Permit CITY OF TIGARD MECHANICAL PERMIT
71 ;' a COMMUNITY DEVELOPMENT Permit #: MEC2010 00396
T [ G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/06/2010
Parcel: 2S110DD02600
Jurisdiction: Tigard
Site address: 10595 SW CENTURY OAK DR
Subdivision: SUMMERFIELD NO. 1 Lot: 33
Project: Caldwell
Project Description: Dryer vent.
Owner: FEES
CALDWELL, SHERYL Description Date Amount
10595 SW CENTURY OAK DR
TIGARD, OR 97224 Clothes Dryer Exhaust 08/06/2010 $33.39
12% State Surcharge - Mechanical 08/06/2010 $10.80
PHONE: 503 - 665 -2505 Minimum Fee Adjustment - Mechanical 08/06/2010 $56.61
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 $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800
. l_._.
Issued By: — . / Permittee Signature: ' _ - , L
i /
Call 5 . 9.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Aug 0510 04:20p Columbia Heating /Cooling 503 -598 -0270 p.1
Mechanical Permit Applications r - - 0 , I OI{ ()I I.I( I: ( tit'. OBI.)
City of Ti and ;� Rived
•J ! �`+ Dates nil= Permit No.:
: / 1 13125 SW Hall Blvd., Tigard, OR 9 2 ` _ \ - r Y I A
G Plan Review
Phone: 50).639.4 [7l Fax: 503.5 98.1960 - /Jei Date/Ely: Other Permit;
'i li Altli Inspection Line: 503.639.4175 ��l�l Date fl //B 1,.,t=: ' El Sex Page 2 m
Internet: www.Iigard-or.gov
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s ., . � .Y ?.. f5 ULE - USE CHECKLIST
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El New construction AtAddition /alteration/replacement Mechanical permit fees* are hexed on the value of the work
performed, Indicate the value (rounded to the nearest dollar; of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
.• .. CATIGORX CQNSr* ONs `a t,i,� ;•i±�r :1;;!. i : :' ;r +, ,#;. :. Value: S
.
R **0 44...gQLIIP T • /9Y$TEMS FEES*
1- and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Mlb- family ❑ Master builder ❑ Other: Description Qty. I to fugal )
. - JOB SITE • INFORMATION AND LOCA3'JOl'i - `' .., •,,;, : .. `..? `; Heating/cooling
Job site address: f ^' ` "' ra Ce 'T f f l i e OW� Air conditioning
{rrqui sat plan showtn( place neat) _ 46.7
CityJState /Z1P: Ti rJ i,- ni
Furnace 100,000 BTU (ductslves) 46.75
x"'11 � � � Furnace 100.000+ BTU (aucwvents) 54.91
I Suiteroldg.7api. no.: P ` roject name: e Heat pump 61.06
Cross street/directions to job site: ' Duct work 23.32
Hvdronic hot water system 23.32
Residential boiler (radiator or
hydronic) 2 .
Unit heaters (fuel -type, no: electric), •
in- wall, in -duct, suspended, etc. 46.75 '
' Flue /vent for any of above 23.32
•
Subdivision: Lot no.: •
Other: 23.32 •
' Tax map /parcel no.: Other fuel appliances _
`' ' / Water heater I 23 32 • apE5CIQ O lrr / : y`^ sc' ,`'h' °;:' ..
i . ; Ri "ids$.
- ' 1 Gas fireplace 33 39 ,
_ Flue vent for water heater or gas
___, . ICY/eyLP-1°_, _ .
fireplace 23 32
V Log lighter (gas) I 23.32
Woodr'pellet stove 33.39
•
Wood fireplace/insert 23.22 r
PROPERTY OWNER ,•.'':I . - . ❑ ..:. Chimney /linerltlurr'vc 2132
" . Other: I 23.32 _
Name: \ J / l o (( / ' r Environmental exhaust and ventilation
r j d' Mange hood/other kitchen I
Address: ��� � J1 AL equipment 33.39
City / State /ZIP: 11 .1 I ft___, Clothes dryer exhaus.. 1 33.39
f? ivY r o is (bathrooms, —
Phone: C toilet Fax: ( ) toilet somp ompartme rtrnents, utility litl• rooms) 23.32
. • ❑ APPLIC!1Na .. x1 4? ;'; a uir , l r. AV a` -: i Attic/sraw•Ispacc fans 23.32
Other: 23.32
—
Business r.ame: Fuel
/1�rV , �f piping
•
C
•
ontact name: r //f r ��� /Y1. ePt .l �m $14.15 for first four; $4.03 for each addi tional -
Address: ' Furnace, etc. i
Gas heat pump
City /S:ateiZIP: Waft/suspended/unit heater
Phone: l 3) t 1 �. a �Q 1 Fax: :66 ) � 9 g . ,0 ( )_ 7 0 ) Water heater
t Fireplace
E -mail: Range
.. CONI°RACTO3t' . :.,- .?,. :... - . . - • • Barbecue •
: � 1 , Clothes dryer (gas) {
��� � 'f il r r Y�7' t -'� CJ� �' � �
Business name Other . 1
Address:6) ` r� bZ,3z -. 3 ! .7 "';: MECHANICAL PERhfTI FEES*
•
City /State/ZIP: 7 Q 9? S f Subtotal 1 q Minimum permit fee ($90.00) (-'10.(10 (-'10.(10 Phone: r) 6,af . .. , a 7 ( 1 Fax: ( 6JF _ 0,)_70
Plan review (25% of permit fee)
CCB iic.; r7(,0 9 State surcharge (12% of permit fm) 1 6 . bt
1 TOTAL PERMIT FEE 1 W_kD __
Authorized signature �� /Q This permit application expires if a permit is not obtainer xii hie fair
_ days atter it has been accepted as complete.
Print name: A ti r . 4 0 gra . . � 4 7 ] t - ) • Fee methodology set by Tn•Coanry Bui.dinb Industry Scrri_c 3oJc
I: Build )ng1PermiesU.LC- permitApp.da IWC1 /09 440 -46 ITT (1i /OJCOM/WEB)