Permit .
CITY TIGARD MECHANICAL PERMIT
I'� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00467
�. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/16/2004
PARCEL: 2S 104AC -04600
SITE ADDRESS: 12783 SW 133RD AVE
SUBDIVISION: MORNING HILL 8 ZONING: R -25
BLOCK: LOT: 190 JURISDICTION: TIG
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: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install of A/C unit.
Owner: FEES
PERDUE, JAMES J /PAMELA J Description Date Amount
12783 SW 133RD [MECH] Permit Fee 7/16/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 7/16/200 $5.80
Phone: Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
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.
Issued By: 1 _r Permittee Signature: ,p
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Jul 13 04 10: 21a PAM DALBY
• • 503-598-0270 p.2
.
Mechanical Permit Application if E1 ' FOR OFFICE USE ONLY .. .
City of Tigard htumt v Received „,." i
ate/By: 1 ' / 6 . 7) Y .
...44. (
op.-mit No.: \ • • ----, Ai q
..... f /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other 'Permit:
Inspection Line: 503.639.4175 i ;L - 3 2poit .40tro, & Date/By:
,,. .4.114,• Date Ready/By: .2 FA See Page 2 for
Internet: www.ci ugard.or.us CITY OF TIGARD dNi Notifieethod: Supplemental information
i \ G
'..!..1":-.,-,::';',.';',':.,::,',.:,t:;,:':::,',;::':1;s'.::::;.:.::•.;'.,'''.,:::::::::--;.4fiffeir,Vvaii,*;:i't,:1:...-::::,.:,::i:.:::,.'..,,!:rr..7,:,::.;-:.;;J:„,::,.,,,,! I2!CON/isefERCZAL,,,FEg"...somiuLE. - USE CHECKLIST
Mechanical permit fees" are based or. the value of the work
0 New construction Sr Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
d.:i.:',igdoz50i--::,Sied-r.giii.o.67.ii51.::::-.',-...::;::.;..-,i-W,Y.,-:7:7 .. . . . , ,. , , .value,I S .,. .
r I and 2 dwelling D Commercial/industrial 0 Accessory building . . ....,... ....
For special information use checidis;.
0 Multi 0 Master builder D Other: i Description I Qty. I Ea. Total
40-iII.ItII**.IrjAiYiXt'01*-610.5.0;54'.'49.1.42I.: .' I ..; I : . : I: I'd.:- .. I Heating/cooling
Air conditioning or heat pump .
Job site address: / „ 4 , 7 r _ / 33 442_ (requires site Oar. showing placement) t i 4.00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) . i 14.00
Furnace 100,000+ BTU (duets/vents) I l 7 90
Sui teibldglapt. no.: I Project name: Gas heat pump I 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
Flue/vent for any of above 10.00
Subdivision: I Lot no.: Other: 1 10.00
Tax map/parcel no.: Other fuel appliances
S.I.H%,;:1,t,l-A.W.1.*:iI,I2--01/,4Y).),IiN*.1.-..",,II.'...".L.::•1:il.:II:4:;:.ITI-- Water heater 1 IC 00
Gas fireplace 10.00
/ /VS "7-7,-// "7-e- Flue vent for water heater or gas
_. fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood firenlace/insert 10 00
10.00
•-• .. ,- .•v•-• - :. -, ...• • , ..:......,..s • -.--,:.,i,.]•.:•.:•,:2;::,,,-.,,•,;.,tits.1.,k14.;..,....,. i .- : „. :. .. L, • : ,....1, Chimney/liner/flueiven t
l . , - ) . ,,W),,,,.jg.)Y. . ''':;"•: I:...')-tI,J.1.1•Li..:•:::: • ....--:......;.) . Other- 10.00
Name: i I) a /24 a 4_, Environmental exhaust and ventilation
Range hood/other kitchen
Address: ja 7g .3 5LAJ i 3341- equipment 10.0C
City/State/ZIP: ..-------
/ / fa d 'I Clothes dryer exhaust
Single-duct exhaust (bathrooms, 10.00
• Phone: (A3 5- 4 / (7, 7 Fax: ( ) toilet compartments, utility rooms) 6 80
I'..-!•'.!•iI,"III-•!.: n)':;)i),,ij.i•ir6.7ta..)..)..--;-45:,,:i.,..;•/:',;:i.I.:;c4i4et.I4iiiiiii:,..:'..7..I.,,I;,,,, Attic/crawlsoace fans 10 00
. Other: 10.00 I
Business name: Fuel piping
Contact name: fil-e ,0-/e,y . $5.40 for first four; S1.00 for each additional
Furnace, etc. I
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
• Water heater
Phone (X --. ) 0 v > 1 ,..2 6 -,z.../ I Fax: : ( ) . <it a„?
Fireplace
E-mail: 1 I
Rang
: I''' •-;lIt".:*;--"II"--.':.'-''-6i5Pfiadfaif,=,-,.:::4:,' e
....':::ii Barbecue 1 I
Bu name: siness n 4 , / ,..f 6 /6_, -e...Je;--np..../C,e, - e. . I I el/ 4.
. C__-0 / /I Cs. • Clothes dryer (gas)
Other \
Address: /OD e,y, c73.c:
[ City/StateIZIP: Subtotal
'7 ' 7o Minimum. permit fee ($72.50) 12 „.)
I Phone: D ) c 0 7 ti t /. 2../ 0 .e..7 1 Fax:b-bs3 ) .... ir o cz . 4.
Plan review (25% of pe+nit fee) I
t CCB lic.: 7 4 a 5 9' ,-'
State surcharge (8% of perrmt fee) I
TOTAL PERMIT FEE '
177,36
Authorized signature: (".74.,7-77---"-e--€1e74L-4-114/ This permit application expires if a permit is not obtained within I
days after it has been accepted as complete.
)
l Print name: /9, 4 , 1 e / A , ,,,q. z57,4 76/ 1 Dater ....7 2.79 9/' 1 ' Fee methodology set 'oy Tri-County Building Industry Service Bar
1 \BuildingUternatsWEC-PcrmitApp doc 12;03 440-4617T (11:02:COM/viSS)
Jul 13 04 10:21a PAM DALBY 503- 598 -0270 p.3
e 'e T,¢
HEATING & COOLING, INC.
8900 S.W. BURNI-iAM ROAD, SUITE E110
TIGARD, OR 97223
(503) 624 -2704
FAX (503) 598 -0270
JOB ADDRESS:
/4 76r Sw 13
SITE PLAN FOR AC OUTDOOR UNIT LOCATION
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 2 -It")) AM PM BUP
Location j - 7 g3 /3 3 . Suite IE �J q--0
Contact Person f Q/''I Ph ( ) 6' a 4— .7 "j PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC N Z�
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear VV“
Framing �nr� //�– � S ��
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING •
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
_PASS—~T FAIL
M ANI
Post& Beam v l( /
Rough -In V
Gas Line
Smoke Dampers
\,, PART FAIL
TRICA7
Service
Rough -In
UG/Slab
Low
Low Voltage
•
Fire Ala rm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call . r reins•ection RE: Unable to inspect – no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job ite.
PASS PART FAIL