Permit q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 00228
TI U A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/29/2013
Parcel: 2S102BA03700
Jurisdiction: Tigard
Site address: 12059 SW 96TH PL
Project: Bernhardt Subdivision: DUBLIN PARK Lot: 7
Project Description: Install a /c. Placement of a/c unit must comply with manufacturer's clearance requirements.
Contractor: COLUMBIA HEATING & COOLING INC Owner: BERNHARDT, ANTON
PO BOX 230397 12059 SW 96TH PL
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 502 -4778
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Air Conditioning 04 /29/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04 /29/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /29/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules
or direct qu= = • • OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: — a
` PerrnitteeSign: ure: .410 I, .11 f
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
04/25/2013 10:50AM 5035980270 COLUMBIA HEATING PAGE 02/03
I
RECEIVED •
],Mechanical Permit App1ieation APR 2 5 201 i',,li OI I Id L E `I O■l 1
City of Tigard CITY OF TIGAR l► " ' -fC /3 .' PetmitNo: /`/ .1013 ao?3
ly 13125 3W Hall Blvd., Tigard, QR. 97223
ic+ Phone: 503.718.2439 Fax: 503.598.196BUILDING I•; it
1 r , - , + 1 ; 1 , 11$c tivn Lino: 503,639,4175 Date. Readyay: ME
Internet: www,tigar4l•or.gov Notified/Method; .
l
t . T .r. :,s'.v is .• "m a nn '1�' •�r'•:-T•��n; 1 ,1 n�.ii v� rr�. ia,
•� -M1 �� th... o�SSiY •rt `.{e::'eKM1•0.,R 'SP. -.�. E..= Mrx -Wan,- �.._`�'� .: x^A
` " Mechanical permit fed* aro based on Me value oftbe wbtt
❑ New construction 1:+ Addition /alteration /replacement perlbnned. Indicate value (ruWuJe t to Mc nmrest dollar deli
0 Demolition ❑'�other. ?� G mechanical materials, ■ui lebo,, ovothead, and .rofi
. \ : `li „ ', 5s';�Stw6 ..::.P ac.- IT c " .: .-:+b�1 % 1117 r !5x i"." ( I.q t'r�e'�e�s.. .n r ,'�i? r �.
kti W� �':�a1.T 1i 4 is t `t/_..a`iFc r:�rja c�oc c
■ I- and 2- family dwelling 0 Commercial/industrial 12 Accessory building For special Infomrallon checklist
❑ Multi - family ❑ builder 0 Other. Description Qty, Ea TOW'
Cr� .04r v . 1. �g 77 Y�. 0 • tr,:'.� - r' IIeatinAkoOl■rW ..
+ jls a � 9n+ , 5 �`� F� Airconditlbning j
Job site addre4s: ' + S C. ;t,��� p tre4n'ro4 sae elan anoccwg pladenttn i f 46.75
Furnace 100,000 BTU (duots/aenta) 46.75
City/State,ZlP:
l i i, .� Furnace 100,000+ BTl1�ctt/venelL, _ 54.91
Suite/bldg./apt. no.: Project name: • ;�� ` 5 Milli HEM pump 61.06
• Cross struat/directicns to job site; Duet nit iileir sAoWfa�pldtaaaeiti7 1 23.32 • M_
Hydronic hor water system 23.32
_ R- sldemial boiler (radiator or
hydrooic) 2332
Unit hemerE (foelrtype. noteeCtric),
• in -wal in -duct, iris. - de . etc'- 4 4.75 _
Subdivision: Lot no:: Flue /vent for any or above 2332
Other. 2332
Tax map/parcel no:: Other Atel- appliances:
tz ,(, -Sec ,g - . ca <1 ',' :t t;: t, IMEIZ .r. Witter "eater 2332
Sri.., KFix �'n....• ^� , � .. i:a..kl a1r��1+1..q�i�a l e- r � ��` ��r {.'. �:w1 �
A i L' I _ �>>. / RI Ar Flan not for rare( beater or gas 33.39
fireplace 7332
-. to>: liitt (gas I .
Wood /pelletiter atnve ) 23
33.7 9
Wood fiieplace/ifl art 2332. -
Yi +r - a. J ..Mr'. M t ][` 1 -:eat" 7 "" . v Chimney/liner /Ilne(vent„ _ . f 2332
„1:1,
..t • a 0 A . u�.•Q•,' 69 4c'. :ice. - ,7716 ' _
d � _ Others .. 2332
Na ": % �w ' a _ 2: � � Environmental extol Int and remits • • a:
Address: • `AR off 'gig IIIP if Range hoodlotherkitchen
• u • 1 3339
City /State/ZIP: r AO. a ril \ Clothes dryerexxhaust 1 `3339
Single -dudx exhaust (bathrooms,
Phone tiii, ,lM.� �yc (� al FAX ( ) 7 t 7r� toilet c�ompartments,utility rooms) 23.32-
•
, L € r✓ ; " ,= r-.7 ia�'e[` ,_- t�.�7.1' , t 1tiit:7alfhu? +�:: 70V r7 :' Attidctawlapa0e fans # 23. 2
l3usineas name: C_olunubia l;eatiag and Coaling, he- Other f 23.32
. FtrW r
Contact name: Ms 1eits Meedoen 514.15 fdi faun S4.0a • - � stdlitiene
Addrete: PO Box 230397 Pomace, etc.
• Gas keat pump
City/State/ZIP; 97281 Wail/
suspeluded/ttt8t heat
Phone: (503) 624.2704 Fax: : (503) 598 -oa70 Water heater
Replace
F mail eolumbhcaitcleport.com Range
.. %'..•• }'" ;;; ;7 ' au ; - ...;:- •t`g .: :i7 Barbecue
llumnteas name! Columbia lfeat % and Cooling, tae Clathex .. er -..
Address PO Box 230397 Q ,^ . 1 s ,
City /State/ZIP; Tigard, OR 97251. •• _ Subtotil
Minimunspermit - (190.00) 9 Phone: (503) 624 - 17'(14 I Fax (503) 590.027 Plain review (259. o ■ (t let)
CCB lic.: 76359 State surcharge (12% • I. - • t foe) /0. ((O
TOTAL. P st'. 1T FEE /Rp. fed
Authorized aigratuie: This ptrmlt afiplieatioa aspires If , , t is mot obtained within 1110 ,
days grow R tam bean • -, . , aseamolele ''ed
Print name: Marline R Meedom Date: 44 44..... (. -1 . Fat ma6ottchi • a,! by 7ri•�COoo6ty BVi •: ag lndustry knits Dowd /,
, . , s :L+ aw...r,.■ norluitn . 4111.4517Y n IT?IMM/WFn1
04/25/2013 10:50AM 5035980270 COLUMBIA HEATING PAGE 03/03
ar
HEATING & COOLING, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503)624 -2704
SITE PLAN
LI.0 )22/.2.ectr_e_4.e,
C7
ADDRESS
41" ,�
MP_ 1_ \ _