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Permit CITY OF TIGARD MECHANICAL PERMIT _ COMMUNITY DEVELOPMENT Permit #: MEC2010 -00280 Date Issued: 06/18/2010 T1GARDi 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 2S 18/201 2600 Jurisdiction: Tigard Site address: 10595 SW CENTURY OAK DR Subdivision: SUMMERFIELD NO. 1 Lot: 33 Project: Caldwell Project Description: Replace gas furnace. Owner: FEES SHERYL CALDWELL Description Date Amount 10595 SW CENTURY OAK DR Furnaces < 100K BTU 06/18/2010 $46.75 TIGARD, OR 97224 12% State Surcharge - Mechanical 06/18/2010 $10.80 PHONE: 503 - 665 -2505 Minimum Fee Adjustment - Mechanical 06/18/2010 $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: Natural Gas Gas Pressue: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: ��� J Permittee Signature: , �"�� �L C' Z77 TA Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Jun 1710 04:52p Columbia Heating /Cooling 503 -598 -0270 p.2 • Mechanical Permit Application , , 1 v ? City of Tigard ,', It. - ili,,ived ,. 1 Date/BY: ( /O/ kv / permit 1454/6—(02/1/0 C✓ 70 ?( O 111 1 4 13125 SW Full Blvd., Tigard, OR 97/ "4 �Q Plan Review / �� Phone, 503,639.4171 Fax: 503,598, 1 �,� Datelsy Other Permit: 1 lCniU) Inspection Line: 503.639.4175 ` \w\ 1 \\) Date Ready: sy: curt.: to See Page 2 for • Internet: www.tigard- or.gov \� \v > � r..- - ��� * + 41eitified/Method �; t Supplemental Infarmancn . 'S S• : YPy^' (QaY 4 J A \ y � ``� . .. r ! f\ I i f - s c{ � . r.AULE - usE CHECF:.I.tsT . .�! ( � !, "•;' ",t,':. 'E '�; .'; +'.i(' .ti "Tf Lri,P����,�Y-�P���� �e ! .;E II f . . . � f : ❑ New construction MtAdd itlonialterat ion /rc menu Mechanical petaiit fees are based on the value of the work performed. Indicate the value (rounded to the nearest douar l ul all ❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead, and pret't Value: S • . CAT$CORY•'QF CoN u N " r ' RESIDEI TWa EQ** VT 1:SYSTEMS FEES* I. and 2.1'amily dwelling ❑ Commercial /industrial ❑ Accessory building i , For special information use checklist ❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. _ Ea. :aal JOB SITE INFORMATION AND LQCATION.: Heating/cooling Job site address: C,� / y. t J Air conditioning / J (rcgctres site plan sOowiiK placement) _1 46 75 City/State/ZIP ]' r l Furnace 100,00© BTU (decw've:us) f 46 75 ��� � /�� Pomace 100,13Q0- BTU Watts/vents) >4.51 Suite.blc a Project g' p t. no.: name � Heat pump 6! .06 Cross street/di:ections to}oo site: Ductwork ' 23 2 Hydronic hot water system 23.32 _ I Residential boiler (radiator or hydronic) 23 32 . Uni: heaters ,fuel -type, not electric), in -wall, in -duct, suspended, etc 46, 75 r Subdivision: Lot no.: Flue /vent for any of above 23. 32 Other: 23.32 _ Tax map /parcel no.: Other fuel appliances [1ESCR ION; OF l ' u . . ' x i,' "..'= :,. i�'i;;t :: rt III i Wafer heater 23.32 I i e1 J ` Gas fireplace 33 39 : 1 1 t ,AA ` 1 A its-, a( 1 Flue vent for water heater or gas 4 fireplace ' 23 32 . . Log lighter (gas) 23 32 Wood/pellet stove 33.39 Wood firepiace/insert 23.32 _ C himney/liner /f ue/ven: 23.32 1 • PROPERTY OWNER • •..i , ' . i ' .;T- E] •TENANT' Other. IIII 23 32 • ) Name \ J 4 ! a J / / 1 Environmental exhaust and ventilation _ - i Range hoodlother kitchen 1 Address: 10 ��, _ . LL i equipment 33 39 _ Clothes dryer exhaust 33.39 ; ff ^ s �� ~� Single -duct exhaust (bathrooms, � -,� NTAGT N �YA4 Phone t ( ) ;'' A compartments, utility rooms) 23.32 �" Fax toilet _ , 0 APPLICAr∎t i i s .'. i 4 ulf0n C] ERSQ q t' ttic crawlspace fans 23. 2 Other: i 23.32 Business name: Fuel t to P g Contact name: / - /(-) Y Af . / . 2 0 ..._ 7 ee� S/4.1S for first four; 54.03 for each additional /� Furnace, etc. Address: Gas heat pump City /State /ZIP: Wa1L'suspendedrunit heater Phone: �� 3) (n 7 • � � ` r ` Fax :: -y 5:q 8 -� ;' 7C. Fire e ter o% P E-mail: Range CONTRACTOR :. Barbecue • Business tern e: Clothes dryer (gas) 11 ..x- a. r . ..t *..i_ Other: • Address: / ''. * :,, �' < ... MMECH.A21'1CAL PF.RMTT PEES* CitylStateiZI.P: 1 ' �� p i78 J Subtotal Phone: ) 1 J h `] ' Fwc; r C p �--j Minimum permit'ee (Sv0.00) �� ` t2a f 7 () L & ` � . Plan re :cw {2 S% of perm i tee) CB lie.: r 7( 5 1 State surcharge (12% cf permi t fee} IC rC ! t TOTAL PERMIT FEE /00 , ,�Ql Aulhonzedsi 21111 : This permit application expires if a permit isaotobtainedN � I . - / 14J,, days after it has been accepted as complete. I Print name: // i ' p „j Date: i j j j ' F e methodolot'set by Tri -County Building Industry Service Biiar.1 ::\ 6uildinalPermitslMEC •PernitApp.doc 10!01/09 440-46ITr(1 1IJ2/CORWBB) ° Community Development : TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM: ❑ Owner 111 Applicant ❑ Contractor L -"Catty Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City /State /Zip: Phone No.: PLEASE TAKE ACTION FOR THE ' M(S) CHECKE ► (✓): �✓1 A j C �`� IN CANCEL PERMIT APPLICATION. c �e � C C t 6 D d e REFU ' ERMIT FEES (attach receipt, if available). • INVOICE FOR FEES DUE (attach case fee schedule and explain below).d 1 D CP I O jl/ ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: E c_ Site Address or Parcel #: t 05 q 5 Cent v y CMG 1/ Project Name: Gic�,Wel i / Subdivision Name: Lot #: EXPLANATION: (A el 1-0 et , I f l e .r coN i i rr A ct v r �tr l i+cnA u- l pr. ►rr.I� 14 )66 r [0 . Fees e nI +e-r--01 cwo( I N t/O r (—cat #0 p e rr- -} I IV e rrd r.( reel `r+ c � rd +rd'vl�Sc( C)l 'c.�nl 00 f�� Signature: Date: /� 0 Print Name: 1r7 cl p, ►�`} ' / (f(J Cd22cG�b /N Refund Policy /O // g/ // O 1. The Director or Building Official may authorize the refund of: (� a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fec when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to S s Admin: Date firm B Rte to Bld. Admin: Date • //O Refund Processed: Date /Q /y /d By :!''' _. Invoice Processed: Date By Permit Canceled: Date :. •■ Parcel Tag Added: Date By Receipt # P7P' /j'3 ,/ Date g/q // d Method C Amount $ 3 7 , '/ V I: \Building \Forms \RegPemvtAction.doc Rev 07/26/07 Record ID: MEC2010-00280 S Pay S- j Apply [� !Refund ® :Void : SQ !Generate Receipt :j 1 I Fund Transfer _7 i Help ♦; Go To JI (1 ) Payment Payment History Professionals (11 Related Records Renewal (0) Section Township Range 7 Status Vali J Total Invoice Amount: 5100.80 Terminal #: Total Payment: 5100.80 Cashier ID: DHOWSE Total Balance: 50.00 Date: 10/14/2010 Amount Not Applied: 50.00 Invoices Invoice # Amount Paid in full Balance 155745 5100.80 Y 50.00 160350 537.40 N 537.40 16.1353 (537.40) N (537.40) Transactions Transaction Transactions Method Receipt # Not Applied Amount Status Received Trust Account ID Date Code _ ._ .....__ Payment Credit Card 175534 $0.00 537.40 Voided 08/04/2010 I' Payment Credit Card 17837; 50.00 • Paid 06/18/2010 d )1•3