Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00250
I Ic DATE ISSUED: 6/1/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 109 DA -10600
SITE ADDRESS: 12926 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 095 JURISDICTION: TIG
Project Description: Installation of A/C unit.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
DAVE CHOPIE Description Date Amount
12926 SW BLACK WALNUT
TIGARD, OR 97223 [MECH] Permit Fee 6/1/2006 $72.50
[TAX] 8% State Surcha 6/1/2006 $5.80
Total $78.30
Phone: 503- 624 -0563
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 624 -2704
FAX 503 -598 -0270
Reg #: LIC 76359
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: 7 , j 1 Permittee Signature: �
Call 503 - 639 -4175 by 7:00 a.m. for inspections 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.
Mechanical Permit Application FOR OF F1(1.: l•tiF. ONLY
' City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 9+722� D Permit Nn. /' , /� 142.5-6
E, . Date, B / L> �f�V Pe ��- oSLIt'�
Phone: 503.639.4171 Fax: 503.59 ;WEN Plan Review
' ,` °"� "oa " DateJB •: Other Pamir.
Inspection Line: 503.639.4I75 '�'' I i y
Internet: www.ci.tigard.or.tls � ' n( 1 2006 �' 1.. Date Re /Meth Aids. ®See Page 2 for
�J IV Notified/Method: Supplemental Information
D
,•n' r, D 10 COMMERCWI, FEE .SCI�:tIUI.E *CHECKLIST
1::1 New construction rrow lTfetanon/replacement Mechanical permit fees" are based on the value of the work
Q Demolition performed. indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials, equipment labor, overhead, and profit.
.. .. , .. . CATEgORl' `O1? CONSTRUCTION... • Value: $
pil- and 2- family dwelling ❑ Commercial/industrial .. `� •RE EQUIPMENT•/ SYSTEMS FEES*
❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other:
For special irrforrnation use checklist.
Description 1 Qty. Ea. 1 Total
JOB SITE INFORMATION LOCATION .' Beating/cooling
Job site address:
4.27471 . l /�� // / /4-4/11 Air conditioning or heat pump
J'i '/�' q t. 4 7 (requires site plan showing placement) ) 14.00
City/State/ZIP: , Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: l Project name: Furnace 100,000+ BTU (dvctswents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work
14.00
Hydronic hot water system 14
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: no ; Flue/vent for any of above 10.00
•
Tax map /parcel no,: Other: 10.00
Other fuel appliances
DESCRIPTION OF WORK . . Water heater 10.00
/..-4J5--7-7=9// ., Gas fireplace 10.00
/7 Flue vent for water healer or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplacc/insert 10.00
ROPERTY OWNER
I O TENANT 10.00
Name: �a� � Other: 10.00
cr _�� - _- Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State/ZIP: I Clothes dryer exhaust 10.00 •
Phone: 3) t,L ��� Fax ( Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80
O'APPLICANT: •.:;:,t CONTACT PERSON Atticicrawlspace 10.00 •
Business name: Other: 10.00
Contact name: / 1 J ? / 46/
Fuel pipe
��TT` 7 �f ! 55.40 for first four; S1.00 for each additional
Address: Furnace, etc.
City/State/ZIP: Gas heat pump
WalUsuspended/unit heater
Phone. a ) G 0 21. 7 / /70 9 ` Fax:: _5-F o - Water heater
E-mail: -
� Fireplace
CONTRACTOR
Range
/ Barbecue
•
Business name: �M h e n- -64_17 �nf /'rl Clothes dryer (gas)
/ Other:
Address: /off !7 0 r,� 3O ?
City/State/ZIP:
MECHANICAL PERMIT FEE54
" �/ ,r� Q� 97 oZ �/ Subtotal
Phone: ( ) / Fax: { Minimum permit foe ($72.50)
CCB l: toll/ 0 / � p �� ) Q" - j Plan review (25% of permit fee)
7 -F�J I State surcharge (8% of permit fee)
(21,„„c TOTAL PERMIT FEE 1
Authorized signature: This permit application expires if a permit is not obtained within 180
Print tfattte:� za 4 /7 days after it has been accepted as complete.
x2 J / a te: `� j > z 9 6 1 • Fee methodology set by Tri- Cottnry Building Industry Service Board
: \Penn :AMEC- PermitApp.doe 32/03 f /f 440A617T(( I1i02/COMJWEa)
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arain,ia, C .,pi., -
HEATING & COOLING, INC.
P,O. BOX 230397 • TIGARD, OR 9728'
(503)624-2704
SITE PLAN
_______ -
•
ADDRESS; / 7,Z sGJ _ 6C, /..,
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