Permit �! CITY ' OF TIGARD MECHANICAL PERMIT
F COMMUNITY DEVELOPMENT Permit #: MEC2010 -00302
TIG AR& 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/02/2010
Parcel: 25111 CC04600
Jurisdiction: Tigard
Siteaddress: 15980 SW'CENTURY OAK CIR
Subdivision: SUMMERFIELD NO. 1 Lot: 69
Project: Beamish
Project Description: Replace gas furnace.
Owner: FEES
BEAMISH, ALICE F Description Date Amount
15980 SW CENTURY OAK CIR
TIGARD, OR 97224 Furnaces < 100K BTU 07/02/2010 $46.75
12% State Surcharge - Mechanical 07/02/2010 $10.80
PHONE: 503-684-8258 Minimum Fee Adjustment - Mechanical 07/02/2010 $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: Permittee Signature: ' ( „ 9 _77 6 . )
Call 503.639: :4175 by 7:00 a.m. for an inspection,that business day.
This permit card shall be kept 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.
Jul 01 10 1,0:54a Columbia Heating /Cooling 503 -598 -0270 p.2
� , �� c� � � l Q l � i V � u �,� t � � �V � ���V� �j�
Mechanical Permit Application , ", ," : , �l�,ul I lc� l a( .ov1: i
C1iy of T garcl e n"B � Permit ?Jn.// a /0 - o3a
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13 [ 25'SW Hall Blv Tig ard, 0t2 97223 �
t, Plan Ravi: Other Permit!
hone 503.639.4171 Fax: 503.5981940 � „ p C'By:
^ i " Inspection 639.4175'
on Line: 503. funs: See Page T•fnr
lt(illl , °as�{lt
Internet: www.tigard or.gov d Y od �C� Supplemental information
N* COMMERC
AG._E *- ULE - USE CHECKLIST
TYPE OF WORK U�� V �� • Mechan perm f ees ' are based on the value of the work
❑ Nev construction Addition /alteration replacement performed. Indicate the value (rounded to the nearest dollar) oral!
0 Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF .CONST6UCITON . ` ''`:' RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
V I - and 2 family dwelling ❑ Commercial /industrial D Accessory building For special information qse checklist
E Multi- family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. i Total
JOB SITE INFORMATION AND LOCATION Heating/cooling l
)t Air conditioning I •
lob site address: J5g 80 1 � CL rri-ia o er. (requires site plan showing placement) 46.75
GityiSta[e)ZIP: C I ;3 ip • t BTU (ducts/vents) 100,000 BTU (ducts:vents) / 46,
' " Furnace 100,000+ s/vents) 54.91
Suite/bldg./apt. no.: + Project name: .4, • i '/ Heat pump 1 , 61.06
Cross street/directions to job site: Ductwork 1 23.32
1-tydronic hot water system 23.32
Residential boiler (radiator or '
hvdronic) 1 , 2132
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above ' 23.32
'Subdivision: Lot no.: Other: I 23.32 .
fax mapiparcel no.: Other fuel appliances 1
•
DESCRIPTION OF WORK Water heater I 23.32
Gas fireplace 33.39
• � in 'I - Flue vent for water heater or gas
/ fZI fireplace 23.32
Log lighter (gas) 23.32
•
Wood/pellet stove 1 33.39
Wood fireplace/insert 1 23.32
mneyIin t n 23.32
• Chi er /flue ve t
�. PROPERT7f OWNER I. .TENANT Cnher•. 23.32 1
Name C/2 6 Environmental exhaust and ventilation
Address: 1 ���
_ -/ n Range hoodlother kitchen '
/n� 33.34 l
City /State /Z[P: !,/ nu �� ��' Cothes 1 33.39
Single-duct lot exhaust (bathrooms,
Phone:af tJre +. E . Fax: ( ) toilet compartments, utility rooms) 23.32
Atticictawlspace fans • 23
❑. APPLICANT :. 0 CONTACT PERSON . `' 23.32 I
Other: .
Business name: Fuel piping
514.15 f or first four; 54.03 for each additional
Contact name: Y !'� �� m �P� ?�'l 1
Furnace, etc.
Address: Gas heat pump
City/State/ZIP: W al Ususpcndedlunit healer
Phone: (a 3) e(,a 4..a70 4. Fax: :E,O3 .5:iota .bas-7O , Water heater 1
Fireplace 1 :
E -mail: Range
CONTRACTOR'. Barbecue 1
• `�� Clothes dryer (gas) I 1
Business name: ('pt L miii f - / v_ ex-04_ i 1. 6, Other: I 1
Address: t &k rQ,�Z 3 9.7 .. . MECHANICAL PERMIT FEES*
/� r a j f i Subtotal I
citylSratetZlY: � � ` � ! g ! 90 , el)
' . Minimum permit fee {u90Aal
•
I hone: V
) tli • 1 Fax: v � "a r - 0- � Plan review (25 °0 of permit fee)
/ r- �
I ' CCB lie.: 7� • State surcharge (12 % of permit fee) 1 /0 i cf
TOTAL PERM8T FEE 7,00 .41
L . 2 // i) A3 \ This permit appcati b if is
Authorized '3igttatur :
t✓ . days s after it t has been accepted as complete.
1
Date: f -, Fee methodology set by Tri- Coucty Bt.ildir.g Industry' Serv:uc Buard
Piintnatne 1
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