Permit CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00253
Date Issued: 06/03/2010
TfGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S110AA91141
Jurisdiction: Tigard
Site address: 10769 SW CANTERBURY LN 104
Subdivision: Lot: 0
Project: Smith
Project Description: Installing A/C.
Owner: FEES
SMITH, DAVID H Description Date Amount
10769 SW CANTERBURY LN #104
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 NW HEATING
PO BOX 622
SCAPPOOSE, OR 97056
PHONE: 503 - 543 -3624
FAX: (503) 543 -6285
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: - / � Permittee Signature:
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.
06/03/2010 11:42 5035436285 PAGE 02
Mechanical
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' '" :' 1 SW Ball Blvd.. Tigard. OR 97223 -
Phone: 503 639 4171 Fax: 503 Other Permit:
�,' i , „ Inspection Line: 503-639.4175 v 1 V V O Date Ready/By: AIM: H Sec rapt 2 for
C iiio. r, Internet: www.tihard or.Rov Notified/Method: •-T(P Supplemental inhumation ^ ITV
CITY OF TIGARD
T I 1 ' i 1 ` T1 VfSION • i ciantiwiElt FEE' scHE»tJLE - IJSE CHECKLIST
0 Ncw construction ® Addition /alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment,_ labor, overhead, and profit.
- CATEdORY OF,CoNstRuc im Vahte $
El 1- and 2- family dwelling ❑ Commercial/industrial ID Accessory building R)&91AE1�1TAI' 1gC�EiXIyT S1C911E;1w1S : 1£9
❑ Multi-family ❑ Master builder ❑ Other; For spacial information use checklist,
Description Qty. Ea I Total
J013 SITE INFORMATION At■D . I,,UCATION llcat3rlg/cooliog
Job site address; 10769 SW Canterbury L e 11104 Air conditioning
VcsuireN Nita plan showing placcmant) 1 46.75 46.75
City /State /ZiP: Tigard, ()R 97223 ■- Furnace 100.00() BTU (ductsiventa) 46.75
Suitelbldq. /apt. no.: + ry, Project name: Furnace 100,000+ BTU (ducts/vents) 54.91
It' l �M
Bad pump 61.06
Cross street/directions to job site: Duct work 23.32
-
Hydronic hot water system 23.32
Residential boiler (radiator or
lrydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
SubdiviSiotl: Lot no.: Flue /vent for any of about 23.32
. _ Other: __L23.3_
Tax malt /parcel no.: Other fuel appliances
' DESCRIP'TION. OF WORK W.rcer he ucr 23.32
Gas fireplace 33.39
Install Air Conditioner Flue vcmt for water howler or ps
-- fireplace _ - 23.32
Log lighter (gas) 23.32
W ood/pellet stove 33.39
Wood fireplace /insert 23.32
0 PR011:1 litir OWNl R. _ r:, iEil A N'T .
Chimney /liner /flue /vent 23.32
Other: 23.32
Name; Dave Smith Enviromnental exhaust and ventilation
Address: 10769 SW Canterbury Lane #104 Range hood/other kitchen
egttipmcnt. 33.39
City /State /ZiP: Tigard, OR 97223 Clothes dryer exhaust 3139
Single-duct exiting' (bathrooms,
Phone: (503)708.4469 Fax: ( ) toilet compartments, utility rooms) 23.32
'Ea APPLICANI : O .CONTACT PERSON , Anic crawJspace fans 23.32 ..
" Other: 23.32
Business name: Same as Contractor
--- Fuel piping
Contact name: $14.15 for first four; 54.03 for each additional
Address:
Furnace eta 1
Gas heat pump
City /Stan /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heate
Fireplace
E-mail: Range
CONTRACTOR • . Barbecue
Business name Columbia NW Heating ------- T , Clothes dryer (gages
Other:
Address: PO Box 622 . IVfI:caAricAI: PEn nt Mg *..
-
City/State/ZIP: Scappoose, OR 97056 --.L W �W • S ubtotal 46.75
Phone: (503) 543 -3624 Fax: (503) 543 -6285 Minimum permit fcc ($90,00) 90,00
Plan review (25% of permit fcc) 0
CCB lie.: 61947 State surcharge (12% of permit fee) 10.50
TOTAL p nt obt 100.80
13
Tit permit nppllcnLtm espirrA a If n perm& hi 'n not t obtnlned within ln ISO
Authorized signature: 4 days after It has been accepted as complete.
1 Print name: Gerri Jacobson Date; 6-3 -10 Fcc mctt,ndningy sat by Tri- County Ituilding Industry Sarvinc Board
1111, nldinp tlh:nnitatMIC- PnrmltArr IMpt/nd 446- 4617T(I1 /62/CO'M/Wal)
06/03/2010 11:42 5035436285 PAGE 03
JOB #1 OS310H
SMITH, DAVE
10769 SW CANTERBURY LN #104
TIGARD, OR 97224
503 - 708 -4489
1 stallation Property Information
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DIRECTION.;
N
Property Line
IX
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FT:
Property Line
(F =FURNACE)
(X= OUTSIDE UNIT) STREET
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Columbia NW Heating, Inc.