Permit ! �-. CITY OF TIGARD MECHANICAL PERMIT
` 1111 ,
- COMMUNITY DEVELOPMENT Permit #: MEC2009 -00682
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/24/2009
T1 G ARD 9 Parcel: 2S 103AA03400
Jurisdiction: Tigard
Site address: 10470 SW CLYDESDALE PL
Subdivision: Lot: 0
Project: Nicoli
Project Description: Install gas furnace.
Owner: FEES
NICOLI, EDNA Description Date Amount
10470 SW CLYDESDALE PL Furnaces < 100K BTU 12/24/2009 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 12/24/2009 $10.80
PHONE: 503 - 639 -7432 Minimum Fee Adjustment - Mechanical 12/24/2009 $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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ('" / Permittee Signature: aAf if7 , Cif �O ///
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.
32/23/2009 16:17 5035436285 PAGE 03
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Mechanical Permit Applicati4ECEIVED I i )It OI f FI t: l Sr. 0\1.1
i . City of Tigard Receives i�I
• P3125 SW Hall Blvd., Tigard. OR 97223 2 p i)steBy, /,, ?3 ei i Permit No �Caoo .e ,......A0 4op�
' 111 ' Phone; 503.639.4171 Fax: 503.598,1960 D E C 2 3 ZOO9 Plan Review
I I i ,s, - 1;1) inspection Line: 503.639A175 DatcBY. other Remit:
Internet; www.tigard-n,gov CITY OF TIGARD Date Ready/Av. /Uri • ®Sec Page] for
BUILDING DIVISION Notified/Me 6.-- Supplemental information
TYPE: op ' 1 001tk
Q . . ( ' Additian /alteration /rcplacement permit fees' am tie t1 the vA(t of the work
New construction Meehan i
Q Demolition Performed. indicate the value (handed to the nearest dollar) of all
Othe mechanical materials, equipment, labor. overhead, and profit.
CAICEG(�1R7t Z'G'�Itt1 Value: $
1 - and 2- family dwelling ❑Commercial /industrial Q Accessory building JCE i t Wit'
For special information use checklist.
Q Multi - family ❑ Master builder
❑ Other:
i OR s Pint .6.1`rOOV ,ANIr.LOCATI G
Description Qty. Ea. , Total • , . Heating/cooling •
Job site address: 1��7 /tJ 5j) �-Z G Air conditioning
(spires site plan showineolaccmenl) 46,75
City/State./Z11. c �''� X3 Furnace i00,000 ATTJ (ducts/rcnta) / 46.75 1 16 75
Suitcdbldg. /apt. no.: Project name: Furnace 100,000+ BTU (dues wc„ta) 54.41
Heat pump 61.06
Cross street/directions to job site: Duct work 2332
14ydr mic hot water system 23.32
Residential boiler (radiator or
hydronic) 2332
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/von for any of above 23.32
Other; 1 23.32
Tax map/parcel Other fuel appliances
.ST CAS
f3 St T1i(1lYP' iblit'l�f i Watenc�atcr
i • 23.32
/1 / / Cj� yl) r? Gas fireplace 33.39
1�"� -�— !'I t1t -'- Flue vent for water heater or gas
fireplace 23.32
Log lighter (pus) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
rte! 11 tfI"P' Chimney/liner /flue/vent 23 -32
b+�e` o • TENAl r.' - ' . . Other 23.32
Name: ( 6 /uQ /UZCOLZ Environmental exhaust and ventilation
Addr 1( -S J ^ )/� 5� ' p/ - Range hood /other kitchen
City /State /71P: 77674 � s equipment 33.39
. ro a . g7�a3 w Clothes dryer exhaust 33.39
� fiJ f � — Single -duct exhaust (bathmnms,
Phone: ( Fax: ( ) toilet oompartmems. utility rooms 23.32
d cotmci' `>� • Attic/crawlspace Etna 23.32
Business name: s9 .._ _ 5 7 7 �,P Other J 23.32
Fuel piping
Contact panne: $14,15 for first four; $4.03 for each additional
Address: Furnace. etc.
(i. ss heatpump
City /5tatc/71P: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) water heater
E -mail - Fireplace
ill Rangc
Business names fF 127 Clothes dot cr (gas)
Address: �C� Z173" �1 `�'
City /Statc/Z1P: 9 Q1) • , p _
L Subtotal +/G„ 7S
Phone: ( � � 7 Fes; ( � / '� / Minimum permit tee ($90.00) 40, pd
.PJ Ala D Plan review (25% oFpermit fee)
CCB lic.: .)/q/./ 7 ,� — State surcharge (12% b of permit fcc) . ' C)
! 1 TOTAL PERMIT FEE 1 , `60 iv
sigtlalure: I 1 'thin permit appricadon etpiret if a pariah it not obtained within i110
r J days after It hen been accepted at complete.
Prin na me: �� A ,! ►^7 _ � 3_
L-4:411 Date: Q • Fro methodology sal Fry Tri- County Building induerry Service Board
I:1 BuildirsVk rmitfiMMEC•pmnilApp.doc 1Winioe 440- 46177(I11ovtoM/Woa)