Permit f �\
CITY TIGARD MECHANICAL PERMIT
vi DEVELOPMENT SERVICES PERMIT #: MEC2004 -00244
� 11i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/5/2004
PARCEL: 1 S134AC -02606
SITE ADDRESS: 11355 SW COTTONWOOD LN
SUBDIVISION: ENGLEWOOD NO.3 ZONING: R -4.5
BLOCK: LOT: 163 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace and install a/c
Owner: FEES
SCOTT KOPACEK Description Date Amount
11355 SW COTTONWOOD LN [MECH] Permit Fee 5/5/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 5/5/2004 $5.80
Phone: 503 - 521 - 0675 Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223 Heating Unt Insp
Phone: 503 624 - 2704 Cooling Unt Insp
Reg #: LIC 76359 Final Inspection
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 -6. ".
Issue• By: _ l � ' Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nex business day
May 05 04 09:44a PAM DALBY 503-598-0270 p.2
■•
NI e...h omit di Permit WE i t "i li ED FOR OFFICE USE ONLY
City of Tigard — Received
Date/By: Sigrey.(1.031 _...d 00e■Iii.."
13125 SW Hail Blvd., Tigard, OR 97223 Permit No.: II_ o•
Plan Review
Phone: 503.539.4171 Fax: 503.595.19614A1 0 5 2004 4,... & Date/By: Other. Pei-rnic:
Inspection Line: 503 Alp - AV Date Ready/By
See Page 2 for ■
Internet: www ci.tigard.or F TIGARD Notified/Meth [hod: es
Supplemental intb.cion
CITY O 0,0
1 .,„:„, ! G. ..,._ .,. ,,•,....
..1. .c:ijiitvitikti.gE=. SCHEDULE - USE CHECKLIST
E New construction `1EXAddition/alterationireplacement Mechanical permit fees* are based on the value of the s.vcrk
' performed. Indicate the value (rounded to the neares: do!larl of al:
D Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
:: ' -; ' •'';- • '. • ''• ..- OP CONSTRUCTION • • --;.. • " • ---• ' 'n' ''• .. • .. ,, • Value: $
. .. ......
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
ciZC1 - and 2 dwelling 0 Commercial/industrial 0 Accessory building
For special information use checkhst.
[1] Multi Li Master builder 0 Other:
Description i Qty. Ea. Tata!
' - " • ,' .• '.. -'... ''.- : ' :' JOB SITE''iNFORMATION* j'AJ■i) •,,- - .' • • - r • • '.:":'' Heating/cooling —
Air conditioning or heat pump i
Job site address: / / :5 5.5 _5 67 op .,,,,,,,, (requires site plan showing placernent) / 14.00
Ct ty'S tate/ZIP : Furnace 100,000 BTU (ducts/vents) / 14.00
Fumace 100,000+ BTU (ducts/vents) 17.90
Suitelbldg.lapt. no.: I Project name:
: Gas heat pump 14.00 •
,
Cross streetidirections to job site: Duct work i , 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. :0.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: , 10 00
Tax map/parcel no.: Other fuel appliances
.'., . -' • .:.', .:'...;'-:..:..;...-."i:.;.;',-•:-.....-.:,:.KS.C14.tirTION'OF„r,woloc*I.:,,f,...,,,, ' Water heater I , 10 00
Gas fireplace 10.00
i2 e / c e :e 4 S - 74.4.A!)."7 e) !" ■,----, Flue vent for water heater or gas
' . fireplace 10.00
,7,1/5 .-/-7/7 /9
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10 00
I ' -'"•' '''''''' - 1 , kiikief iiNVN'tii:.':,;-4..,..::•:::.;:.;.i4.;.:-:,:,,,-,z,::tfttstiliq, t, :....,_, : ,:::, Chimney/liner/flue/vent 10.00
10.00
Name:
' ai,.'1. ?" F' , /". . Environmental exhaust and ventilation
Range hood/other kitchen •
Address: // 3 5 c 5 ,_) C ode:, (...e.x. • equipment I 10.00
C1ty/S tate/ZIP: A 7, Clothes dryer exhaust I 10 00
I A 2 ,...3
Single-duct exhaust (bathrooms, , .
Phone: , c5 . 0 ) 5 7, ( , Fax: ( ) toilet compartments, utility rooms) 6.80
' - • '...:,." ;'"• . ' 74 .''' ..: Attic/crawis 10.00
! • • -
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additiona
Address:
Furnace, etc. 1
i 1
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater '
. :
' Phone: ( ) Fax: : ( ) ' -- 1 Water heater 1
Fireplace
E-mail:
Range
:.:: .::':.: ':::..: . - ::'...',.:. : -.....;:n... ....-T:: Barbecue
• Clothes dryer (gas)
Business name: 7 i‘f b IA ..' /1-c_m-,- -4- CAM e. I, ev 4.
Other:
Address: e;i 6cix c3 3b.3 - 7 - -, - • .,,, .,., J--.., ':-:i:,!.k.t.CHANICALTERMIT'FEES- ,
CiryiState/ZIP: Subtotal
7 / 4- A9-4-41 Oa— ? 7.1.,-R. '1 ,
.
Minimum permit fee (572.50) 7•1• 5-6)--:
Phone: !"5 ) C. ,,,, ,./ oz c , „ Fax. ,.."....„, e• 6
: ' Plan review (25% of perm:: fee)
• ,
CCB lic.: 2 4- 0 ,5 9' State surcharge (8% of permit fee) ; 5-t IC
TOTAL PERMIT FEE 78
Authorized signature: a.---2.--72 This permit application expires If a permit is not obtained within ;SO
days after it has been accepted as complete.
t Print name: 2 c / ...4 ,4 e , ; z,.. 7. 6, . Date: 5 c , -< : • Fee methodology set by Tri-County Building nuitzrry Ser.icc Board
I . .a,,talnOcrrnws , NIEC-Prm.lApp.d; 12:03 440-46 I 7T I'. I/V./COM:WEB)
May 05 04 09:44a PAM DALBY 503 - 598 -0270 p. 3
G6.4 e6T4
HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE E110
TIGARD, OR 97223
(503) 624 -2704
FAX (503) 598 -0270
7 /
-ter
JOB ADDRESS: / / , 5 3
SITE PLAN FOR AC OUTDOOR UNITLOCATION
CITY OF TIGARD 24 -Hour
BUILDING • Inspection Line: (503) 6 9 -4175
INSPECTION DIVISION Business Line: `150 .39-4171 MST
BUP
Received Date R quested d `ks" AM PM BUP
Do d �
Location � / .3 515 � ' ' � Suite / y a i f 7
Contact Person Ph ( ) a - "a 1 6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC N 6--
Footing
ELC
Foundation
Access: %,./A LNcJ'r � its ELR
Ftg Drain /� '
Crawl Drain G lS c"/� -- 30
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear I /4/1
Framing
Insulation • J c g V4
Drywall Nailing • � ' " ` 6 -��
Firewall
Fire Sprinkler
Fire Alarm M / Ai / u f, 0 (7-- ,gym P / '
Susp'd Ceiling 6 ,
Roof
Other: /�/
Final 2 4 f bl s C ,O/�1f� f f \" \
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
PAS RT FAIL 6(F:
hiaCHANI AL '
Post Beam
Rough -In rfr
Gas Line
Smoke Dampers
PAS PART FAIL
ELECTRIC AL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection.. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA /0 , � O
Approach /Sidewalk Date ( Inspector Ext
Other:
Final DO NOT REMOVE this inspection record r;' m the Job site.
PASS PART FAIL