Permit CITY OF TIGARD MECHANICAL PERMIT
• . COMMUNITY DEVELOPMENT Permit #: MEC2009 -00608
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/13/2009
Parcel: 1 S 125DA04000
Jurisdiction: Tigard
Site address: 6704 SW WALNUT TER
Subdivision: Lot: 0
Project: Hoffman
Project Description: Install gas furnace.
Owner: FEES
HOFFMAN, WILLIAM A & SHARAN Description Date Amount
6704 SW WALNUT TERRACE Furnaces < 100K BTU 11/13/2009 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 11/13/2009 $10.80
PHONE: 503 -244 -6861 Minimum Fee Adjustment - Mechanical 11/13/2009 $43.25
Contractor:
COLUMBIA NW HEATING
PO BOX 622
SCAPPOOSE, OR 97056
PHONE: 503 -543 -3624
FAX: (503) 543 -6285
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct que OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: !v% Permittee Signature: �
Call 503.639.4175 by 7:00 a.m. for an Inspection 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.
''11/12/2009 09:32 5035436285 PAGE 02
•
• Mech Permit A lira
City of Tigard CEIVED ru i; t i i c l : t • ,.1
II 13125 Permd? .: r-/ee_ f Received
13125 Sw Hall Blvd. Ti OR 9 y / �„ 0 ��
Phone: 503.639.4171 Fax: 503.5981M V 1 2 2009 Plan Review
. i , i ;,, i , . , Inspection Line: 503.639.4175 Date/By: Other Permit;
Internet www.tigard•or.gery CITY OF TIGARD
Date
r � a see Page 2 far
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reenf informa
.-E +.!!OING DIVISION
.mow . '
❑ New construction 'Addition /alterationreplacement Mechanical permit tees' are based on the value of the work
[] Demolition Other performed. Indicate the value (rounded to the nearest dollar) of all
mcdtanie materials, equipmvrt l abor, overhead, and profit
: ihT OF teiNgPttetIbT4 val $
On- and 2-family dwelling ❑ Commcrciallrndushtisl 0 Accessory building EQT1 Al I'l5Y l ISIEFS.
0 Multi-family ❑ Master builder [] Other For special information use checklist
.. > Description I Qty I Pa. _Omni
'site • .. �D' LO�ATlipl�' : Hesb�rn inn
y Job 'site address: t; -7QG/ SJ (V I /
�'1 76/ f. Air conditioning
r ��/ ,T ^ ✓(/ (requires site pin showing placement) 4635
CiCity/State./ZIP: 7 i / e � L 7,2 2 3 Furnace 100.000137U_ (dacetiven,A) 1 46.75
Suite/bldg./apt /apt nn.: pmj : Furnace 100,000+ BTU (dngtyveaa) 54.91.
Heat p
Cross street/directions to job site: 23.32
Ductwork 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fixel -type, not electric),
in -wall, in -dduct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Tax map /parcel no.: Other 23.32 _
Other thel appliances
.;`., : <.:; ; :, — " ' '.:.: . 'liESCIOOTION Ot*OW(. water heater "
23.32
./1.1.3 ' oz/f 1/ Gas f tfor 33.39
�►!�� Flue vent for water heater or gra
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
;: , repia�rlaert ,
:OVISE . • ' :.: 1 • . • • • 0 " EIQAt$ Other.
Chimney/liner/Due/vent
,..... .._ 23.32
Name: � [)O CJ)f9.Y f �' 23.32
Address: ! n ('► J
Range es her and ventilation
� ! !'7'r 17117 7 Range hood /other kitchen
City /State/ZIP: sI � - .2 3 s� — Clothes dryer of 33 -39
Phone: ( � � ax: ( ) Singleductexhaust(bathrooms,
of7 � '2% - et/ F 33,39
e : -.. .. - ty rooms) {
toilet a+rr�arttnentx udli roams 23.32
JkP1 11V3' in jL�DN P°E SON At /cravyl fans
' � 2132
l%usiness name: C�ry1 r7linl�7le e 23.32
Contact name: ` E+ry l � cam` - Feel piping
514.15 for that four; $4.03 for each additional
Address: Furnace, etc.
City/State/ZIP: Grai heat pump
WalVsimperdedAmit heater
Phone: ( )
I Fax: :7-7-------
( ) Water heater
•
E-mail: — - Fireplace
: C G!OR . Rarbeace
Business name: C - Clothes dryer (gas)
Other
Address: R t/ ^d
City /StatcJZIP: N u �+ r�r Q C� 'r A %.rito.tr k � : .: : .
" 1�`. ( �' ! `�ro S - ( 46. 7 5
Phonc: ( 5 3 3._ lJ Fax: (3 54/3 r 85 Minimum permit fee (590.00) 1 go. Q..)
CCB lie.: `!� 7 7 I review (25% of permit fee)
Crate surcharge (12%ofpotmit fee) /Q, $'O
i,i / r /
TOTAL PERMIT FEE ark 3
a �t This permit appl entieo ex Wu
t�rtl e d not obtained within 180
Authorized signature: A((1 IL days after if has been ace ceptepre d e. complete.
" 7, a • ■1t I Date: `/ /e7 • Fee methodology set by Tri -County Braiding Indmdry Service Board
metraRingerem,iceta c- remlimpaAste 10/01 A19
M04e17r (1 IK/UCOM/WL7B)