Permit
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2009-00363
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
Parcel: 1 S134DB11500
Jurisdiction: Tigard
Site address: 11000 SW BRENDEN LN
Subdivision: DAKOTA GLEN Lot: 17
Project: Olsen
Project Description: Install A/C Must maintain a 3' rear and side yard setback
Owner: FEES
SCRIVNER, RACHEAL & Description Date Amount
OLSON, JOSHUA, 11000 SW BRENDEN LN Air Conditioning or Heat Pump 07/21/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 07/21/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 07/21/2009 $58.50
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97223
PHONE: 503-624-2704
FAX: 503-598-0270
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:~ PermitteeSignature: 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.
, ,Ju %ZG'09 04:14p Columbia Heating /Coolin 503 -598 -0270 • p,2
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�,u Ywai l� JUL 2 0 2009 tB� PermitNo. t, Dq - 3 4 , 3
k { , , ,i City of Tigard aateive'
IK 13125 SR! Hall Blvd., Tigard, OR 9,72 Plan Review
■ O Perrnir.
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� a i ,, Phone' 503.639 4171 Fax 03.59S.1960 CITY OF TIGAR E Date/B y `
I1a1Jar� ^�� ` Inspec.UOn Line: 503.639.4175 0 n , r � �+ ( ��e Izcady - .,,is.: 0 Set Pagea for
1Tk1GAItD1 BUIL®ING DIVISI l' Iirotified/Method L Supplemental for
ormatioo
ti�vaa��u��rll�a Internet: www.tigsrtl- oY;go�
TYPE OE WORK CON '1 RCEAE_ FEE* SCHEDULE — USE CHECKLIST
Mcchan permit fees* are based on the value of the work
0 New conStruetion Addition/alteration/replacement ' perform d. Indicate the value (rounded to the nearest dollar) of all
Other: mechani al materials, equipment, labor, overhead, and profit.
9 Demolition Other: $ •
CATEGORY OF CONSTRUCTION . : SIDE��L EQ SYSTEMS FEES`
1 - and 2- family dwelling ❑ Cornmercial!industrial ❑ Accessory building For special information use checklist.
El Multi- family ❑ -
Vi
asterbuilder 9 Other: Descripi 1 Qty.- 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heatin: cooling
,� /11 Air con itioning or heat pump / ,
1 i 14.00 � .
Job site iaddfeSS (requires .rte plan allowing placement)
��- F 100 BTU (duets/vents) 14.00
City /State/ZIP: ► i v p2. F 100,000+ BTU (ducts/vents) 17.90
Project name: as .., pump 14.00
Suite/bldg./apt. no.: 1 G h
1
Duct w�� rk 14.00
Cross street/directions to job site: Hydro c hot water system 14.00
Reside dal boiler (radiator or
hydron c) I 14.00
Unit +i erg (fuel -type, not electric),
in -wall in -duct, suspended, etc. 10.00
F1uely. t -for any of above 10.00 I i
Lot no.: Other. 10.00 •
Subdivision:
Other uelariliances
Tax map /parcel no.: Water: eater 10.00
DESCRIPTION OF WORK Gas fi ilacc 10.00
Flue v nt for water heater or gas
firepl. re 10.00
Le :li; ter :as 10.00
Woo. pelletstove 10.00
Wood fireplace/insert 10.00
Chi �. ey4iner /flue/vent 10.00
❑ PROPERTY OWNER 1 ❑ TENANT Gibe J 10.00
Envi ■ nmcntal exhaust and ventilation
Name: - Rang ,hood/other kitchen 1
r
Address: I, 0 : ` . � 4 _ 70 ® ji el equip ant 10.00 exhaust 10.00
Cloth: s dryer ex
CitylStatelZlP: Singl -duct exhaust (bathrooms,
toilet compartments, utility rooms) _ 6.80
Phone: Fax: ( )
❑' CONTACT PERSON Atti crawlspace fans
10.00
❑ APPLICANT Oth : 1 i 10.00
Business name:• Fuel piping
/ '— — $5:40 for first four; $1_O0 for each i dditioual
Contact name. ...tai-,A., �j Fun: e, etc. .
Address: Gas eat pump
War suspended/unit heater
CitylStatelZlP: Witt r heater •
Phone: cb3 ) 7 4 2. � I Fax :: 63),..c--8'-- 6 7 Fire lace
Bane ,
E Bari ecuc
CONTRACTOR
Clo . lo es dryer (gas)
Business name: (� ) ( % �' / C J (.2,-0, ``'- 0 r
() MECHANICAL PERMIT SEES`
Address: �� % p X „2.3 � 3 9 —7 •
Subtotal
City /Stete'Z1P: ” / / d , .e ,Q, 1 7 `�/ Minimum permit fee ($72.10)
�n 1 .i Li — 7) t/ Fax: ( ) S c 0:.)- P lan review (25 %of permit fee)
Phone: (� v ,. t� ./
State surcharge (12% of permit fee)
CCB lie.: r
J TOTAL.PERIIIIT FEE Jl
1 TI is permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• a ri se ssignature: signature: Date: 7 • 4, Fee methodology set by Tri County Building Industry Service Bout
Print
Print name: il _r . a _)®
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