Permit l 'Q.4 , ;v , . CITY OF TIGARD MECHANICAL PERMIT
i; c :, COMMUNITY DEVELOPMENT Permit #: MEC2010 -00210
'i Date Issued: 05/0512010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: ,-- S112CA02400
Jurisdiction: Tigard
Site address: 15220 SW GENTLE WOODS CT
Subdivision: GENTLE WOODS Lot: 16
Project: Shelley
Project Description: Replace furnace, heat pump and water heater. Unit must meet 3' minimum rear and side yard
setbacks.
Owner: FEES
SHELLEY, MARY M Description Date Amount
15220 SW GENTLE WOODS CT Fumaces < 100K BTU 05/05/2010 $46.75
TIGARD, OR 97224
Heat Pump 05/05/2010 $61.06
PHONE: 503 - 684 -9898 Water Heater 05/05/2010 $23.32
12% State Surcharge - Mechanical 05/05/2010 $15.74
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 $146.87
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 calling 503.246.6699 or 1.800.332.2344.
Issued By:
�������yyyy — '_, , P ermittee Signature: (TA/- �/l'/ G / ( .N.."
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.
May 0410 10:19a Columbia Heating /Cooling 503 -598 -0270 p.2
Mechanical Permit Applicatio ��" �.� � ; ' F all l f i' r • •4a
�. it p�y /t�C, / /�
f q��r "� City ofTigara �1LYJ Received � � D PemtitNo/ 1 4 ,� ��^� � U
q 13125 SW [tall Blvd, Tigard, OR 97223 / �L'J� /
Z Q � Q PfanRcvcw
.4 e -_ Phone: 503.639.4171 Fax: 503.598.1960 MAY — 4 p Other Permit:
II
Inspection Line. 503.639.4175 Date Reaev /t3 A� .s. S Page 2 for
T[GAAiD 9: M C
.- _ Internet tiww.figard- or.gov CITY OF TIGARD Notified Method: ) lei' Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ ?Jew construction �Addi €ion /alteration /replacement Mechanical permit fees' are hosed on the value of the cork
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, tabor, overhead. and profit.
CATEGORY OF CONSTRUCTION • • Value: S
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
R 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special Information use checklisi.
❑ Multi-family El Master builder ❑ Other: Description Qty. I 1:a Total
JOB SITE [INFORMATION AND LOCATION Heati ng/cooling
� / Air conditioning
Job site address: {")� 7`i✓ �, tt rc u'res site ]an showing placement) 46.75
l, f `� woo Di, ( 4 P F P ) _
Furnace 100,000 BTU (duets/vet:s) i 46.75
City!Stalc /7.IP:
- OA_ 97ZL y Furnace 100.D00+ BTU (duc,s'vents) 54.91
Sui.tc.'bldgJapt. no.: Project name: Heat pu`3 4 61.06
Cross sr to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hvdronicl 23.32 _
Unit heaters (fuel -typc, not electric).
in -wall. in -duct, suspended, etc. 46.75
subdivision: Lot no.: Fluefvent for any of above l 23.32
Other '• 23.32
Tax map /parcel no.: Other fuel appliances
DESCFUP ION OF WORK Water heater , 1 23.32
Gas fireplace 1 33.39
Att_,/_tr,t `' / !Q • Flue cent for water heater or gas
Il r ✓ fireplace 23.32 •
Log lighter (gas) 23.32 •
Wood /pellet stove .33.39
Wood fireplace/insert 23.32
Chimney/liner /flue/vent 23.32
❑ PROPERTY OWNER ❑ TENANT Other: 23.32
ti'amc: `4lf� ,-! Environmental exhaust and ventilation
Address: Range hood/other kitchen
2 SI lie gvvX -Ar equipment 33,39
—. Clothes dryer exhaust 3339
CIIt'r5lalc/ZIP: 1 /�, 4-c--�� �� 5 `").2
! Single -duct exhaust (bathrooms. i I
Phone. ( ) Fax: ( ) toilet compartments, utility rooms) i ! 23.32
AM c /crawls ace fans 23.32 I
❑ APPLICANT ❑CONTACT PERSON p i --
Other: 23.32
Business name: Fuel tin
P g
Contact name: ', ee 514.15 for first four; 54.03 for each additional
Furnace, etc.
Address. • Gas heat pump
Ciiy!Statei7IP: WalVsuspendcd/unit heater
Phone: E )3) ( a 7G4- { Fax ::66 57 8 -b .7O Water heater
Fireplace
I. -mail: • Range T _
CONTRACTOR Barbecue
I Clothes dryer (gas)
Business name: a _ . ,, .4_ Al .i M�� A • _ ..2, 4,.._
Other:
Address:1_ 0 x r�2,�(v.i C� 7 MECHANICAL PERMIT FEES'
City /StaterZIP: % / 9 0 0 _ 7 _ ! Subtotal I3/ , /_J
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�� Minimum permit fee (S90.0C)
Pho e: / tl ) l _Q.:7 Fax: w� NSF — Ota7-0 Plan review (25% of penult fee)
CB 11c.. '76 e1 ✓ 1 State surcharge ((2 %ofpermit fee) /5
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PERMIT FEE /C/ ,
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This Permit application after expires if a permit is net obtained within IAB
Authorized s nature: d l .f da s after ft t has been accepted red a' corn fete.
Print name -i (��,0 - ant) Date: st� f) ` ' Fee methodology set by Tri- County Building industry Service Bnnr
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