Permit •
4 ' `
r ' CITY OF TIGARD MECHANICAL PERMIT
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;. COMMUNITY DEVELOPMENT Permit #: MEC2010 -00199
A ' Date Issued: 04/30/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
-_..w,.4 Parcel: 1S134AD02900 •
Jurisdiction: Tigard
Site address: 10820 SW BLACK DIAMOND WAY
:::
Subdivision: BLACK BULL PARK Lot: 17
Project: Luther
Project Description: Replace gas furnace
Owner: FEES
LUTHER, LINDA L Description Date Amount • •
10820 SW BLACK DIAMOND WAY
TIGARD, OR 97223 Furnaces < 100K BTU 04/30/2010 $46.75
12% State Surcharge - Mechanical 04/30/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 04/30/2010 $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: fIs rL..) Permittee Signature: OA ilt sl pp t T C Ar te' c J /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. il!
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.
Apr 29 10 01:55p Columbia Heating /Cooling 503 -598 -0270 p.2
_
'�,% � FO ICEIUSE t � 0 ! J
Mechanical Permit ApPIicatiO CEIVED .
Re crvod Permit No.: `. 2( 10 —CV 1 i y
q City of Tigard oaten
13125 SW Hall Blvd. - TigaM, OR 97223 APR 2 9 ` i Plan Ret'iex
n Other Pennn:
4 t Phone: 503.039 4171 Fax: 503.598.1960 Dace
r'''''''"*" * ' Inspection Line: 503.639.4175 C ITY OF TIGARD Date fteadv By: 1 i //�® Sec Page 2. for
eTdGAhD■ Nctitied•Tlethod: V Supplemental Information
F Internet; www.tigard-or.gov BUILDING DIVISION
- OMMERCIAL FEE* SCHEDULE — USE CHECKLIST
TYPE 03+'.:NrORh . . �.
Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alterati /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equipment, labor, overhead. and profit. ,
. CATEGORY OF CONSTRUCTION
Value: $
RESIDENTIAL EQUIPMENT! SYSTEMS FEES"
1- and 2- family dwelling ❑ Commercial'industrial D Accessory building F specral vformafict use check! fsf
❑ Multi - family ❑ Master builder ❑ Other: Description j Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION . Heating/cooling _ .
l 0 8 -0 5-w et ^C K 01,4 .10 ul � A irconditioning 46.75
Sob site address: / 1 '" , ,rcyunes site plan showing Placement)
- Furnace 100,000 BTU lducts/ cnts) 46.75 -
City +Stoic /ZIP: l ���
Furnace 100.000+ BTU Iductsnems) 54.91
Suitelbidg.!apt. no.: I Project name: )'NO' I,u't4 EIe _Heat pump 61,06
Cross street/direction to job site:
Duct worn 23.32
Hydronic hot water system 23.3
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: I Lot no.: Other: 23.32
Tax map /parcel no.: Other fuel appliances ,
• . Water heater 23.32
DESCRIPTION OF WORK Gas fireplace _ 33.39
fU 2tkcE- H A!`'G E ` Dui. Flue vent for water heater or gas
fireplace 23.32 _
Log lighter (gas) 23.32
Woodrpellet stove 33.39
Wood ftreplace/inscrt 23.32
Chimley;l iner!fluc(vent 23.32
® PROPERTY OWNER . 1 0 TENANT Other: 23.32 _
Name:
k Ett ' Environmental exhaust and ventilation
t NDA Range hood /other kitchen
Address: / O e( r 'c,) LACK OfANio, LA) y• equipment . 33.39
Clothes dryer a>;haust 3339
City/State/ZIP: ` 6-A (60 Single -duct exhaust (bathrooms -
Phone: (11) 3) O 3-I p " 1 C� I Fax: ( ) toilet compartments, utility rooms) 23,32
Atuc/crawlspace fans 23.32
® APPLICANT ❑ PERSON 23.32
_Otite ,
Business name: COLUMBIA HEATING AM) COOLING Fuel piping
514.15 for first four; S4.03 for each additional
Contact name: MA RLENA
Furnace. etc.
Address: PO BOX 230397 Gas heat pump _ _
CitytState'ZIP: TIGARD OR 97281 Wa11/suspendediunit heater
Water heater
Phone: (503) 624 - 2704 Fax: : (503) 598-0270
Fireplace
E -mail: COLUM BHC a!TELEPORT.CON1 Ran e
CONTRACTOR Barbecue .
Clothes dryer (gas)
Business name: COLUMBIA HEATING AND COOLING Other:
Address: PO BOX 230397 MECHANICAL PERMIT FEES*
Subtotal
CityStatc /ZIP: TIGARD OR 97281 Minimum permit fee ($90.00)
P one: (503) 624_2704 Fax: (503) 598 - 0270 plan review (25% of permit tie)
State surcharge (12% of permit feel
CCB tic.: 76359 TOTAL PERM FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
��/ _ / /1 • ' Fec methodology set by Tn- Countq Building industry Sc� 1ce. Board
Print name: MARLENA 111EEDOI�1 Date: ! ° / V
. 440-46177 (1 1 !nLCOhbWF. n7