Permit CITY OF TIGARD MECHANICAL PERMIT
• t _ COMMUNITY DEVELOPMENT Permit #: MEC2013 -00027
T [ GAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/15/2013
Parcel: 2S104BA02400
Jurisdiction: Tigard
Site address: 12049 SW WILTON AVE
Project: Anderson Subdivision: COTSWALD MEADOWS NO.3 Lot: 105
Project Description: (1) gas fireplace installation
Contractor: COLUMBIA NW HEATING Owner: ANDERSON, RICK DAVID AND
PO BOX 622 CAROL DIANE
SCAPPOOSE, OR 97056 3837 NW BANFF DR
PORTLAND, OR 97229
PHONE: 503 - 543 -3624 PHONE: 503 - 970 -3055
FAX: (503) 543 -6285
FEES
Specifics: Description , Date Amount
Furnaces < 100K BTU 01/15/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/15/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/15/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 Notification 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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
i
Issued By: ' ,/ / , Permittee Signature: D11 App! i cA -TJQ
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.
Mechanical Permit Ai nlica ECE Y hD Received , { , ►; r„.,:,, ►. ► , r t) ;, ,,
U pnmitNo /) 90 3 - C0'
City of Ti R ec e ive
14 .-- 1317. SW Halt Blvd.. Tig a t, OR 97223
Phone: 503.639.417i Fax 503.59s.196Qj 1 4 2013 ""
DeteRr other Perna;
Inspection Line 503.639.4175 Date Riady/By . to See Palle 2 ter
1 i.; F: ,) w.ttgtni or - $w CITY OF TIGARD tt: ,�a�� sepptancual i"°"io"
®�ILOING pt11ISION
• TYPE 'OF WMK. COMMERCIAL PEE! SCITEAULE. - :USE C iECKLIS7 •
Mechanical permit fees* arc bored an the value of the work
performed. ❑ New construction �i4dditioIl /alEeratiOlJreplatC�terd the value (rounded to the nearest dollar) dell
❑ Demolition 0 Other: meclmnical materials. a rc(1�t neat, labor. overhead. and ptofrt-
. Vat= P1'
• C . . .Y OF.CON 1IiilCtYdiV
. t SYSTEMS FMS"
RESIDENTIAL; EQUIPMENT
1 - and 2 - famtTy dwelling ❑ CoontteRaat/industrial ❑ Accessory building For special information use citeectrsc
❑ Multi --f my ❑ Marta' bud Description ❑ Other: • cs& `
ption I QEY- 1 Ea. 1 Total
JOE arra INY IRHIATI?Dia AND LOCATKET - R coo>n
Job site address: 6,10 -/ q „ sty t f z _ t ON ' Air conditioning 46.75 •
pomace r' +,r_i.12. 1. "� i=IM 4635 • , r
City/State/ZIP: r� 5491
F bmaa 1 00AD0* BTU ()
Suite/bldg./apt no.: Project name: Hod 61.06 ■ 2332
Cross street/directions to job site: WOE
ti c trot water : 2332
. 2332
Uni heaters (Bad -type, not electric],
in -welt, in •• • . . • • • etc. 46.75
I - Flue/vent far any of above ■ 23.32
Subdivision: no : Oth r 23.32.
Tax map/pareol no.: .:
Olher fuel a u - iii
•DT ON OF. WORK • . • • • ' . 23.32
3339
•i` & L (0TJ f /C_ ='+`t' Fine vent for avatar heater or has
- 23.32 • _ • er ME 2332
• Wood/pellet stove 3339
Wood fireplac e/nascrt 2332
Chian linet/11ne/vent 43.32
PIt01PERTY UWNF3t D TF1ciANT Other. 2332
Name: / I -�I Baviro 1 exhaust sad verd8atkm
� Range hood /other kitchen omq �7� gee _ �• crR 3339
City/StatviZlP: Z60 Q 7��� Clothes • . exhaust _ 33.39
� Single -duct ciduni t (bathrooms,
Phone (. a
) ! 70 - .t35.5 Fate ( ) ... .. ... uttl rooms 23.32
Attie/cta -..,,. fans 2332
APPLICAN 1 Qp1G7 ACT : SON, Other' 2332
Business name: Same as Contractor
Contact name: $14.15 lbr first four $4.03 (Or each additional
err:
Address: MI
City/SnttealP:
I Fax: ( ) Water hems Ir.
Phone: ( ) b - ,
E-mail: ' -
CONTRACTOR • Barbease
Business name: Columbia NW Heating Other: � MEM
Address: PO Bur 622 MECHANICAL P.E. Pi..r E'ES' ` . . .
City /State/ZIP: Scappoose, OR 97056 _ subtotal Rr�
Adi �snm permit fee (590.00) ' [.b
Phone: (503) 5433624 I Fax: ( ) 5436285 Plan review (25% of • ern* fee) .-
COI lie.: 61947 Stale ama6>ege (l2% of permit fee) I 0
TOTAL PERMIT FEE CO,. • O
1 il ! / /� 7145 pe uift.phd�ve OI{db if a y�rrdt net obe>daost within 180
�Author¢ed signature: • � ` � der eta it hog bKn Accepted as Mete.
1 Print name. Gerri Jacobson I pert= /4 3 — 1 ' Fee revih •delese set by ?ei-Cam tp Wilding indinm7 service Beard
1 :1B•ddimt■Permits1MF•PmMMAapAoc 160109 410'4617 (11/02/coMtWF.0)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12049 SW WILTON AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
04/25/2013 00:00
MEC2013-00027
PASS - No C of O
Electrical minor label number ELS 347824
Violation Summary:
Inspector Contractor