Permit � h �. MECHANICAL PERMIT
,.
" CITY OF TIGARD
` a COMMUNITY DEVELOPMENT Permit #: MEC2010 -00265
Date Issued: 06/11/2010
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S104BA08300
Jurisdiction: Tigard
Site address: 13796 SW LIDEN DR
Subdivision: CASTLE HILL NO. 2 Lot: 118
Project: Andringa
Project Description: Gas line to range.
Owner: FEES
ANDRINGA, GREGORY A & RHONDA V Description Date Amount
13796 SW LIDEN DR
TIGARD, OR 97223 Fuel Piping 06/11/2010 $14.15
12% State Surcharge - Mechanical 06/11/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 06/11/2010 $75.85
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: ` - Permittee Signature: / /
CaII 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.
Jun 09 10 12:28p Columbia Heating /Cooling 503 -598 -0270 p.2
Mechanical Permit Application 'I u !,�l ,t.�t, �. � �� .4,4t W
" City of Tigard Permit No.:
g REC ii. CCC110d
r ete/t3 }: v6 1i ' �� e . - to — ice
�� 4 13125 5V4 Hall Blvd., Tigard, OR 97223 Plan Revle
4'x' ti. Phone: 503.639.4171 Far 503.598.1960 Date/By, Other Permit:
:"0 IT IV
Inspection Line: 503.639.4175
islglC *► O 9 2010 Date Ready /By: lurks I1 See Page 2 for
te.17.4 Internet: wtsw.tigard-Or.gov J Notified/Method: 1ji Supplemental Information
TYPE OF WORK 1 , � TIGARD t
a t s r�IIIISIO�� COMMF.RCTAL FEE' sCHEnUL — USE CHECKLIST
cat � tpltdC Mechanical permit fees' are based on the value of the work
❑ New construction .0 Addition/alteratio ace ment pctfornrod. Indicate the value (rounded to the ne: est dollar; of all
❑ Demolition ❑ Other: mechanical materials, equipmen Lk or, ove -,.., and profit.
CATEGORY OF CONSTRUCTION .. . • . . Value: S j....r.'+
� RESIDENTIAL EQ t' 111 I.SY IS FEES*
,'CJ I and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special i • ormarion use check!! •r.
❑ Multi - family ❑ Master builder ❑ Other: Des 1 Qty. Ea. 1 Total
JOB SITE INFORMATION AND LOCATION .. • Heating/cooling
Sob site address: i
Air conditioning
'a r ,,E-1....i (requires site plan showing placement) 1 46.75 i
City /State/ZIP: - T; ;r te 1. dc Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91 ,
Suite /bldg. /apt. no.: Project name: 4/4Vl7_\ t -1, Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) ! 23.32
Unit healers (fuel -type, not electric),
in -wall, in -duct, suspended, etc. i , 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 ,
/4 / , e'', Gas fireplace 33.39
t. . y ,, ‘--1.--e . 0 --""^ - ,-04 Gas
Flue vent for water heater or gas
fireplace 1 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplacelinsert 23.32
Chimney/liner /flue/vent 23.32
,Er PROPERTY OWNER _ . i + ❑'TENANT . .
c
Other 23.32
�
Name: ,( ,� t A i .., �J Environmental exhaust and ventilation
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 • ❑ CONTACT PERSON Attieicrawlspace fans 23.32
. Other: 23,32
Business name: Fuel piping
Contact name: irk] r k nn � / j - e'oWn $14.15 for first four; 54.03 for each additional
Address: " Furnace, etc.
Gas heat pump
CityiSlate/ZlP: ^ ,s� Wall/suspended/unit heater •
Phone: (a3) r a Q 7 4. Fax: :53.3, 5 8 -v �7Q . Water heater .
�1 Fireplace
E -mail: Range l
' CONTRACTOR Barbecue
Business name: • Clothes dryer (gas)
.. // � -_ . ��. = l .. �. Other:
Address: 1 a k � .� 9 . 7 . MECHAN1CAL PERMIT FEES* 1 4 4 , I S'
City/State/ZIP: l , & ) r 9,70 7t g 1 Subtotal 1 - yTd{v
/ /� QQ Minimum permit fm ($90.00) 1e); dc) _
Phone: ) �7 FaX• ) l t ) - Ca-70 Plan review (25% of permit fee)
CCB lie,: '7(o i€ ) - /!r State surcharge (12% of permit few:) 10,10
( TOTAL PERMIT FEE Ido,,
Authorized sigtlatur J A Al / t CCC
J f i / •� _/ This permit application eepires if a permit is not obtained within 180
days after it has been accepted as complete.
L name: j—(p Afk " (} Date: 4
fee methodology set by T i - Cetmty Building Industry Service R:iard
t'i3uitd irig1Pennits \MEC- Pe+nit Apr. doc 10(01109 440.461 7r I lin/comiWEB)