Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: MEC2010 -00105
T ['GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/11/2010
Parcel: 1 S 133AC09300
Jurisdiction: Tigard
Site address: 10825 SW 130TH AVE
Subdivision: HAWK'S BEARD TOWNHOMES Lot: 11
Project: Potts
Project Description: Install a /c.
Owner: FEES
POTTS, JEFFERSON & NANCY Description Date Amount
10825 SW 130TH AVE Air Conditioning 03/11/2010 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 03/11/2010 $10.80
PHONE: 503 - 475 -9314 Minimum Fee Adjustment - Mechanical 03/11/2010 $43.25
Contractor:
COLUMBIA NW HEATING
PO BOX 622
SCAPPOOSE, OR 97056
PHONE: 503 - 543 -3624
FAX: (503) 543 -6285
Type of Use: SFA
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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: di% I \ 1 ' L) Permittee Signature: Q Op
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.
03/11/2010 10:17 5035436285 PAGE 02
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Mechanical Permit App#icatio q 9 r i q y c R 4 e':. 1 ,,, :, I' (1 }1„. { 1,' �� , I (I),. j,,,,„ ' 4 .. ,
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a 13125 SW Hal1 Blvd, Tigard, OR 97223 Ptao 1(eviow Other Permit
L Phone: 503.639.4171 Fate 503.591T.1960MAR 1' 1 2013 tare
x {< %.e Inspection Line: 503.639.4175 y /B Y ® SCE Page 2 tnr
Re d Inter Inspection
www.tigard- or_gov CITY OF TIGARD NotlRod/Method: \ supptementat Information
PutaiNG DJVISiOr1_
TYPE OF WORK COM111gRCIAL FEE* SCHEDULE .- USE CHECKLIST
❑ Ncw construction 'Addition/alteration/replacemtut
Mechanical Indicate fees' are based de the value of the work
performed_ Indicate dte value (rounded to the nearest dollar) of all
❑ Demolition ❑ Othen mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CVivb 4 RUCTION Value: $ -
.RESIDENTIAL EQUIPMENT / SYSTEMS rEE3`
0 " 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special vfforanvrian use checklist,
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty, 1 Ea_ 1 Total
JOR SITE INItORMATION APO) LOCATION Heating/cooling
IJOb site addrt`53: /pp, Air cflttditianing
S J 13[� ST (regains site plan ahowingplacemcnt) / 44.75 yl ..75
City/State/ZIP: •-7 P r az 4 -7� , FIflh1 a 100,000 BTU (ducts/rems) 46.75 ,
Pomace 100,000+ BTU (doctr/vvnia) 54.91
Suite/bldg./apt no.: oject name_ Heat p 61.06
Cross street/directions to job site: Ductwork 2332
Hydronic hot water system 2332
Residential boiler (radiator or
hydronic) 2332
Unit heaters (fuel -type, not electric),
in-wall, in -dnot, suspended, etc. 46.75
Subdivision: no : Floc/vent for any of above _- 23.32
.. Other. , 23.32
Tax map/parecl no.: Other feel appliances
DESCRIPTION OF WORK Water healer 2132 ,
Gas fireplace 33.39 •
L.,_J ; 6- 'J C ) OZ - '-lFi' Flue vent far water heater or gas . -
fireplace 23.32
Log lighter (gas) 23.32 ,
Woad/pcllet stove 3339
Wood Iirepla nscrt 23.32
tirP[tOPERTY OWNER ❑TENANT. Ot ytl;nerlflue/vent 2332
Other: 23.32
Name: JEF / o tz) d a a NC\I e'7 T$ Environmental exhaust and ventilation
Address: / )�a 5 _50 2e S? equip hoodlother kitchen •
equipment 3339
City /Statc/ZTP: Tz6, a ,),(7 17 • _-7 Clothes dryer exhaust 33.39
Single -duct calmed (irathrooms,
Phone: ( 533) 1 115C' - Q3 /L/ Fax: ( ) toilet compartments, utility moms) 23.32
(, APPLICANT ❑ CONTACT PERSON Attidcrnwtapace fans 23.32
,�/ �JI� p Other: 23.32
t u iness tarns: (� S w! �� �_�u �I�+�L7 Fuel piping _
Contact name: $14.15 for first four; $4.03 for rash additional _
Furnace, etc.
Address=
Gas heat pump .
City/State/ZTP: ' Wal1/stspeeded/unit heater _
Phone: ( ) Fax:: ( ) Water haver
Fireplace
E-mail: Range
CONTRAC'T'OR Barbecue
Business o af C i 1 / 1 +6 il ( 07c717-)6 Clothes dryer (gas)
Other:
Addrecc: ) i6J� MECI#'ANiCAL PERMIT FEES•
City /State fP: / i pp�E � C , 97O �7 6 _ Subtotal a„ 7 5
Phone: ( � ) � - � Fax: ( j3) 5 ' / � Minimum permit fec
(2 perrnIt fee) �O .(10
CCB tic.: c( j 4`T" State surcharge (t 2% of pcnnir.fec) d- $o
TO'T'AL PERMIT FEE f QC}. �O
T rp
his permit plicctinn expires if n permit fin not obtained within 1R0
Autharirxd signature: t da after it has been accepted as compkte
-"i 1 ' j I Print name: G ag 1 Date: 3 //_ /6) • Fee methodology set by Tri -Crnmy ranitding indutlry Service Hoard
tOliildiu tkPennhAPAEGPmmMApp.doc 10101109 440.46171 (11 /021COMM'6a)
03/11/2010 10:17 5035436285 PAGE 03
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JOB #1OP180H
POTTS, JEFFERSON & NANCY
10825 SW 130TH ST OR
Installation Property Information 5O3 - 4475 75, -93311 97223
503 4
PJRECT_LON:
Property Line
Fr: Q
Property Line
(F= FURNACE)
(X= OUTSIDE UNIT) STREET
Columbia NW Heating, Inc,