Permit CITY OF TIGARD MECHANICAL PERMIT
" ° COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00613
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/19/2008
PARCEL: 2 S 102 BC -00106
SITE ADDRESS: 10290 SW BROOKSIDE CT ZONING: R -4.5
SUBDIVISION: WALNUT ACRES LOT: 005 JURISDICTION: TIG
PROJECT: DICKMAN
Project Description: Replace gas furnace.
CLASS OF WORK: ALT 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:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
AL & CLAUDIA DICKMAN Description Date Amount
10290 SW BROOKSIDE CT
TIGARD, OR 97223 [MECH] Permit Fee 12/19/200 $72.50
[TAX] 12% State Surchai 12/19/20C $8.70
Total $81.20
Phone: 503- 705 -7806
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 OU NC by
calling 503.246.6699 or 1.800.332.2344.
Issued V �� AA Permittee Signature
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.
iiiii
Mechanical Permit Applicat ` I!" - ' F )R (wi l L . ,O NE': '
IN ■ Received t No.: L
Permit City of Tigard R Re e 1 Z -[ C"a8 r(t?C� „log 0Col
13125 SW Hall Blvd., Tigard, QR 9.223 DE _ 2008 Plan Review
Phone: 503. 639 4171 Pax: 503.595 1960 G Other Permit
Date/By:
inspection Line: 503.639.4175 ® I]atc Rcn /B ® See Page 2 turn
rlcn:n CITY F AGAR® dy y
Lniertret: www.tigard -0r.gov NotifedrMerhod: '\ C J Supplemental Information
3UWP E... SVIS ON
TYPE OF WORK : I COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
E New construction El Addition/alteration/rep a.e>xl Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1- 2-family dwe[lin ESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial industrial Cl Q Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qry. r Ea. I Total
JOB SITE INFORMATION AND.,LOCA ON Heating/cooling
Job site address:
i .Air conditioning or heat pump
z v29.0 i / - ",. Q )i ,5 [ (ren,uires plea hawing placement) 14.00
City /State/ZIP: 7f l Furnace 100,000 BTU (ducis/Yents) t 14.00
Furnace 100,0004- BTU (ducts/vents.) . 17.90
Suitefbldg. /apt. no.: ' Project name: • 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: I Lot no.: Flue/vent for any of above 10.09 .
Other: 1 10.00
Tax map /parcel no.: i Other fuel appliances
DESCRIPTION OF WOK{ , , Water heater 10.00
Gas fireplace 10.00
ef?" ic/ a- r ? -t,,- mi■ Flue vent for water heater or gas
I fireplace 10.00
. Log lighter (gas) 10 00
Wood/pellet stove 10.00
•
` Wood fireplace/insert 10.00
ROPERTY OWNER , n TENANT Chimneyllinerfflue vent 10.00
, Other: 10 00
Name: 4/ ,a e-.i/ j ,-f f 4,,,---) Environmental exhaust and ventilation
Range hood/other kitchen
Address:
equipment 10.00 !
CityiStateJZIP: i Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phonei0 ) 1 Q_ 7 9-6‘. Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT Y ❑ : OONTACT PERSON Atticfcrawlspace fans 10.00
•
Other. 10.00
Business name:
Fuel piping
Contact Hamer ` f( j � y' __ $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
! Gas heat pump
City/State/ZIP: 7 ? 'l - �/ } Wall/suspended/unitheater
Phone: 7 � 3 ) 6 � t . 70 `T Fax:: (5,..1-3 6 - 2 6.) Water heater
Fireplace
E-mail: Range _
CONTRACTOR I Barbecue
Clothes dryer (gas)
Business name: 1 �/+; 1 71 G., �-1-6-1(-1 rt 2, . 6.0-01i,-, c,
Other:
Address: qj / J „ .2- D 3 I - 7 0 b 3 S . MECHANICAL PERMIT FEES
City/State/LISP: P 2 ,, 7 Z - Subtotal
) 6 ,1- q --) Plan review ( 5 Fax ) jjy Minimum permit fee ($72.50)
Phone: (.
_ q S �� 70 /o of permit fee)
CCB lie.: 7 / r State surcharge (12°/ of permit fee)
. I TOTAL, PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name: ./9( 24 1 f :/ - � 2 � Date: ' - j 1 / 4 . • Fee methodology set by Tri- County Building Industry Service Board
1 • i Hill '.el nut Varm item Ff_V anni, A nn tint C14111,51(1 C14111,51(1 K I �' � I 440 -4617T r1/ r02/CY7 1
Z'd 0L20 ONIld2H d18Wf11OO OLl.:80 80 86 000
CITY OF TIGARD
BUILDING DIVISION -3. PERMIT #: MEC2008-00613
13125 SW Hall Blvd., Tigard, OR 97223 40 ", DATE ISSUED: 12/1912008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 A:0- 11.
INSPECTION WORKSHEET FOR DATE: 1/512009 TIME: 7:01AIVI: PAGE: 16
SIT ADDRESS: MO SW BROOKSIDE CT CLASS OF WORK:
lJBDIVISION: WALNUT ACRES LOT #: 005 TYPE OF USE:
PROJECT NAME: DICKMAN _
DESCRIPTION: Replace gas furnace.
OWNER: DICKMAN, AL & CLAUDIA PHONE #: 603-706.7606
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503-624-2704
Inspection Request Scheduled For: Date: 1/5/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Mess-_, -
3 a,41')
699 Mechanical final 079364-01 503-705
Corrections/Comments/Instructions:
Z-- /9 S r7
•
Zi PASS 0 PARTIAL APPROVAL
/
/
CANCEL 0 NO ACCESS
FAIL El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: — Date: i 00 Phone #: (503) 718- Z-6X
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