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Permit •A . CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2005 -00575 DATE ISSUED: 9/15/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S133DD -05900 SITE ADDRESS: 12651 SW WINTER LAKE DR ZONING: R -4.5 SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT: 098 JURISDICTION: TIG Project Description: Furnace replacement. 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: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: < =10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Owner: FEES FULTON, COLBY L + DEBRA L Description Date Amount 12651 SW WINTER LAKE DR [MECH] Permit Fee 9/15/200° $72.50 TIGARD, OR 97223 [TAX] 8% State Surchar€ 9/15/200f. $5.80 Phone: 503 - 504 - 6752 Total $78.30 Contractor: COLUMBIA HEATING & COOLING INC P.O. BOX 230397 REQUIRED ITEMS AND REPORTS TIGARD, OR 97281 Phone: 503 624 - 2704 Reg #: LIC 76359 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: 4 Permittee Signature: /! „ %/ Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit APRECEIVED FOR OFFICE USE ONLY City of Tigard RteCV 7/3/05– B " V et.„�J 'O6 DatelBv: ?ermit N. y :3125 SW Hall Blvd., Tigard, OR 97223 SEP 13 2005 ?tan Renes+ Phone 503 639 4171 Fax. 503.598 1960 ?emit 6 , Y.B�' l ;� Date/By Inspecuor Li ^e. 503.639 4175 ,_.j,1 :1i, I I Date ReadyrBy: to • RI See Page Z for Internet: www.ci.tigard.or.us CITY OF TIGAR . "" Notif:ed,T9etl :od 1 Supplement :dInturnution BUILDING DIVISION : - - - - • <TYP1L OR,lWOO]C , t.'- • •. . ' - . • • • • :COMMERCIAL•FEE' SCH EDULE - USECHECKLIST ❑ New construction .ddlt :on /alterat :onlrepla-ement Mechanical perrrit f_es• ore based ot: the value of :h: .-I: — performed. Indicate t:te value (ro..ndcd to t :c nea C.) :. .. I E Demolition ❑ Other mechanical mater.als, equipment. labor. over'nc:,_` ar.i •`.Jr_ I t .i .- .� ' •''` 1 ; C) EGOitY .O1~' CON$'1<'RwmoN :- bake S I 'arc 2- family dwelling Commercial /industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEY g ❑ ❑ Accessory build :ng For special info•ntr;19n u.s checklist 1 E Multi- family ❑ Master builder ❑ Other: Desctauon 1 ! t:s I L..... ",....i . • JOB SITE INFORMMATION,AND- LOCATION , •. Heatingicooling I Job site address: /c265> s^f 4 �,q� DA— A:r conditioning o pump --------- (req.tires site plan showing phen cot; . ! Ci v'State /ZIP: Furnace 100,000 BTU (du- ts've:its) / 1 iii I — Furnace 100,000+ BTU tenets. v: r is) 4. Su::e/bldg.!apt. no.: I Project name: I' - --- — - - -- Gas heat pump IS tr; Cross street:directions to job site: Duct work ; .,, __ — -iydronic hot water system . .4 Residential boiler (radiator or hydronic) 14 t; +; I Unit heaters (fuel -type, not elcctnc;, • in -wall, in -duct, suspended, eve. :0. :s.; Subdivision: Lot no.: Flue /vent for my of above t 10 00 — Other 10 0'.' Tax mapipa_cel no.: Other fuel appliances . a` • ' r, ' • : .• ' ,.. , 4. . ,. "__'.DESCkEPfON :,QB WORK •;,;, ,_,• , •.: _• • • Wa er heater 1 I0 C.4: _ -- — Cas fireplace I 1 %,+; _ _ __ _./1,,% e.c.D Q,(� _, Flue vent for water heater or gas / fireplace I:. ;4: Log lighter (gas: IL! a. - -- - • Wood/pellet stove IC! :1- Wood :ireplace /•:nsert I 10 , .i, _ ` PRDPE i[Y,OWI �,; Chimney/ tner/flue,vcnt I� • . •. ' . , :.,. A l ; -? kr . -vt - : : < :. - -- Other: I , � Name: Ca /6,, / /7 Environmental exhaust and ventilation Address • Range hood/other :cixhen equipment C ! •.r City /State'ZIP: Clothes dryer exhaust . .0 0 i - Single -due: exhaust (ba:brooms, Phon ( Fax: - �J' . � ( 1 bile: compartments, utility rooms) o .s..1 • .. ,'©:''APPL7CALY :' - r. t 4:. , Q�v � 4r$iJN Atticfc awlspace fans ! IC 04 I . -y�.F C: E' P , Business :tame: Other • :C 0.3 Fuel piping Contact name' � jl•, 0 /e) ,/ $5.40 for first four: $1.001•oreach additional - Acdress: J Furnace, etc Cas heat pump City/State/if': Wa:l/suspendediunit heaver Phone: ���� ,/ Water heater Yak7 . y ,7'7 fJ,i Fax: Se� 41,(,71) Water i E - mail: I - - -• - Tt Range • - • :t -. -, ' CON'•F 'QR •. : *•" ' Barbecue Business name: 4 ( h ,Ll.- Clothes dryer (gas) I 'nI✓C �o a iL/ Other• Address 0 �O }t 3 b .3 l7 - MECHANICAL PERMIT FEES' Ci :v /Slate ZIP 7 4- �.Q� 0/a- ? 7�a`3 Subtotal t - Phone: — ((�� 1 / . ( Minimum petrrt 'eu , .? ;0; t% ' G o? q ez70 ` Fax T �D.j j ,S9 f 642 76 Plar, re,.tew 25? . , (__ �1 Vie' nil fee; � CCB lie. 740.5? - -- --- State swchaig_(S %of per-ni: tee; ; �7 TOTAL PERMIT FEE ' Authorized signature' �a/y�? /.Ci.e 0J esue This permit application expires IL permit is no: obtained %.tthtn iS0 days after it has been accepted as comp.eir Pont name: fi4/1e 4_ O.p J / �/ Date: � �a�s' • Fee methodology set byTr Cca.nyBut!din�lrj,ao.Se.wei. _a•J . 1 • ,Idmc•Pc tEC•PeaaAooduc 12 v / y ' / .�• v �n..,.,�.,, Z•d OLZ0869E09 BugeeH elquJnloO eL I. :1 l SO E l deS CITY OF TIGARD j -- BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: MEC -00575 Phone: (503) 639- 4171 9/15/2005 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 11' SITE ADDRESS: CLASS OF WORK: SUBDIVISION: 12651 SW WINTER LAKE DR LOT #: TYPE OF USE: PROJECT NAME: VILLAGE AT SUMMER LAKE PARK 3 098 DESCRIPTION: FULTON Furnace replacement. OWNER: PHONE #: CONTRACTOR: FULTON, COLBY L + DEBRA L, PHONE #: 503-504-6752 COLUMBIA HEATING 8. CnOI ING NC' 50 .- 62107704 Inspection Request Scheduled For: Date: Pour Time: 9/30/2005 Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 016896 -01 503-624 -2704 Y Corrections /Comments /Instructions: ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL • CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: , / Date: 9 #: (503) 718-