6 Z0 LO 46 unf
t.
£
HEATING & COOUNG, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503)624 -2744
SITE PLAN
ADDRESS: • / c _s /,c�
OL30 ONILV3H vievIrnoo d£1 Z0 LO unr
CITY OF TIGARD
BUILDING DIVISION' PERMIT #: MEC2007 -00352
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/14/2007
Phone: (503) 639 -4171 11 u � '
Inspection Requests (24 Hrs.): (503) 639 -4175 - P '' L.
INSPECTION WORKSHEET FOR DATE: 7/31/2007 TIME: 7:07AM PAGE: 75
SITE ADDRESS: 11576 SW SHEFFIELD CIR CLASS OF WORK:
SUBDIVISION: BRITTANY SQUARE NO. 2 LOT #: 029 TYPE OF USE:
PROJECT NAME: FORNER
DESCRIPTION: Replace gas furnace and install a/c unit.
OWNER: FORNER, HENRY E JR AND, PHONE #:
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503- 624 -2704
Inspection Request Scheduled For: Date: 7/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 053031 -01 503624 -2704 Y
Corrections /Comments /Instructions:
cr JL— 3' 3 i on - 1
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
CITY TIGARD MECHANICAL PERMIT
° ' COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00352
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/14/2007
PARCEL: 1 S133DB -00500
SITE ADDRESS: 11576 SW SHEFFIELD CIR ZONING: R -12
SUBDIVISION: BRITTANY SQUARE NO. 2 LOT: 029 JURISDICTION: TIG
PROJECT: FORNER
Project Description: Replace gas furnace and install a/c unit.
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: 1 DOMES. INCIN:
NAT 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
FORNER, HENRY E JR AND Description Date Amount
BARBARA J
11576 SW SHEFFIELD CIRCLE [MECH] Permit Fee 6/14/20W $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 6/14/2007 $5.80
Total $78.30
Phone:
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 c . l/ 4/1 i Permittee Signature: S Q !Jp f cal;
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.