Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00117
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2011
Parcel: 1S133CD04000
Jurisdiction: Tigard
Site address: 11712 SW SWENDON LP
Project: Moraes Subdivision: Lot: 0
Project Description: Change out gas furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: MORAES, MYRON J & JULIE M
PO BOX 230397 BY NIKE, INC - EXPAT
TIGARD, OR 97281 1 BOWERMAN DR
BEAVERTON, OR 97005
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/22/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/22/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/22/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 . • Ica • - 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 dir-ct questions to ► N► .y calling 503.232.1987 or 1.800.332.2344.
Issued By: I j , 4, 4 - r Permittee Sign -ture: / `
1 � —
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.
III CITY OF TIGARD RECEIPT
1 3125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TTG.ARD
Receipt Number: 181855 - 03/22/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2011 -00117 Furnaces < 100K BTU 2300000 -43102 $46.75
MEC2011 -00117 12% State Surcharge - Mechanical 1003100 -24001 $10.80
MEC2011 -00117 Minimum Fee Adjustment - Mechanical 2300000 -43102 $43.25
Total: $100.80
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 902265 DADAMSKI 03/22/2011 $100.80
Payor: Columbia Heating & Cooling Inc
Total Payments: $100.80
Balance Due: $0.00
t
CITY OF TIGARD PERMITS
13125 SW HALL BLVD
' TIGARD, OR. 97223
TERMINAL' I.D.; 8817340880800313065881
MERCHANT #: 8083130658
VISA
#IrW:k;k6776 *
SALE
RECORD #: 1 IOU: 008801
DATE: MAR 22, 11 TIME: 86:42
BATCH: 694
RUTH: 982265
AUS RESPONSE: Z
CVU2 RESPONSE: P
5 DIGIT ZIP MATCHES, ADDRESS DOES HOT
TOTAL $100.80
I AGREE TO PAV ABOVE TOTAL AMOUNT
ACCORDING TO CARD ISSUER AGREEMENT
(MERCHANT AGREEMENT IF CREDIT VOUCHER)
CUSTOMER COPY
Page 1 of 1
Mar 18 11 04:33p Columbia Heating/Cooli
lr 503-598-0270 p.2
.•.', . '
Mechanical Permit Application - '-, 1. twucr. usi: oNLI
111 City of Tigard OR Permit Nu Vie -- 4/
, ,.--- • 131'15 SW Hall 13Ivd., Tigard, 97223 ' <., N. s';; N
: lg . Phone. 503.639.4171 lax: : 900 .-es,',7';'' ' C'-`."-/ . Dm Plaa a/13 1tev y: iew
Other Permit;
C: ‘ •-•\ --)
Inspection line: 503.639.4175
II littii.i) Die Ready/By ha.a: 12 See Page 2 for
bites lid. vivify...6gal d-slir. goy Notified/Method: Supplemental Information
. - .
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1 . TYPE . OF WORK : COMMERC1AV SCHEDULE - USE CHECKLIST
Mechanical pamit fees* are hasrx1 nn the value of the ',sink
. 1 D New ..:onstruction gAdditionialt.Tationireplacttwnt
performed. Indicate the value (rounded to the nearest colku., ..1
0 Deniuliti:Ar D Other: mechanical materials, equipmer.t labor, overhead, and pre:it
CATEGORY OF CONSTRVc.TX0S' :':'• •:.': ''';'' .: *:- ' Value: S
1 ..._ • . RESIDENTIAL EQUIPMENTi.SYSTEMS FEES4
lid 1- and 2-family dwelling D Commercial/industrial C] Accessory building
For special information use checklist
0 \1u ii lamiI El Master builder 0 Other: , - --
Description Qty.
JOB SITE INFORMATION AND LOCATION . - :: '' .....:.i: . . -.'...,'• - • ' Heating/cooling
Air conditioning
Joh itir a...:d:ess: „ AI if 4)/ /I Ala 4111
..• - __• . 1. CMILIULICS site plan showiag placctnan:i -lb 75 I
_... r
City.`Staie..7.1?: Furnace 100,000 BTU (ducts/vents) i 46 75 .
I p ty 1CP/ . . Furnace 100,000+ BTU /A.:cm:vents i . 54.91
r----- • -
Sur.e/oltigJapt. Au : Heat pump
Cross street: c irections to Job st,e. Duet work 1 1 3'
- - • Hydronic hot water system 23.32
Residential boiler ;rad iatur or
hp:ironic) 23 .32. '
I--- Unit heaters ((uel-t not ype, electric),
in-wall, in-duct, suspended, etc. r i 46 35
I -- - Fluelvent for anv of above 23.52 i
S abd i v i ion: I Lot no.:
Other: _.3. J.:
I :I.\ mapTarecl nc : Other fuel appliances ...
DESCRIPTION OF WORK . .- : • • . ' - ' :s: ...: '. - Water heater FT'..3.3 - . '
Gas fireplace . 33.39
• 'i .... a ' • , • 0 - at - 4 A diLi Flue vent for water heater or gas
fireplace 23 32 :
—,...
i-- --- Log lighter (gas)
Wood/pellet stove 23 32
1 :H39-
' •
Wood fireplacefiasen • 23.32
0 PROPERTY OWNER i - 0 TENANT .
., ChimnevAineritlue/vent 23.32
• Other 1 23.
i, 5 a l r - 4 i 31_i_ ... _ ... ,
. Nutlt.:: Xekt Environmental exhaust and ventilation
Range hood/other kitchen
.l.
1 1 •
4 _ L. . ... , d 1 .. I • ‘.
I Ackinz .. , r 1 , . , e, , ..- .
Ik c in •ment
/„ A !1/. O _Li ja i p • • 4W Clothes drver exhaust 33 39 '
---..- .. -- - IF ..ir Single-duct exhaust (bathrooms,
l
, - 00 .a..i.D..._..0 Fa x: ( ) ie act corn ..runents, utilit , rooms) . 23.32 '
0 APPLICANT 0 CONTACT PERSON '•• • Attie/crawls .ace fans , 23.32 ,
I— : Other: 1 23.3: :
13....siness name • I Fuel piping
_........—
Ccntoet. rinrnc: r /... /-)a /2-7e(c.ri517 ! 314.15 for first four: S.4.03 fur each additional
Furnace, etc.
Address GE heat t um.
...__. . ... ____._....___._ ..._
• City;Statc/K1P: Wall/sus. aded/unit heater
_
— . c .2 . • ,-. . r., -
Phone: rk30; Or.d4.-. /01- Fax: :563 di3E3 _CQ-70 Water heater
Fire .lace •
i
-mail: i Rart_c
- ------- --- -
CONTRACTOR . ..,. •:. • . • . . ... . . 1 Barbecue
1 --..—
1 i
liusimms name: e f ,„..... mr ...gm' , . AI.- ... _
1..''‘ „ : . 0.21a
iTcdy,._ 41 i'-' I
Clothes dryer (gas)
. MECHANICAL PERMIT FEES*
I City:S1ute/Z11). 77679:pr) 0.• i7,-)3/ Subtotal j ,..1
I-- Minimum permit fee 19C.00) 1 i i0 ' -Do
Phone i3 ) ( c —a: , 1 Pax; 1101, 5 i i ..
Plan review (25% of permit : I •"'"*"....."-'
Slate surcharge ( 2% olperrnd :eei I • 0 • C
TOTAL PERMIT FEE ! :CO. 0
AlltIturridd SIVIdi unji f , This permit application expires if a permit is not obtained shin I.
„ i: „1,elviip ,
1 (.. days after it his been accepted as complete.
Print name:ff
Date. %, • Patti_.:
r • Fee methodology Tri
set by -Comty duildia :e Li
g industry Ser■i.vs..:
La- "._'_0 Alia
:,h,..k.k....p.miledtALIC-Pcnottiarisnds 1041109 44C-4617T 't :A/COM/Wail
Mar 18 11 04:33p Columbia Heating /Cooling 503- 598 -0270 p.1
l ue 40i ZU1 rJ ID: 4i bd uit ibb, CITY OF TI*RP ..4* , . , •• . PACE. 92/02
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13125 5W Hall $1►d,� p oir OR 97223
Ahroa 503.559.4X71 , Nxi; ` 50308.1960
I , I . f) Insprtio n Liars :;A 3,639.41.1$
iateme.t ; www.t tst- orr.gw
PAYMENT AUTHORIZATION FORM
Permit No, (if available):
Job Site Address: i / 7 [ j) Loop
Project Name: j4 GA.m er
Credit Carajoforrn&tion:
VISA ❑ MasterCard ilP -_ t . si • 7 •
❑ Discover (Csuit • Mcn.ntNu..ibc4
Expiration Date: a I
Cardholder Name (on. card): o o I . '�• Ap L/ +r_ 4 tU tr
Contact Phone No.: — a l . a7o-
.Address for this card is: /c6 COX , q
Zip code for this card is: q70,51
glectrical Trust Account information: For electrical permit applications only.
Trust Account (CCB) No.:
Contractor Business Name:
Contact Phone No.:
I
hereby give the City of Tigard permission to pay for the above referenced
permit with the credit card or electrical trust account =witberprovided above.
Authorized Signature: g / //' _ / ! AAA"
Name Printed: Al i, ' d I 44 ' ' i rill
Date: --
Please FAX this completed and signed form to 503.5984964
To p.cowct ctvdit card information, do not email this farm.
This form will be destroyed after your payment has beer, ptocesscd:
1. \ R v l dro +alParomnuluthnint don doc 43 /n3 /7
Inspections Required for Permit No.: H e C -D / / - Od /7 7
Permit Permit Permit Description Permit Permit Permit Description
Code Type Code Type
01 BUP Building — structural 07 SIT Site Work
02 ELC Electrical 08 SWR Sewer Connection
03 ELR Restricted Energy 09 FPS Fire Protection
04 MEC Mechanical 10 RER Re -Roof
05 MST Master — residential combination 11 CMS Commercial Manufact. Structure
06 PLM Plumbing 12 SFM Single- Family Manufact. Structure
J Req'd Insp Inspect Description J Req'd Insp Inspection Description
Inspection Code Inspection Code
Building (structural) inspections Electrical inspections
205 Footing 105 Underground/slab cover
210 Foundation walls 110 Temporary electrical service
215 Footing drain 115 Electrical service
220 Slab 120 Electrical rough -in
225 Post/beam structural 125 Wall cover
230 Underfloor insulation 130 Ceiling cover
235 Shear walls /anchors 135 Low voltage
240 Exterior sheathing 140 Sign installation
242 Interior shear walls 145 A/C or heating unit circuit
245 Firewall 150 Hot tub /spa/pool
250 Roof nailing • 195 Misc. inspection
255 Wtr proofing basement walls 199 Electrical final
260 Tilt -up panel
265 Masonry
270 Reinforcing steel (rebar) Mechanical inspections
275 Framing 605 Post/beam mechanical
280 Insulation 610 Gas line
285 Drywall nailing 615 Mechanical rough -in
287 Suspended ceiling 620 Hydronic piping
289 Approach/sidewalk 625 Duct work
295 Misc. inspection: 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
Fire Protection System inspections 695 Misc. inspection
905 Sprinkler underfloor /slab )' 699 Mechanical final
907 Sprinkler hydro test
910 Sprinkler rough - in/test
915 Fire alarm rough -in Plumbing inspections
920 Suppression trip test 305 Plumbing underslab
995 Misc. inspection 310 Crawl drain
998 Alarm final 315 Post/beam plumbing
999 Sprinkler final 320 Plumbing rough -in
322 Shower pan
Site Work inspections 330 Water service
405 Excavation 335 Rain drain
410 Fill 340 Storm drain
415 Grading 345 Culvert/catch basin
420 Sprinkler supply lines 350 Septic tank
495 Misc. inspection 395 Misc. inspection
498 Grading final 399 Plumbing final
499 Final inspection
Manufactured Structure inspections Sewer inspections
805 MFG - Structure grading/footing 505 Sanitary sewer
810 MFG - Structure set -up 585 Misc. inspection
899 MFG - Structure fmal 599 Final inspection
INSPECTOR SIGNATURES ARE NOT REQUIRED ON THIS DOCUMENT.