Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00689
Date Issued: 12/29/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111DC14400
Jurisdiction: Tigard
Site address: 9145 SW DURHAM RD
Subdivision: Lot: 0
Project: Blakely
Project Description: Replace gas furnace.
Owner: FEES
BLAKELY, CATHY Description Date Amount
9145 SW DURHAM RD
TIGARD, OR 97224 Furnaces < 100K BTU 12/29/2009 $46.75
12% State Surcharge - Mechanical 12/29/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 12/29/2009 $43.25
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: 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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ZE 9 94,4)--Le_ . Permittee Signature: o 4-70/3 G /e —j.7-70,-k/
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.
Dec,8 09 11:38a Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit ApplicatioE r ( } } yy �_� e
C�IU .} f)l I .* tit ,w f , -. • City Received
ty or Tigar Received 3' • - y t)atdU � O Permit No �
a 1 3 t 25 .S W f i a t ! Blvd., Tigard, OR 97223 DEC 2 2009 / 9/ �C°��� r ,/� ���
-
' - ��� Phone: 5.03.639.4171 Fax: 503.59A.i9 9 °IanRcvic�w'
Ti /B : Oche Pe� nnil:
cellos : ina: 503.619.4 175 v OF Elite R - I
rT1i'G'r\ R'IJ ns D p 1 r rrG� Y
nlc El See Page 1 for
met: wu�,.tiRarJ�rr.guv P� � RD No �l
l� N�i G - Supplemental Information
TYPE OF WORK tY tV . COMMERCIAL Fn. SCHEDULE - USE CHECKLIST
1 71 New c�rsinlct 4 , lyd ition /alteration /replacement Mechanic l permit feet' arc based on the value of he work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ !)cIn IitiOn ❑ Olh r: mechanical materials, equipment labor, overhead, and profit.
CATEGORY O F -CONSTRUCTION . • Value: $
,�,/ 1 - 2 - family dwelling • RESIDENTIAL EQUIPMENT! SYSTEMS FEES*
PJ g Q Comrt:crcial /industrial ❑ Accessory building
For special in;orniairon we checkii.v.
❑ N I':iti- Tamil ❑ Master builder ❑ Other:
Description -
Qty 1 lia. 1 Mini i
JOB SITE INFORMATION :AND LOCATION HeatinWcoolir�
/ 1 Jam' � c � f f d r c conditioning
:oh site address: / "-� J`r['p`JJ` �
(q rcmres site plan sLow•ing placetnent) 46.75
Ci:v':'State /7.1P: 77 g fj t �.'7' � OP_ Furnace IOfl,000 BTU (ductsvens) 1 46.75
Sui :e %apt no 7 V�� L 1rroject name: (�� Furnace 100,000- 3T J (ducttiv:nts) 54,91
I_____ Z.t / Q k v Heat pump 61.06
( ctrcc. directi ors to lob site: Duct work I 23,32 `
Hvdronic hot water system 23.32
Residential boiler (radtator or
hydronic) ; 23.32
Unit heaters (fuel -type, not electric), •
in -wall, in -duct, suspended, etc. 46.75
Si'.bdi isms: Lot no.: •
FL .le /vent for ary of above 23.32 1
Other: • 23.32
Tax map/parcel no.: Other fuel a t tliances
DESCRIPTION OF WORK Water heater r 23.32
,�, , L Gas fireplace 33.39
(J(�/ cf..S_cl.k)finaCQ Flue vent for water heater or gas
fireplace 21.32
Log lighter (gas) 23.32
— Wood/pellet stcve 33.39 - _
Wood nreplace!inscrt j 23.32
1 4, PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other 23 32
I Name: Environmental exhaust and vcnrilation
�� Range hood /o her kitchen
Address: : lipp*or :—....a 41 �., L. equipment 33.39
C i :s,''Statei7 di OR, Clothes dryer exhaust — 33.39
Single-duo exhaust (bathrooms.
Phone: I. 1 4 Fax: ( ) toilet compartments, utility rooms't 1 23.32
❑ APPLICANT . ❑ CONTACT PERSON Attic /crawlspace fans 23.32
1 Rosiness name: Other: 23.32 ! J
Fuel piping J
Con 13cl name: /7-210 k' Ara /2� / ee da n $14.15 for first four, 54.03 f or each additional r / Furnace. etc. J
. ^)dclruss: --
Gas heat pump
1 C'itylStatei7.IP: Wall/sustcndcd/unitheater i
Water heater
)nnc: ( ' . 7)4 c7+0 / I Fax: :5 3 3 - OQ7C Fire dace
Ran I.
CONTRACTOR . . • : Barbecue
/ Clothes dryer (gas)
Ru >incss name: 1m��1t -r t�s j+•� � t ,� f (��/ ��
Other: I r
Address: O Fes" J 'y W� 9 .7 ` � `r °; ° f� � �J MECHANICAL PERMTT'FEES".
itviState /7.1P': f ^^ I '��J O I � 9\7c� f Subtotal
i 1
Phase: 5 ) r �7 1� ` Fax: ( I JQ _ p0 Minimum permit fee (590.0) 9 ,
D t r i L.59 o d '1--J
Plan review (25% of permit fee)
CCfi tic.. '7(n v State surcharge (12% of permit fee) /Q ./--6 i--
TOTAL PERMIT FEE , /Q() ,AO v
`, ./ `� �'� This permit application expires if a permit is nn: o stained within I8D
Authcr.zed si atur :
days sfter it has been accepted as complete.
Print name_ /r /P. n , - i 67-7) Date: / • Fee rr cdmdoloE.-r set by "In- County Builrii l industry Service Board
J.iIdin rcrnitoMEC- PcrnaApp.do: IC.'O I,e9 dnat6l {I IfO2 COtuAVEB)