Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00272
Date Issued: 06/16/2010
TiG RD;' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134BD07006
Jurisdiction: Tigard
Site address: 11360 SW COTTONWOOD LN
Subdivision: ENGLEWOOD NO. 3 Lot: 231
Project: Ramer
Project Description: Install A/C. Unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
RAMER, DANA P Description Date Amount
11360 SW COTTONWOOD LANE Air Conditioning 06/16/2010 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 06/16/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 06/16/2010 $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 $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 41. /e , -
Permittee Signature: d 6 L / e,.y- 7
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
06/11/2010 11:40 5035436285 PAGE 02
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Mechanical Permit A �lxcatioln � 11 . , ��� .� e ^r ,,," , 7 ��
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° 13125 S W Ball Blvd„ Tigard. OR 9 - 2 3 ' '' 4 Received r Date/By: 6 �. a Permit�ro.:���r!J„ /0 ��. ' f '
m Phone: 503.639.4171 Pax 503,39 .J960 1 ")A Plan Review
f ` " 1k „ ..i Inspection Line: 503.639.41 .0 a y: Other Permit �'FFl_i PI 1),
'•thcv.va04 Internet: www,tigeud- or,gov (� V I el Set Mum Z for
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_ TYPE of :w$ C + , �'
P��! • • • COMMERCIAL PEE" t
ID - . sCtu.rnJk,a�. - is�:.CI17C><rrK ter
6_,1 New construction IS Addition/alteration/replacement Mcchafl 4al permit F ees" are based on the valve of the work
f=1 Demolition Qt11t C: performed. Indicatethc value (rounded to the nearest dollar) of all
mechanical mater i m eg1, labor, overhead. and profit.
.ATECOIZY OF CONSTRUCTION value; $
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL COMMENT / 45'9($1418 1:; 5•.
❑ Multi-family ❑ Master builder ❑ Other:
Tor speck,/ information use oilman
ncscnpttolt Qty &r. Total
• . JoR 511E INFORMATION AND LOCATION HcMinri/cranHng
Job site address: 11360 SW Cottonwood Lane Air conditioning
re iros tee Ian ahOwin rTkecment) 1 46.75 46.75
City /Stare/ZIP: Tigard, OR 97223 Furnace 100 46.75
Suitt /bldg. /apt. nn.: Pmjoxt name: Fumacc 1 BTU (ducts/vents) _ 54,91
Heat pump 61.06
Cross street /directions to job site: Duct wait .. .. _ ... 23.32
Hydronic hot water system 2332
Residential holler (radiator or
hydronic) 23.32
Unit heaters (fuel -type. not electric),
in -wall_ in -due, sampcudcd, etc. 46.75
Flue /vent for any of above 23,32
Subdiviainn:
Lot no.:
Other: 23.32
Tax map /parcel no.: Other feel appliance. .._
DESCRIPTION OF WORK heater T 23.32 {
Install An Conditioner 6+as fireplace 33,39
---- Flue vent for water heater or gas
fireplace 23.32
r Log lighter (gas) 23.32
Wand /pellet atoms 33,39
Wood fireplace /insert 23.32
•
PROPERTY Ow 4i;I� Chimney /liner /fludve 23.32
tri
❑ 'TENANT
Name: Dana Ramer -
ChM 23.32
Environmental ex/must and ventilation
Address; 11360 SW Cottonwood Larne Rangc.haod/mher kitchen
equipment 33.39
City /State /ZIP: Tigard, OR 97223 Clothes dryer exhaust 33,39
Phone: (503)590-2854 Fax: ( ) Single -duct exhaust (bathrooms,
toilet: compartments, utility rooms) 23.32
El APPLICANT • 0 CONTACT PEl.8ON Attic /crawlspacc 23.32
Business name; Same as Contractor Other 23.32
Contact name;
lApMnin
$1 for first four, $4-03 for each additional
Address: Menem ere.
Gas heat romp
City/State/ZIP: Wall /suseended/anit heater
Phone: ( ) Fax:: ( ) Water healer
E-mail. _ — - Fireplace
Range
CON'C' ACTOR :Aran
0 o
Business name: Columbia NW Fleaitinrt Clothes dryer (gas)
Address: PO Box 622 W alter
' MECTUNICAL PERMIT .FEES!
City/State /ZIP: Scappuoac, Olt 97056 snbtornl 46.75
Phone: (503) 543.3624 Fax: (503) 543 - 6285 Minimum pis ttat Ice ($90.00) 90,00
Plan review (25% of permit fcc)
Z i CC13 (ic.: 61947 State
surcharge (12% of permit fcc) 10 - 80
/1 , �' TOTAL PERMIT FEE l 00.xC)
Authorized signature: /� / l �' �`�� ; y J ,p. Tbls permit application M tarp its permit ►R rat obtained within .IFO IV
A / F days after It has beta accepted an emnplete.
Print name: Gcrri Jacobson Date: 6/11/10 * Fee methodology so Tri -c'ni Building Indus
_ v5 mY R try ScrvieC Board
T:\ nuildinp \Prypitits \MGC- PmnilApp.dnc 10Nh/f9
440-461 TM 1/O2ic:OM/WrIr)
06/11/2010 11:40 5035436285 PAGE 03
JOB #10R17H .... .
RAMER, DANA
11360 SW COTTONWOOD LN
TIGARD, OR 97223
Installation Property Information 503- 590 -2854
gRECTIQN
Properh+ Line
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Property Line •�°'•`
(F- FURNACE)
(X;OUTSIDE UNIT) STREET
Columbia NW Heating, Inc.