Permit CITY TIGARD MECHANICAL PERMIT
�i . DEVELOPMENT SERVICES PERMIT #: MEC2005 -00830
I c- DATE ISSUED: 12/20/2005
--�' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S134AD -09500
SITE ADDRESS: 10753 SW 106TH AVE ZONING: R -4.5
SUBDIVISION: WINDSOR PLACE LOT: 032 JURISDICTION: TIG
Project Description: Replace furnace.
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: 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
GEORGE KRAL Description Date Amount
10753 SW 106TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 12/20/20( $72.50
[TAX] 8% State Surcha 12/20/20( $5.80
Total $78.30
Phone: 503- 330 -3147
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 By: / Permittee Signature: _r; D ..� P
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business d y\
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.
• RE.: CEIVED
• Mechanical Permit Application FOR OFFICE USE ONLY
City Tigard 2005 Received %�
Date/8y 0 d • P etnit Ko VVEC172e0i -R:g3
' 13125 SW W Hall Blvd., Tigard, OR 97223
Phoney 503.639.417: Fax: 503.598.1960, v ! Plan Review
0/1 I v: i l�;t.� K //avt:. 0, 1 Datee Other Permit:
Inspection Line: 503.63 ?.4175 r • � !` �_ p, 1 %1
Internet: www.ci.t a rd.er.us ���{ DING l� I�ll -r r
g Date i fied/ eM y/By: rg�� ` e See Page 2. for
Date / f
` I Supplemental Information
.-',..,.;.:.. :; ;T^y.f. ; py WORJc : C07Vi1VMERCIAL SCFIEI)ULE - USECHECKL•1S
❑ New construction dditiorJalteration'replacernent
Mechanical permit fees' are based or tie va:ue of the work
performed. Indicate the value (rounded to the nearest dol:ar) of .
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and rotit
k r i . ti 4O'?,YT C°,O'lt`L O1~ 'CGNSTRTICTION. :l Value: $
:, � 4EID;ENTIAL EQUIP SYSTEMS FEES*
2F1 and 2- farnily dwelling ❑ Commercial/industrial ❑ Accessory building
❑ Multi-family ❑ Master builder ❑ Other: For special in/iw1narfon use ch.ecx.is:
Description, Qty. Ea. Tout:
.t „J.OB `sr gTsiyop yrg.ION YA,"1D'I OCATI Oi 1 Heating/cooling
Ai r conditioning or heat urn
Job site address: IV .3 > V /U � F / � g pump
1 S / � /w'L (requires site plan showing placement) 14.00
City /State/ZIP: ; Furnace 100,000 BTU (ducts/yews) / 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suitefbldg.lapt. no.: I Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 1-1 00
. Hydronic hot water system :4 00
I Residential boiler (radiator or
1
hydrenic) 14.00 ,
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: ; Lot no.:
1 Flue /vent for any of above :0.00
Other: 1 0.00
Tax map/parcel no.: Other fuel appliances
r . ,1} +.1c p� p�E.. {i t, A , 1. 1 Water heater 1
Y.'C l;i j ..3' . yi;( 11 :: ,µ F `;.?2F'S1 WEI�LV ,V WPIX.: 4 i , � ..r..., : .. 1 G.�G
Gas freptace 10.30 _
L /�,
/G i 0 44,y . Lf,L 2 I Flue vent fo- water heater or gas 1
1 fireplace 10 30 I
Log lighter (gas) 10.30
Wood/pellet stove 10.00
Wood fireplace/insert 10.30 1
y���++pp /� yy.� tci n Chimney/liner/Cue/vent 10.00
J 41 ' Li .1 'ii 1V: ..s A { : h, t''... �� .f rAjs'J :
� ±5r,C Other: 10.00
Name: i _� ^ ��J A,2� / Environmental exhaust and ventilation
Address: , ` 1 Range hood /other kitchen
i equipment 10 00
City/State/ZIP: Clothes dryer exhaust 10 00
Phone. ,��!! Single -duct exhaust (bath-oorn..
.Y�3 ) .3 ��j' Fax ( ) toilet compartmerrs, utility rooms) 6.€0
'_ t.:. ,c r dAP)P G ,t, a , , : t ;, ,: C • P #. • A tec /crawlspace tans 1000
Business name:
Other: 10.00
Fuel filing
Contact name: / e) / 4 " 44 a, /b y $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
Ci[y;State /Z]P: Wal fsuspended /unit heater
Water heater
Phone 3 :I loot I / "2 0 47 Fax:: ( . 5,-„, 1 , a �O Fireplace
E -mail:
f xi�_ 1rwzr a c eta 01Y R t:a.t. � -
.l :.iL ..' -N.,r , � w.ti n �.... « �k .... e� .. ^.; Barbecue
Business name: C..0 f N M h / e , pile_ i r-►G4 4- c / N . Clothes dryer (gas)
� � Otter:
Address: AQ /30y, a 3e3 97 :: s .
iii FE
Ciry;State2IP: G 49-.21? OZ 97rkrA.1 _
Subtotal
Phone: a) 4.19 7 0 I Fa "',0,3 ) 9 . . c a 7o as r e i ewt 2 o it fee r mit e)
✓ `T - Plan review (25.0 of permit fee)
CCB lic.: 7 4 0.5 9 State surcharge 18% of perrr.it fee)
TOTAL PERMIT FEE
Authorized signature: ,4 - '40--€1e7 a , 1641' This permit application expires tf a permit is not cbiained within 15
/ days after it has been accepted as complete.
Print name: /2 0 44 4. ey, // �/ I Da:e: �pZ/�� ow r
• • Fee methodology set by Tri- County Building ::;dry 5e.ic: Boise
iiBuildint \PemtitslMEC- Permii Ann .l.' - 1,M1 f C/d ..., .,. --
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