Permit s°� CITY OF TIGARD MECHANICAL PERMIT
` COMMUNITY DEVELOPMENT Permit#: MEC2009 -00545
Date Issued: 10/15/2009
(�,qRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S136AD00300
Jurisdiction: Tigard
Site address: 10430 SW 66TH AVE
Subdivision: VILLA RIDGE NO. 2 Lot: 3
Project: Spence
Project Description: Replace gas furnace.
Owner: FEES
SPENCE, THEODORE A & LINDA L Description Date Amount
10430 SW 66TH
PORTLAND, OR 97223 Furnaces < 100K BTU 10/15/2009 $46.75
12% State Surcharge - Mechanical 10/15/2009 $10.80
PHONE: 503 - 245 -1549 Minimum Fee Adjustment - Mechanical 10/15/2009 $43.25
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97223
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
issuanc , i wor 1 ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Center. ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or rect questions to OUNC b ca • 5 3.246.6699"or 1.800.332.2344.
Iss ed By: 1 1 (Y Permittee Signature: tiorr Ow?
•
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.
;el NMechanical Permit Application 7 . `` ' rcti i -t� =r t . ... r r`" 1(° „
' ° ' . . :: , C of Tigard E n4 Permit Nr,.: i&0 4151 I
.-•"..' k 13125 $t' Hall Blvd., Tigard, OR 9T Plan Review
Phone: 503.639.4171 Fax: 503 - 598.1''6 D Other l'cr u
tTIG'R,IJ, Inspection 1..inc 593.639A175 OCT A 1 2009 ppn DucRcadyBy. ® See Page t(. -
..,- . Internet www.tigard or.gov y�� Natificd/Mcthod: 1 : )C Supplemental In
T fC71Y�ttt7 l
TYPE OF W
COMMERCIAL 'FEE* SCHEDULE - USE CHECKLIST D G DIVISION Mechanical permit fees' are based on the value o1 the work
❑ Ncu constniction ❑ Addition /alter rep acement
performed. Indicate die value (toundca to the nearest dollar) of na •
❑ Demolition ❑ Other: mechanical materials, equipment, labor. o>•erhead, and profit.
I CATEGORY OF CONSTRUCTION - - value: S
i RESIDENTIAL EQUIPMENT / SYSTEMS FEES* •
❑ 1 - and 2- family dwelling ❑ Commcrcial'industrial ❑ Accessory building
For specia information use checks. ,t
1 ❑ Multi family ❑ Master builder ❑ Other: Description Qty, I Ea. Total
JOB SITE INFORMATION AND LOCATION HeatinWcooling
f / 'f' C v1 Air conditioning I
.for) silo address: I . . ) A� V if 6-, & :requires site plan showing_ placement) ! , 6. 7 ) 1
Citv'State 7.IP - Furnace 100,000 BTU (dnctt`vents) 1 =6.75
Fumacc 100.000+ BTU (duetsvents) 54.91
Suitabld a t. no.: Project g•' Pecl name: p 3 Heat pump � 61.96
Cross street to job site: Duct work 23.32
livdronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric).
in - wall, in -duct, suspended. ctc. 46.25
Flue /vent for any of above 23.32
Sdhi ision: Lot no.:
Other: 21.32
Tax clap /parcel no.: Other fuel appliances
DESCRIPTION OF WORK - - Water heater 23.32 1
Gas fireplace 33.39
L ie . i _ Flue vent for water heater or gas
1 I fireplace __. 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplaccrinsert 23.32
Chimney/liner /flue /vent I 23.32
PROPERTY OWNER ❑ TENANT Other 23.12
Name: Environmental exhaust and ventilat
-- Range Range hoodiother kitchen
Address- equipment 33.39
C'ity/State /Z1P: Clothes dryer exhaust 33.3
Single -duct exhaust (bathrooms.
Phone: S' 3)) 2 t S L! Q Fax: ( ) toilet compartments. utility rooms) 23.32
) I J Atticicrawlspacc fans 23.32
❑ APPLICANT ED CONTACT PERSON
Other: 23.32
Business name: Fuel piping
Contact name: /2" Y /i , - epor j S 14.15 for first four; S4.03 for each additional
Furnace, etc._ 1
Address: Gas heat pump
C i h'State/Z! P: Wall/suspended/unit heater
?Bone: f 3) la r� ..ald T- lax:: 63 E -d 70 Water heater
Fireplace
E-mail: Range _-_-
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: • . , s L�a7/ tea Siii.. _.
�. I w[ r Other: -
Address :. ' ,q.. 46: • ' • • • MECHANICAL PERMIT FEES
Ciiy1,StateaZIP: 7167912.0 0.0 1 17 51
Subtotal
Minimum permit fee ($90.00) 9
Phone: } n
h-� flan review (25% of omit fee
CCI3lice: '7/ "Q State surcharge(12 %oP permit fee) AO . SD
1 TOTAL PERMIT FEE 6/400 .09
This permit oppticanon expires ita permit is not obtained ivi 6in 1Rfl
Authorized sigllatur : , ^ 9 , ; NA da after it has been accepted as complete.
Priri name: • U , .- i f Date: 71 Fcc methodology et by•l ri- Count} • Building industry Service Rr:.1
1\ti.iil d,nuWermn s',1.1 RC-Permit non dm IOiOI� 430 -4617) (11 l721 MfWhB)
Z'd 0LZ0 6uiIoo0 /bui1 eH eigtunlo0 e9t7:60 60 t l 100