Permit TM �� CITY OF TIGARD MECHANICAL PERMIT
-'' 2 COMMUNITY DEVELOPMENT Permit #: MEC2010 -00131
Date Issued: 03/31/2010
:T1G'ARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111ACO5100
Jurisdiction: Tigard
Site address: 14800 SW 92ND AVE
Subdivision: LAUNALYNDA PARK Lot: 19
Project: Hartman
Project Description: Replace gas furnace
Owner: FEES
HARTMAN, DAVID Description Date Amount
14800 SW 92ND AVE Furnaces < 100K BTU 03/31/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 03/31/2010 $10.80
PHONE: 503 - 807 -4492 Minimum Fee Adjustment - Mechanical 03/31/2010 $43.25
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97281
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: ,e4Y4 t Permittee Signature: /f / ,D1 / C.4?—/
/a /
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.
Ilit,a‘lit'Til ,� • nieal Permit Application � r ,,,, a , tt a ye ,, . , ,U1 � F \ r; , , 1�eC�l a ,, • r r ; Clt} of Tigard a . Date/B �/3/ /0 49-V— Permit Nn.,yt�Ca26 / 0 ' d 0 /3', ' C 13125 SW Hall B!vd., Tigard, OR 97223 P lan Revie(
Other Pcrmir.
' - j Phone: 343 639 4171 Fax' 503.598.1960 60 MAR 2 9 201 i Date/By.:
iT] Gi� d Inspection Line: 503,639.41 75 1 g D atc Rc�Cy;' ly° •t 'i+ BI Sec Page Z for
ttsrR ris aer' lnternel. tt'ltl+'.tigard- ot.gov CI p° � 0 l( --iAR I Notit"itseimcthrnri I � , Supplemental lnfcnnatien
BUILDINIC 1, Jr r
TYPE OF WORK I COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees` arc lased on the value ofthc work
❑ New construction ❑ Additionialleraiion /replacement performed. indicate the value (rounded to the nearest daa art gran
❑ IDcrr. iaion ❑ Other mechanical materials, equipment. Tabor, overhead. and nrofn.
CATEGORY OF CONSTRUCTION value:
L RESIDENTIAL EQUIPMENT /SYSTEMS FEES* 1
❑ I- and 2- Family dwelling ❑ Commercial /industrial ❑ Accessory building --- --
Fos special:nforma :roe use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. � Pa. Total —
JOB SITE INFORMATION AND LOCATION Heating/cooling
.l h sit:: address: l 0 W 0 5 ` , eel Air conditioning
(requires site plan shewinp placement) 1 1 36.75
C'it /Stalci /.I Furnace l
: Furnace 100,000 BTU !ducts'vews) / I 46.
Furnace 100,000+ BTU (teucts;sents) 1 54.91
Suite/bldglapt. no.: Proi.ect name: Heatpum: I 61.06
Cross strcct/dircctions to job site: Duct work 23.32
Hydronic hot water system 1 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct suspended. etc. 46.75
Flue /vent for any of above 23.32
Subdivision, Lot no.:
Other: 21l.32 _
Tzx map /parcel n:.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32 .
Gas fireplace 23.39 .
/ ` .0 .• • `. Flue vent for water healer or gas
— — Fireplace 23.32
— Log lighter (gas) 1 2±.32
W'ood/pellc( stove 33.39
Wood fireplace/insert 23 32
Cltimncyilincrlflueivent 23.32
❑ PROPERTY OWNER ❑ TENANT Other. 23.32
Name: 2)/9 V/ Ay i y ' Environmental exhaust and ventilation
Range hood /other kitchen
Address: J 7 • equipment 33.39 ,
City /State/7.1P: : Clothes dryer exhaust 33.35
Single -duct exhaust (bathrooms,
Phone: lSt 4e . 7 - ,9',..2 Fax: ( ) toilet compartments, utility moms) _ 23.32 i
❑ APPLICANT ❑ CONTACT PERSON Atticicrawlspace fans 23.32
Other: 23 32
Business name: Fuel tin
PP g _
Contact name: 7 YQ /' / /? J ePd b7r $14 -15 for first four; 54.03 for each additional
Furnace, etc.
A d:'. rzss :
Gas heat pump
City /StatciZIP: Wallisuspendedlunit heater
7 ,rte —7
Water
Phone: ( 3) ( ,f..• c 7QC/ Fax: y �9 t, -lJJ / 0 A ater heater
Q Q1 Fireplace -_
E -mail: Range i 1
CONTRACTOR Barbecue I
Clothes drver (gas)
Business name- 1 ..x O I - all♦ • C. Other: _ _ 1 ____ - _
Address: 1 MECHANICAL PERMIT FEES*
City /Statc/71P: fC� / , O T7C3 Subtotal _
7� J ` I L� .' M i nimum permit fc (590,00) 90 , c _
: Phone:6 a7 ['ax: `� 6 _ O� (� Plan review (25 % of permit eel
CCBliC: Xi Q . - State surcharge (12% of permit Feu) /0.
'` ` � I TOTAL PERMIT f ET teM , 4
Thia permit application expires if a permit is not obtained within ISO
Authorized signatur 4 2 , ,, days atter it has been accepted ma complete
Print name_/ i-10 e � Date: 7 Z4 ( i t, • rec mcthodoloo .d by Tri -Ccun y 13nadin� Iti lusti y Scrvicc Board / r
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