Permit '.: MECHANICAL PERMIT
"I q CITY OF TIGARD
"t ' Permit #: MEC2010 00382
a ! COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 08/03/2010
x ,,,.! ., ; Parcel: 2S 109 DA04000
Jurisdiction: Tigard
Site address: 12892 SW PINE VIEW ST
Subdivision: SUMMIT RIDGE Lot: 17
Project: Summit Ridge
Project Description: A/C installation. Unit must meet minimum 3' rear and side yard setbacks.
Owner: FEES
ARNOLD, MARK M Description Date Amount
12892 SW PINE VIEW ST
TIGARD, OR 97224 Air Conditioning 08/03/2010 $46.75
12% State Surcharge - Mechanical 08/03/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 08/03/2010 $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:
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.
NIP
Issued By,.., Permlttee Signature: .,... . -
'
i
Call 503. • 9. , 5 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.
Jul 30 10 12:56p Columbia Heating /Cooling 503- 598 -0270 p.2
Mechanical Permit Applica>i6� �1 I t olr•� l I It t tit (1' I
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` m: City afTig -` . pate i � i - , _.. _ ' _
■ 13125 SW H all Blvd., Tigard, OR 97223�U L 3 0 2 01 O Plan Review Ottur permit
Phone: 503.639.4171 Fax: 303598. Dat e/By.
I�"ln4 g
Inspection Line: 503,639.4175 r Date Readv /By: Ju ris: QI See Page 2 for
J f I . Al t) Internet: www.tigard- or.gov Crl OF i it/ y Notified/Method: II i Supplemental information 1
BUILDING DIVISION L
ta)M1YEERO,. FEE; SCHEDULE - USE CHECKLIST 1
TYPE OF WORK . , ..
.. permit omit fax• are based on the value of the work
0 New construction caditionlalteratiortlreplacemcnt performed. hidiceite the value (rounded to the nearest dollar) °C all
Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: S
CATEGORY OF .CONSTRUCTION
. RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
.'i- and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building Forspeciu( information use checidisi.
D Multi- family ❑ Master buildcr 0 Other: Description Qty. Ea. 1_ Total
JOB SITE INFORMATION AND LOCATION P,N ‘ Heating/cooling ....
/�� .5"7"" _ Air conditioning
Job site address: / 2ZT Z />t'!J /I�� � . (requires sue plan showmy / 46.75 Ito, 7 S
I City /State/ZIP a -�J Furnace 100,000 BTU (ducts/vents) 46.75
// �' Furnace 100,006+ BTU (ducts/vents) . 54.91
Suiterbldg. /apt. no.: Project name: C i t /2-:d y Heat pump 61.36
Cross street/directions to job site: cJ� � Duct work 23.32 /
Hydronic hot water system 23.32
1 Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivisior.: Lot no.: 23.32
Tax map /parcel no.: Other fuel appliances 2' 3�
DESCR1P77Ol�i OF wow Water heater
Gas fireplace 33.39
.r A'x 1 P Ce, PT Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/peliet stove. 33.29
Wood fireplace/insert ' 23.32
Chimney/liner/flue/vent 23
0 PROPERTY OWNER TENANT Other: 23.32
Name.: 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: ( ) toiletcampartments, utility rooms) 23.32 I
Attic/crawispace fans 23.32
❑ APPLICANT ❑CONTACT PERSON . '. Other: 23.32 1
4 Business name: Fuel piping
I Contact name: � r /�a� n r}- ) / 5 $14.15 for first four; S4.03 for each additional
G1 `� / f Furnace, etc.
Address: Gas heat pump
City /State/ZIP: J J �77 1l - 7/� Wall/suspended/unit heater •
Phone: 53) (pa4't 702" Fax: SI8 - 0�/ V ,_ Water ter
L- broil: Ran
•
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: 0 W M,►_ t t arlit a . _ , 7r OA- . _ Other.
Address: l c \( ,� 3 MECHANICAL PERMIT FEES"
6
City /5taCity/State/ZIP: LaTT n t / n j) ., 7 U
Q i — Subtotal
Q pp Minimum permit fee (90.00) � , JC
Phone: 63 ) ` L A lux: ( - 1 0 ) 1 r, - 0,170 Plan review (25% of permit fee) • CO3
tic.: '76, 355:C1 State surcharge (12% of permit fee) 10 ,
TOTAL PERMIT FEE 1 1 (Q ,
� 2 This permit application s b if a permit complete. is sot obtained within 1R0
Authorized OriZed signetu days after it t bas been accepted as complete.
Print name• t / / !1 /Q ✓1 ����q D ate: 7 Gee methodology set by Tri- County Building lnJuury Scrvrcc Board
V. � /�
440- 46l7t(lt,07JCObL'WEB,
C vlk,,mh o 4-e.€1 \,. 4-Ce6144
Jul 30 10 12:57p Columbia Heating /Cooling 503 -598 -0270 p.3
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HEATING & COOLING, INC.
P.O. BOX 230397 . TIGARD, OR 97281
(503)624 -2704
SITE PLAN
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ADDRESS: r '�-q pt r