Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 - 00295
DATE ISSUED: 6/30/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: IS136CB -04200
SITE ADDRESS: 10975 SW 83RD AVE ZONING: R -4.5
SUBDIVISION: STEVE + HUGHIE'S PLACE LOT: 014 JURISDICTION: TIG
Project Description: Installation of 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
NANCY VALDEZ Description Date Amount
10975 SW 83RD
TIGARD, OR 97223 [TAX] 8% State Surcha 61301200E $5.80
[MECH] Permit Fee 61301200E $72.50
Total $78.30
Phone: 503- 684 -1612
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: c5
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 Application rolz orrlri: l 5t: ON I.1 -
City of Tigard Rec — l, L permit No. t 14i,
13125 SW Hall Blvd., Ti rho ' /- A
Tigard, OR 9T Plan Rev w
Phone: 503.639.4171 F �� � 14''',{.11Wi l Date ily: Other Permit:
Inspection Line: 503.639 � ooG a •� �� Date Ready/By: H See Page 2 for •
Internet: www.ci.tigard.o 2 �} Notified/Met od: Supplemental Information
S U N 0
` C U IA1 K COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction alifion/alteration/replacement Mechanical permit fees* are based on the value of the work
❑ Demolition em ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: 3
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
❑ Multi- family ❑ Master builder ❑ Other: For special Information use checklist.
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION • Heatingfcoollnj
Job site address: /0 ? C S‘Ot.i 83. -h° Air conditioning or heat pump / 14.00
(requires site plan showing placement) 1
City/ State/ZIP: Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (ducts/ventst 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
hydronic) _ 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: ! Lot no.: 111 Flue/vent for any of above
I ,_ 10 -00
Other. 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10
/!! // /"C.-• Gas fireplace 10.00
Flue vent ant for water heater or gas
fireplace • 10 00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
%PROPERTY. OWNER. J ❑ TENANT Chimney/liner /flue/vent 10.00
_
Other. 10.00
�i4
Name: /d. 4 /G �/ ¢ Environmental exhaust and ventilation
Address: / l/ Range hood/other kitchen
equipment 10.00
City /State/ZIP: Clothes dryer exhaust 10.00
Phone a� � �V / 6 . ( ) Single -dud exhaust (bathrooms,
J Fax toilet compartments, utility rooms) 6.80
❑ APPLICANT CONTACT PERSON Attic/crawlspace Outs 10.00
Business name: Other: _ 10.00 1
Contact name: �t Fuel piping
/x /� /11 �ii
16 (� S5.40 for first four, $1.00 fo r each a dditional
Address: / Furnace, etc. I
Gas heat pump
City / State/ZIP: _ Wall/suspendedhmit heater
Phone 3) �,, a /70 1 Fax: : 7) S9 D Water heater
E -mail:
7 Fireplace
Range
CONTRACTOR Barbecue
Business name: (i4,/ate b / /_ / wry ' / _ /ice? Clothes dryer (gas)
/ � 7 � C• � Other:
Address: Pe g of J 3O j � MECHANICAL PERMIT FEES*
city/ slate/ZIP: 72 %, n D? ?a �,l Subtotal
Phone: .3) 4R if r,?70 ( Fax: 1/4 (23 ) 5- an review (25% fee nnit fee)
I vCJ� � Q Plan review (25 /o of perm it fee)
CCB lic.: 7/ 3S 9 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: Thin permit application expires if • permit is not obtained within 180
days after it has been accepted as complete.
Print name: 4 . � /A 8 a te: 17X;7, ' Fee methodology set by Tri- County Building industry Service Board
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..CITY_ DIE TIGARD -
BUILDING DIVISION PERMIT #: MMEC2006 -00295
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/30/2006
Phone: (503) 639 - 4171 , 1 •ICI''
Inspection Requests (24 Hrs.): (503) 639 -4175 �.. &.- F.
INSPECTION WORKSHEET FOR DATE: 8/4/2006 TIME: 7:04AM PAGE: 104
' SITE ADDRESS: 10975 SW 83RD AVE CLASS OF WORK:
SUBDIVISION: STEVE + HUGHIES PLACE LOT #: 014 TYPE OF USE:
PROJECT NAME: VALDEZ
DESCRIPTION: Installation. of NC unit.
OWNER: VALDEZ, NANCY PHONE #: 503-684.1612 '
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503- 6242704
Inspection Request Scheduled For: Date: 8/4/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 034299 -01 503-624 -2704 N
Corrections/Comments/Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: < Date: e,._4-or Phone #: (503) 718-
I
Jun ,29 06.01:01 p Columbia Heating
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