Permit U CITY OF TIGARD MECHANICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: MEC2013 -00314
-F [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/10/2013
Parcel: 1S133DA03400
Jurisdiction: Tigard
Site address: 12605 SW GLACIER LILY CIR
Project: VANHORN Subdivision: AMART SUMMER LAKE Lot: 56
Project Description: NC replacement. Placement of NC unit must comply with manufacturer's clearance requirements.
Contractor: COLUMBIA HEATING & COOLING INC Owner: VANHORN, RALPH & CORALIE
PO BOX 230397 12605 SW GLACIER LILY CIR
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Air Conditioning 06/10/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/10/2013 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 06/10/2013 $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: — _, Permittee Signature:
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.
06/07/2013 01:22PM 5035980270 COLUMBIA HEATING PAGE 02/02
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RECEIVED .. ...
Mechanical Permit Application For, OFFICE US 1' ON L'
` OFTIGr'3RD
C Of Tigard JUN di 013 ost � 14:1714:17"" -
III —' 131 $0,/ Hell Blvd,, Tigard, OR 97223 / � Pty: � u /���u� 4••• I
Plot Review Oltln'Pomit
Phone; 503.71824,99 Fek: 383:59 1 p,
1 - I ( „ \ „ t t iroPeelion Lint: 503.639;4175 Date Readv,E�r: - • . tabs: El 'eePage 2Sor
Internet : iv�vw.tigard or.gov BUILDING DIVISION Notified/Method: - rpc Sap ' art tizr,otitre
.Z'.h 1 pw '.� i•i ir4.I�•..1'Mr -•�.(1.74, '4,,,i.!t11,.t7-
k �: t' - .. :F "...�.'''37C�•r7l�dR�'?�aii}C�` .N„ :Siv, �-�.tr rw�ovauc:� :- t.o3�:oi`_.�rt�7 ��.�'II' 1 1,, .._ 1,
id3 pennitfe t e'are based on e value trite work
❑ New construct/op arm
)KAddition /e)teration/ieplacentent , , ed. indicatc_thcvaaue (mimic ■ to the nearest •doU>r) of all
❑ Demolition ; 0 Other: cbaniaal materials, equipment; lobo, overhead, and,proort.
t a �, e , to Va1tt4: $
s .• '•a1F ..Kw.: �.oYf: S:.�i� {lk.,• :wt •1�. �!•h) 4: E.i t a i ea” .5'f 11. 1Tffii9 LA.,. •''..74.,.§i 1
"4 1 - and 2- family dwelling ❑ Commercialtindustrial LI Aecosscry building For sitecia1Infomration tchdeklitt• •
❑ Multi-family ❑ Waster builder j' Other. a criptids Qty. I Ea J Total
l wl.` x'frs ' i m T 11 11 �• 1 r> t:r T '• - .4... ' ,. 11 trttngkoo btg,: • .. .;.. Zei!_ _ !1 ni raral 46.75 li b •
^ � F.mace 100.00013TU1doetaieente) I. 46.I5.
City/Scam/ZIP: ' OR 7� ..` F orate 100.0001 BTU - . I 54.91
Suite/bldg. /opt. no'.: t?fOje t rtarge . I a 11 ■ . •14 4 t pump •
Cross strcet/direc or>s to job sites i � ' t.a+ . labahm+cy ' 6 , I i2
rdlanichatwater• cm 23.32
•
_ .. ' ' t (repair otial bolkr or �
. h ,.. I 73.32
U it heaters . (111C1type. net eledtricN I
•
' wgil,in-duet,stispentfed,leta: J 46.15
•Subdivision: I ! •
F c/vcntfor any of. ebme 23:32
Lot trot: � 2332
Tax map /parcel nor I ■ , fuel apptianeex;
” c° s s'� t' .�.�1. vI.l 1
w . 4 . 1 . a 11.212 su?1;, . ,.4 r �1 atet heater 2332
KI'.. •.•lyA!!!�Lp� ?: 116: ' ' `J ' 2r�L�Fv:.a- "�^Y.�.Y;..!`Q� :'�,�Y.C9
f_ •
• • fireplace 33:39
. _ F • rent for water heater or gag
• fi place 2332
. • ' ,g.liRtiter (Ras) - 23,31
' ood/tallet stove .... .. ... .... ...... . 33.39
Odd fiieplaccfuistrt ., _ . . ' . 23.32 - _ .
' y ,,1 "b vp o "7 ,1± _ .rl •, q•: .r imney/lirudfae/verit 23.32
�/�!� � �► 0 er:.....
i MI x23.32• ,
e i���I F; Tel �' ii 10) A E • vGorimeital exbauat'add venlfIad_ bn,
r I • • e liood/other kitchen
r s . • iPment I ..3339 •
City/S 1 d`/ r (A - h- - . • othesdryer.e>;ha1st 3339
. 40 Phone: S ag1e•duct•exhaust pttahmoma.
! � ' F ( ) .: et cornpattme ttg utility rooms] . 2332
,.<•. ' S r, 3MI i. r "' = L n 'fi` r:*. A • icM"02 c t kns 2332
(Business Decor. Columhta Resting rind Co/fmg. lne. O ... • • . 3 -
R of plplltg
•
Contact name: Marietta Meedom S`4.45 cheIrgc Anil 91.03 r each akido'
Address; PO.130030397 eta
• City /State /ZIP: 9728 n" hctt •
• • ,: 1/suspended/Oairht:ater
Phone: (S03) 6Z4 -2704 Fax:: (503) 598 -0270 arer heater .
' • F • eplaec
E -mail: cOlumbbe®teloport.eom.
liminess nanle: Colwnbta:tteatlog and C:oonng, inc. ' •O1ee (Irvin (ere) ... _
• Address: PO Box 230397 o ro(
c. i • • t v . t 1 .177.1 " :i':,"
CiryiStateraP: TON, OR 97381 i Subtotal it .. — I
• Phone: (503) 624.2 / I Fart: (503) 598 - 0270 Known] permit (5l90.00) 40 .tJ t3
(// Flan ti vier (253t, • it tea)
CCB tic.: 74359 _ i State sin has .((2% o pcmlit fee) ( . E-71
TOTAL JT FEE (d0 ... cite
Authorized signatures 4 , ! / , . l %hit per mIt opoiteation expires if a De t n n o t withla 180
1 - �.�`�� days aReritlts.6ean'aoeM se gawk t:
Print,nattte: Markus R Meedom Date: (p_ --1 3 ' Pee medloilalogy set by Trt•Cotwp• t3 iii • >: ]ndusay Service Mead
149 a0...xA+.ell.•o•.w WIS,Ortll ■ aeM14MTr 1l I, eOWWFR1
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