Permit ' CITY OF TIGARD MECHANICAL PERMIT
I '' a COMMUNITY DEVELOPMENT Permit #: MEC2010 00196
TIGARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2010
Parcel: 1S134DC09500
Jurisdiction: Tigard
Site address: 11558 SW TWIN PARK PL
Subdivision: TIGARD PARK Lot: 11
Project: Sheeler
Project Description: Replace furnace.
Owner: FEES
SHEELER, CHARLES Description Date Amount
11558 SW TWIN PARK PL Furnaces < 100K BTU 04/30/2010 $46.75
TIGARD, OR 97223
12% State Surcharge - Mechanical 04/30/2010 $10.80
PHONE: 503-598-0510 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:
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: 7 I ; - Permittee Signature: Q� � e,./C9-/"7d/i
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.
Apr 29 10 09:11a Columbia Heating /Cooling 503 -598 -0270 p,2
Mechanical Permit Application_ � k �-olt LIII � ti r - °
"'` "� City of Tigard °R ECEIi1ED Rceived
e t r .t
x : : y Dated l i�d/ 6 o/4 -60/ 9'
Fly It `, a 13125 SW Hall Blvd., - I igard, OR 9 7223 Plan Row • Other Permit: {' y l � Phone 503.fi39.-l171 Fax: 503.5%.1960 APR 2 9 2 010 Date/Ey:
�A•sr '. i ns eetien I,inv 303.039.4175 Dale R hu 5 to f Sge 2 for
7 1G A R t) p � � Sec Sa Icmcnral Information
c �.s�h Inle:nel: www.tigard -or.Env CITY OF TIGARD NOtifie!/Metttod: , pp
TYPL: O F R D ON -. COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit ices* are based on the value of the work
❑ New construction Eddit /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
E Demalitirm ❑ Uther: mechanical materials, equipment, labor, overhead. and prnlit,
Value: $
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
I - t and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special Enforrna%ion use cheekiest.
❑ Multi- farnil■• ❑ Master builder ❑ Other: Description i, Qty. I -:a. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
//5' �� I Jt �� �K �� Air conditioning
Soh site address: (requires site plan showing placement) 46.75
City/Slate/ZIP: 7— l (.5A/2. 0 Furnace 100.000 BTU(ductsrvems) 46.75
' Furnace 100,000+ BTU (ducts vents) 5 -91
Suitc/bIdg.apt. no.: I Project name: Heal pump _ 61.06
Duct work 2 3 32
Cross streeVdirections 10 job sites 2.
Hydronic hot water system 23.32
Residential boiler (radiator or
y'dronier 23.32
Unit heaters (filet -type, not electric).
in -wall. in -duct, suspended, etc. _46.75
Flue /vent for any of above '23.32
Suhdivision: lot no.: Other: 23.32
Tax map /parcel no.: Other fuel appliances '
DESCRIPTION OF WORK. Water heater 23 3 _
Gas fireplace 33 39
hi 2 /LA 6- C HI N CI C "VfI9.- Flue vent for water heater or gas
• fireplace 23.32
Log lighter (gas) , 23.32
Wood/pe1et stove 3339
Wood fireplace/insert 23.32
Chimney /liner /flue/vent 73.32
[— OPERTY OWNER 0 TENANT Other: 23.32
Name: C HA 2 c- J SN£ Environmental exhaust and ventilation
/ � Range hood /other kitchen
I /�j if 5'C J ( G -rr/�/ ��e`f Pt- . equipment 33.39
Clothes dryer exhaust 23.39
C'it!Slatc 7.1P: i 6 '& -.o I Single -duct exhaust (bathrooms,
Phone: (503) 6" - £7f10 Fax: ( ) toilet compartments, uti{ity rooms) _ 23.32
El APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 2 3.3 32
Other: 23.32
Business name: Fuel piping
M / 814.15 for first four; 54.03 for each additional
Contact name / / I/� Y /... �� e�°( / (�m
Furnace, etc.
Address: Gas heat pump
' Citv,rStatc /'LIP• , Wall /suspended/unit heater
PI (OM 3) (p a4L' a70 4 Fax: : 9 a ( EE5 .n L7O ` V heater
Fireplace
[ -mail: Ran tc
CONTRACTOR
Barbecue
Clothes dryer gas)
Business name: / „. �. . .. Cr Other:
_ i .. 1/ r ,..'� �
Adorc:ss:9 _ MECHANICAL PERMIT FEES*
I �
Cll ll): 7 7 ^y g Subtot G�
lc7( } CD r 1r77
Q � j Minimum pc:rr,it fcc ($9000
one: ) �� p2� Fes ��() ` �ot ! v Plan review (25% of permit fee) G
C B tic.: State surcharge (12`!-0 of permit fee) /0 r U d
7(�-q TOTAL PERMIT FEE /CD . 10
This permit application expires if a permit is not obtained a.ithin JCt '
Authorized sigtalurt j ` 2 // jug days after it has been accepted ea complete.
l} / n y )^ i D ate: 1 ' pee methodolog set by To-County 13ui1dir.g industry Service Board
Print name: (!�J a
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