Permit C ITY F TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00332
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/26/2008
PARCEL: 2S111 DB - 09400
SITE ADDRESS: 15565 SW OAKTREE LN ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.10 LOT: 582 JURISDICTION: TIG
PROJECT: DALBY
Project Description: Replacing gas furnace and installing NC.
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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
PAM DALBY Description Date Amount
15565 SW OAKTREE LN
TIGARD, OR 97224 [MECH] Permit Fee 6/26/200E $72.50
[TAX] 12% State Surch 6/26/200E $8.70
Phone: 503- 624 -2704
Total $81.20
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. 230397
TIGARDRD, , OR 8 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:
(J ► " , Call 503.639.4175 by 7:00 a.m. for inspections that business'da .
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.
M "Me Permit Applicatio
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1114 City of Tigard H a l l 97223 00� Received v _
D a y' a � l rm'tN °.. ThFc '�ti-.tc�&- -r.U1'
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b Phone' 503.639.4171 Fax: 503.598.1919 60 Jv G �RTeview
G� \ err. Other Permi
T I C n t: u lasptxxloa Line: 503.639.4175 0 �v Ready/By: Rex RI See Page 1 for
Internet www.tigard- or.gov 1 n lwlrjV Notified/Method: —1,-- Supplemental Informat
' ' 'TYPE WO ..':.::' : , x ',; :- ...:•,...,.:-•-:,.....:-..... : .
�^' .:.:... :- ::.•. .. tCO1NMERCfA]:FBE . SCIiEDULE '= CHECKLIST
Mechanical permit fees' arc based on the value of the work
❑ New construction Addition/alteration/replacement
El Demolition performed. Indicate the value (rounded to the nearest dot lsr) of all
❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CON. CTION';;:`:. Value: $
7i, 1- and 2- family dwelling ❑ Comsnerciallwdustilal RESIDENTIAL EQUIPMENT SYSTEMS FEES'
❑ Accessory building
El Multi ors ecial informarian use checklist.
y ❑ Master builder ❑ Other.
Description I Qty, I Ea 1 Total
........: ,i;:•.4 T , JOB IN
. SITE. FORMATION:: AND'LOCgT)(QN: .. v, Heating/cooling
' lob site address! !3 6 O5 eat/' Y,(i �� Air conditioning or heat pump / /
" (requires site plan showing placement) 14.00 fit l
City/StatePLlP: Furnace 100,000 BTU (ducts/vents) / 14.00 /N, ere)
��[ I /� a
Project name: vJ Furnace 100,000+ BTU (du(ducts/vents) 17.90
Strite/bldgJapt no.: , �1J
`r`� i Gas heat pomp 14.00
Cross street/directions to job site: Y Ductwork 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
j 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
3ubdi■tision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
/ C •,DESCRIPTION OF-WORK Water heater 10.00
4...70 Gei y Flue fireplace for water heater or g
foe 10.00
// �-� � ,,,,,,e.....„, Flue vent as ,e/ •lac -ZP i ,e9
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
•
Wood fireplaaluuert 10.00
t[YPROPERTY OWNER ' Chimnd�•/lincdflue/venl 10.00
77�_ . • � :..... •;.... [J'TENAN'[':..:::: >' Other 10.00
Name: /'_ - 4f A i / �`
(y �v/ C 0 S Environmental ezbaast and vtndladon
Address: Range hood/other kitchen
equipment 10.00
City/State/ZIP: Clothes . er exhaust 10.00
- Slagle -duct exhaust (bathrooms,
Phone 3) 3 9 7? Fax: ( ) toilet compartments, utility rooms) 6.80
❑ • APPLICANT .: • _• Q 'CONTACT PERSON' .. ;: ` Attic/c awlspaee fans 10.00 • Business name: Other. 10.00
Fuel piping
Contact names' ' f 1 I 6 1/ $5.40 for first four; 5I.00 for each additional
Add Furnace, etc. • Gas heat pump
City /State1ZIP: Wall/suspended/unit heater
Phone: )3 )12- '1 - 2--)0L, Fax:: 93 )S Gj t % 6)-20 Water beater
E -mail: Fireplace
Range i
I.OR _•,'
,.
COYIRAC : Barbecue
e.,.0 V
Business name: p II.'? h/ c „,, ,, ,, c „,, ,, ,, f'�.e.a/L / Ir;. e., c, potties dryer (pas)
dress: Other
Ad
qt, 3 OX r O 3_9 i .:, ..:, 04NICA_ LPEI 'sF WS,:
City /StatetZP: G ,2,4„, D2 ei72F-/ Subtotal
Phone: (5) & i `f J �. -2/0 4 I Fax: (SP, ) S ./ 0?-7e.) Minimum permit fa ($72.50) '7 Sp
t Plan review (25% of permit fee)
cca tic.: 76 3 S 9
I State surcharge (12% of permit fix) .
�
TOTAL PERMIT FEE r i
Authorized signature: �� ���h�.
This permit application expires permit boot obtained Wit 180
days after it t has has be been accepted as complete.
Print name:
,0, Date: ‘4:45/0/ ' Fee methodology set by Tri- Cousty Building Industry Service Board
Z'd OLZ0 869 ONIld3H Vl8Wf1100 8 £V 80 80 9Z unf
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CITY OF TIGARD,.
BUILDING DIVISION PERMIT #: ME C2008-00332
00332
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/26/2000
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639-4175
WORKSHEET FOR DATE: 7/2/2008 TIME: 7:01AM PAGE: 50
SITE ADDRESS: 15565 SW OAKTREE LN CLASS OF WORK:
SUBDIVISION: SIJMMERFIE_LD NO.10 LOT #: 582 TYPE OF USE:
PROJECT NAME: DALBY
•
DESCRIPTION: Replacing gas furnace and installing NC.
OWNER: DALBY, PAM PHONE #: 503- 624 -2704
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503 624 - 2704
Inspection Request Scheduled For: Date: 7/2/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
G99 Mechanical final 072092 -01 503 -624 -2704 Y
Corrections/Comments/Instructions:
rr
" 1 " a G� s 4 4 E/ . / 70 370 c2/
el
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
4
Inspector: -'I Date: 7 a -' 7 ' Phone #: (503) 718-