Permit CITY OF TIGARD MECHANICAL PERMIT
a ,,u a
j ,a Ig COMMUNITY DEVELOPMENT Permit #: MEC2010 -00250
Date Issued: 06/03/2010
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 114BA14100
Jurisdiction: Tigard
Site address: 16240 SW COPPER CREEK DR
Subdivision: COPPER CREEK NO. 4 Lot: 106
Project: Cannon
Project Description: Add a /c.
Owner: FEES
CANNON, STEPHAN & SUSAN Description Date Amount
16240 SW COPPER CREEK DR
TIGARD, OR 97224 Air Conditioning 06/03/2010 $46.75
12% State Surcharge - Mechanical 06/03/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 06/03/2010 $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 Notificat' . 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 q stions to OU C - • g 503.246.6699 or 1.800.332.2344.
•
Issued y: Permittee Signa ure: a h�r
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.
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Jun 02 10 03:04p Columbia Hea ' .'.' r , it r 503 -598 -0270 p.1
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Mechanical Permit Application 30\1 0 2p1� ; ",' r p : � .M,6 i " i oa,orFlM F�us oN1 „ `, ( ,A,,,,: uY � 0
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4 w v Phone: 503 639.4171 Fax: 503 598 r A ; E Dateii y: Other Permit
nTl1� D1"Rv Ins Line: 503.639 rV i!li'a'� pateReadyrBy: ® See Page 2for
n� rxi<"x Internet: www- tigard- or. sov Notified /Method: r , S u pplemental Informat
TYPE OF WORK COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
El New construction � .[�"Addition /alteration /replace Alechanioal permit fees" arc based on the value of the work
performed. Indicate the value (rounded to the nearest dollar} of all
❑ Demolition ❑ Other: mechanical materials, equipment, lab o,rheea�d and profit.
Value: $ f CJ ' .'..cad
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
N (E ] and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION. AND
� LOCATION Heating/cooling
Air conditioning
te\lii l ` ;��� r �� 46,75
,lob site address: (,- r� 1 �,
I (,� 1 4 �, frc site plan sho�einc placemcm)
City/State/ZIP: -- Ft (...,-1-0.....0 00,000 L3TU iductsircuts) 46.75 ,
Furnace 100,000+ 31 (ducts: :vents) _ 5:1 -91
Suite/bldg. /apt. no.: Project name: 0 Heat pump 61.06 _
Cross street/directions to job site: Duct work 23.32
Hydrenic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel - type. not electric},
in -wal1, in -duct, suspended. etc. 46,75
Flue / /vent for any of above 23.32
Subdivision: Lot no.:
Other. 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
— • Gas fireplace 33.39
•- P L t re._.. -- 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 i
Chimne■/Iiner;flue /vent 23.32
® PROPERTY OWNER ❑- TENANT Other t 23.32
Name: Environmental exhaust and ventilation
L Range hood /other kitchen
Address: equipment 33 39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms.
Phone: ( ) Fax: ( ) toilet compartments. utility rooms) 23.32
® APPLICANT 0 CONTACT PERSON Attic /crawlspace fnns 23.32
Other: 23.32
Business name: COLUMBIA HEATING AND COOLING
Fuel piping
Contact name: YIARLENA S14.15 for first four; S4.03 for each additional
Furnace. etc.
Address: PO BOX 230397
Gas heat pump
City /Statei'ZIP: TIGARD OR 97281 Wail /suspended /unit heater
Phone: (503) 624 -2704 Fax: : (503) 598 -0270 Water heater
Fireplace
E -mail: COLOMBHCrJTELEPORT.COM Range
CONTRACTOR Barbecue
Business name: COLUMBIA HEATING AND COOLING Clothes dryer (gas)
Other:
.Address: PO BOX 230397 MECHANICAL PERMIT FEES*
City/Stale/ZIP: TIGARD OR 97281 Subtotal G6
Minimum permit fcc ($90.00) /p •
Phone: (503) 624 -2704 Fax: (503) 598 - 0270
Plan review (25% of permit feel — e—
CCB lie.: 76359 State surcharge (12°4 of permit fee) /0.80
TOTAL PERMIT FEE /00 . $O
This permit application expires if a permit is not obtained within 180
Authorized signatur : 1 - l' days after it has been accepted as complete.
L rint name: IILARLENA MEEDO31 Date: i Z —/ ' Fee methodology' set by Tti Ccunty Bt ilding Industy Sen Board
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Jun 02 10 02:20p Columbia Heating/Cooling 503-598-0270 p.2
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HEATING & COOLING, INC.
P.0, BOX 230397 • TIGARD, OR 97281
(503)624-2704 . .. ... . -- - — -- ..
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