Permit ir 4' 1; ' CITY OF TIGARD MECHANICAL PERMIT
' ; COMMUNITY DEVELOPMENT Permit #: MEC2010 -00244
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/27/2010
to
Parcel: 1S133DC09700
Jurisdiction: Tigard
Site address: 13165 SW SHORE DR
Subdivision: WINTER LAKE Lot: 25
Project: Sparling
Project Description: Installing A/C.
Owner: FEES
CINDY SPARLING Description Date Amount
13165 SW SHORE DR
TIGARD, OR 97223 Air Conditioning 05/27/2010 $46.75
12% State Surcharge - Mechanical 05/27/2010 $10.80
PHONE: 503 - 747 -5504 Minimum Fee Adjustment - Mechanical 05/27/2010 $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. 1.800. • . .
/ / f
Issued By: �/ � Permittee Signature:
‘ 010r�
Call 1 3.639.4175 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.
4 ' i r " t i iiimp PEKE U SE ONIYR�,gq : ' , g1P
Mechanical Permit Application - -,, : � ai + tgtt4r . , :.. E µ�, rFj2 . ,�t t< „�, � �.,t��� s, if ,t t.
' Illt4` ii, I Re ceived
t� (61 � I I, City of Tigard ' P ermit No.
ft� iGa'' x ' Datz,B�. �� Ti �t - �dlo— uoak`1
37.4 131_5 5W' Hall Blvd., 1'i ard. OR 97223 � ,,,,� , Plan Res�iew
r Phone: 503.6.9.4171 Fax: 503.598 - 1 ■ l ' 1 Other Permit:
Datc ;
' is Inspection Line. 503.639A175 2 5 Zo� Date Keady
i:TI GR'D M �/ � 'f3y tutus' . [3 See Page 2 For
h� 4 i..! "teittit Ii Internet: www, tigard or.gov 1tt1t - � 1 Nolified'Methoc: ITO Supplemental Information
^ OF 116I\BD . .
TYPE OF.WORKG i \.J lO1', • CONItMERCIAL FEE SCHEDULE — USE CHECKLIST
❑ New construction Addition /altcratiomre neement Mechanical permit tees are based on the value of the work
perfomied. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead. and profit.
___ CATEGORY OF CONSTRUCTION Value: $ ,•- '1 t _i • ' "
�J RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
J I- and 2- family dwelling ID Commercialiindustrial El Accessory building
///
Fur special injorr iauo#r use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
__ Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Hcating/cooling
Job site address: 4 , �3� 1
— ircgiurcs tc plan showing placemcnrl 1 16.7$
City /State /ZIP: oR q? ,, D -3 Furnace 100.000 BTU ;ductshe:nc) 46
Furnace 100 .000+ BTU(datet.:•'venrs) 54.91
Suite/bldg. /apt. no.: Project name
I leaf pump 61.06 l
Cross street/directions to job site Duct work 2_.32 ' 1
Hydmnic hot water system 23.32
Residential boiler (radiator or
hvdron is ) 23.32
Unit heaters (fuel -type, not electric), j
in -wall. in -duct, suspended, etc. 4675
Subdivision: Lot no.: Flue/ vent for any of above 23.32
Other. 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
- Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
® PROPERTY OWNER Chimney /liner /Flue /vent 23.32
ANT Oilier 23 32
Nance: tin r ,(" �l f Environmental exhaust and ventilation
Address: If ` r h Range hood/other kitchen
// n equipment 33.39
City/State/ZIP: ` �'� t� ' C Si lothes drexhaust 33.39
::// ' ngle d uct nbe exhaust (bathrooms,
Phone 7 /7 Z0 Fax: ( ) toilet compartments. utility rooms) 23.32
® APPLICANT... ❑ CONTACT PERSON _ Atticfcrawlspace fans 23.32
Other 23.32
Business nacre: COLUMBIA HEATING AND COOLING Fuel r in
Pup g
Contact name: NIARLENA 514.15 for first four; $4.03 for each additional
I Address: PO BOX 230397 Furnace, etc.
Gas heat pump
City /State /ZIP: TIGARD OR 97281 Wallisuspcnded,'unit heater
Phone: (503) 624 -2704 Fax: : (503) 596 -0270 Water heater
Fireplace
E -mail: COLLMBHC .TELEPORT.COM Range
CONTRACTOR Barbecue
Business name: COLUMBIA HEATING AND COOLING Clothes dryer ieasl
- Other i
Address: PO 130X 230397 MECHANICAL PERMIT FEES"'
• City /State'ZIP: TIGARD OR 97281 Subtot I
Phone: (503) 624 -2704 Fax: (503) 598 -0270 Min imum permit fee ($90.00) go ...0Q
Plan review (25 %ofpermit fec)
l CCB iic.: 76359 State surcharge (12 %of permit fec) 1O ye
TOTAL PERMIT FEE ado • Wd
alure: J(� This permit application expires if a permit is not obtained within 180
Authorized Si
b'tt / e days after it has been accepted as complete.
I Print name: 111ARLENA NSEEDOM Date: ,..1-...9 - _ / 0 " F e e intrlhodringy set by 'ti- County Building Industry SCtV1CC Beata
1 ∎BoildnETern,it s Pcrmlt App.doc r o'ot,cs 440 (I I :o21convwEn)
6'd OLZ0 6u!loo3i6uITeeH eigwnio3 d617 :£0 06 9Z 'eV
05/24/2007 00:12 5036400939 DALBY PAGE 31/01
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ter t7.4t / 4 IC 49,
HEATING & COOLING, INC.
P.O. BOX 230397 TIGARD, OR 97281
(503)624-2704
Sin PLAN
.. _
1 A t
ADDRESS.