Permit h w
CITY TIGARD MECHANICAL PERMIT
l j DEVELOPMENT SERVICES PERMIT #: MEC2005 -00374
A, `-' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/22/2005
PARCEL: 2S1 02 BC -03900
SITE ADDRESS: 12820 SW WATKINS AVE ZONING: R -4.5
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT: 031 JURISDICTION: TIG
Project Description: Furnace replacement.
•
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
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
PALM, JULIE C Description Date Amount
12820 SW WATKINS AVE [MECH] Permit Fee 6/22/200° $72.50
TIGARD, OR 97223 [TAX] 8% State Surchaq 6/22/200E $5.80
Phone: 503 620 - 8364 Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397 REQUIRED ITEMS AND REPORTS
TIGARD, OR 97281
Phone: 503 624 - 2104
Reg #: LIC 76359
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Issued By: ,. , Permittee Signature: /)-
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
"JI ilk ,. 05 08:17a Columbia Heating 5035980270 p.2
4 .Me.. Permit ApAeation, FOR OFFICE USE ONLY
City of Tigard ',
'' �j l / ' Received /
3125 SW Hall Blvd., Tigard, OR 97223 a � / f Date/By: 42 A2 j ?emit riy'.:0 cj o � -O0 57/
Phone: 503.639.4171 Fax: 503.598.1960 U' fi ,:y.. Plan Review r /
1
Inspection i ine: 503.639.4175 - "r "' _ ' : ' �I : 1 DateiHy: Oche: Permit
Internet: www.ci.ti$ard.f>r.us ��j � r Date ReadyBy 7 LI See PaEe 2 for
Cr' _ Notified/Method:
&Ui/ , .fl,',,- � Supptementatlofarmatloo
..':.� ._ �.� " ,�t ? ='�` �� � ti %�. w. -fi ��� : •,. r .,.,•
f � •:- MIPTXIEV - : T 1 SE ' GHECKx,TST
❑ New construction Addition /alterationfreplacennent Mechanical permit fees• are based on the value of the work
Demolition Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials. equipment,
�3 * ' � - � 1W 1 eq p ., labor, overhead, and
"k y ' � ''**�T1p� a �x +s�•K,. ; •s• � profit.
�..:.,�. Ri+ D p� ry q , ��?(?OLY t� . .;f::! . 5'":t y y �� , .�.;� "PM �'^' ��
° s. :..- : - µ�fi �!r�1t Value:
1!2P1 and 2-family dwelling in • • '' •_ 4 _. .. _;...,
Y g ❑ Commercial/industrial 0 Accessory building i? � • E � ? x r . 1SY$ ! ,S 1fEES+
❑ Multi- family 0 Master builder For special Information use h
}: Other:
checklist J
.-- f •L' ( "'�j • �f.Yl , ^Y�'QBk�W,�.: ..rO,v.O J u ••+� ,.. ",.._ „_,.,,,. Descriptio I e � Ea Total
.t.. °P �..:,..f Qty. Toter
u� � �'''��•.� E�Td'O�I•, �q:'�':; i•�''.9� = 1•l�i•' 'leafing/cooling
Job site address: f 2 .1' , a ful �� � ` ,vs / Air o res ite plan or heat pump
Ci /Suite/ZIP:
Furnace 100,000 BTU (ducts/vents) �c `jF (requires site plan showiaR placement) / 14.00
ry 14.00
Suire/bldgJapL no.: (Project name: Furnace 100.000+ BTU (ducts/vents) f 17.90
Gas heat purr), 14.00
Cross street /directions to job site: Ductwork
1400
Hydro nic hot water system 14 60
Residential boiler (radiator or
bydronic) 14 00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot Flue/vent for my of above 10.00 '
Other:
Tax map/parcel no.: 10.00
;144 ,7 q .�c , + _� s. v Other fuel appliances
'; f. 'arAN � g _ .xt, .f "-:_ s•! Water heater
r tct'� s•': *.��1�:• � > :T%:�ia . T; -. �.. : ''�,';�'. _ 10.00
Gas fireplace 10.00
� a!i- Flue vent for water heater or gas
fireplace 10.00
Lop lighter (gas) 10.00 _
Wood/pellet stove 10.00
.• ` �_ ^�( Wood ey/lin ii flue/v 10.00
� +q,-' I " :41 5`+�� "::ai`' ;'..' :1.; : - ;` :K:•� ,' 1mer /fludvent
?.`- x� ff=k�.- �.�:.:��• �a �.. • �, �� :� 10.00
':`'' i OtChher 10.00
Name:
1
amc:
// e-- // Environmental exhaust and ventilation
Address: � � d S /..i/4 f!G /NS Range lava /other kitchen 10.00 I
equipment
City/State/ZIP: / _ ai Clothes dryer exhaust 10.00
Phone: 3 ) 6 2,9 7 4 . Fax: ( Single duct exhaust (bathrooms,
h tc f,„-„�,�•„• -44
[� yy1 ) toilet compartments, utility rooms) 6.80
, 1 3 - WRa Algol 'f :x!G74 '`,� R 9 ar_ a(k(•s (ANC Attic/crawi ce fa
Business name: Other. 10.00
Fuel piping
Contact name: /a/5 t9,9-16 y 55.40 for first four; $1.00 for each additional
Address: Furnace, etc.
City /State/ZIP: Gas heat pump
Wall/suspended/unit heater
Phone a.,) h? y *2 7 O '71 I Fax: : ( 3?( 0.,? "7l0 Water heater _ -
E -mail: T Fireplace
:j.4 �? .atle,: ltfRlt+ q. 'e.��o.u'ri1 .,aew� , ... Range
ri i :ry X.}i gu ATE ,il.��"'r: ?''E. -` ] 43.5 ; � a r iF. . r : •: '- : ' Barbecue
Business name: CA l eA J`'f 6 1 a.. {q .77 pa � e, t, eu4 Clothes dryer (gas)
Address: /00 410y, 30 3 97 t`: r '� J ....• 4 . : _ i
City/State/ZIP: T 4. s;, -.-.n 0� 97 a -� subtotal
Phone: M 1 ) 4 a ei ,27O _ f l I Fax: - _ 5 -
) .9 r D d el ? Minimum permit fee (S72.50)
� Plan review (25% of permit it fee
fee)
CCH lie.: - 4. , 0.3" 9 State surcharge (8% of permit fee) _
TOTAL PERMIT FEE / ( 6 , 2 )0
Authorized signature: ef:20.4--72/.!ye This permit application expires If a permit Is not obtained within ISO
/ days after It has been accepted as complete.
Print name: I ' i 1. - Fee methodology �i � 4 ..- Date: 4. 2 U • F iet by Tri-County Building Industry Service Board
LAB°i 5permitat EC•p°tmitApp.doe 12/03 440-46 ITT (I l/02/COMIwEa)
CITY OF .TIGARD ti
BUILDING DIVISION PERMIT #: MEC2005 -00374
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/22/2005
Phone: (503) 639 -4171 ^a� yijl�i�
Inspection Requests (24 Hrs.): (503) 639 -4175 �� `__.
INSPECTION WORKSHEET FOR DATE: 6/30/2005 TIME: 7:06AM PAGE: 24
SITE ADDRESS: 12820 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 031 TYPE OF USE:
PROJECT NAME: PALM
DESCRIPTION: Furnace replacement. • OWNER: PALM, JULIE C, PHONE #: 503- 620 -8364
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503 -624 -2704
Inspection Request Scheduled For: Date: 6/30/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 010540-01 503-620-8364 Y
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: g
Date:6 Phone #: (503) 718-