Permit CITY OF TIGARD MECHANICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: MEC2010 -00478
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/01/2010
Parcel: 2S110DD08100
Jurisdiction: Tigard
Site address: 15750 SW HIGHLAND CT
Subdivision: Lot: 0
Project: Hess
Project Description: Furnace replacement.
Owner: FEES
HESS, HENRY T /MARY C Description Date Amount
15750 SW HIGHLAND CT Furnaces < 100K BTU 10/01/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 10/01/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/01/2010 $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.
Issued By: - _ Permittee Signature: aa 4
CaII 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.
Sep 2910 08:21a Columbia Heating /Cooling 503- 598 .0270 p.2
Mechanical Permit APPareiCRIVED ) (>it 01.114 •1. 1 SI 1/NI.1
City Ti and R1 ceived •
IN 131 SW Hall Blvd., Tigard, 018 2t 9 Date/By: �� Permit l:o. :. v O- L
Phone: 503.639.4171 Fax: 503.598.1950 2690 y `v"" OtbcrPermit:
Irspectiun _ire: So3.639.a1Z3I OFTIGARD Daze R LA,: ' 21 See Page
I1tinIl Internet: www.tigerd -or.g NotifedrMetiwd: •��_ Supplemental Information
aU ILDING DIVISION `-` cs
: c .. ,,. j ^' . :# : - ,:i • : ': ‘ ki . figtittegriajAttAteggiglItg :7: 1./.1 CHECKLIST
❑ New constriction Addition /alteration /replacement Mechanical permit fees' are based the value of the work
performed. Indicate the value (rounded d to the nearest dollar) of all
❑ Demolition 0 Other mechanical materials, equipment, labor, overhead, and profit
tGe Value: S
CAT RY• O .. , �.t I .';;. .�,;�. :,;, er '•e�
IIIP SYSTEMS FEES'
I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ' " fir'
For special Jnfcratatron we check,sr.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty I Ea. I. Tota:
....: JOB SITE: LNFQRMATION : : AND.q:OCATION : '� j : ::; rt:;: ^ Heating/cooling
y
J Air conditioning �� -.-
lob
lob sire address: /5-7.5-t) S w ` T t, I f e et / e7-- e (requires site plan showing placement) 45.75
Cit /State.'Z1P. ,f Furnace 100,000 BTU (ducts/vents; 1 45.75 F
l / D� C l . 7 "
,j G�-!r Y Furnace 100,000+ BTU (ducts/vents) 14.91 I
Sui :eib :dg. /apt. no.: Project name: f / -"J Heat pump 61 06
Cross streeticirections to job site: J Duct work 23.32
1 Hydronic hot was system 23.32
Residential boiler (radituor or
' hydranic) I 23 32
' Unit heaters (fuel -type, not electric), I .
in -wail. in -duct, suspended, etc. ' 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 1 . 23.32
1 Tax map /parcel no.: Other fuel appliances . _ :
: a ,�(, •r .L; Water heater 23.32 I -1
; 3111 E. 4 C RI�' 170N . ` O �� ' WQ,�K� '��:� , �k_=';�� a . , , �
`� _ _ Gas fireplace 33.39
� ya�6`' z4 Flue vent for water heater or gas ,
fireplace 23.32
t / Log lighter (gas) 23.32
Wood/ pellet stove 33.39
Wood fireplace/insen 23 32
• . ❑ PROPERTY OWHEIL. i .: '1:.., ❑.,TENAN Chimney/liner/flue/vent 23.32 1
v . .. Othe^ 23.32 •
Name: 44 f , I LS _s Environmental exhaust and ventilation
•
f� Range hood/other kitchen
Address: j 5-) yz _ 6,J rp , f e r4rr ✓ �( / equipment 33.39
City/Statc/'LIP: -- / Clothes dryer exhaust 33.39 1
I f. ^,� /r � S7 Z z �/ Single -duct exhaust (bathrooms,
Phone: ( ) 6239 _i 3 t/-, Fax:: ( ) toilet compartments, utility rooms) 23.32
. ❑ APPLICANT '?>- ?? p .Qi,GQNTACT P AI ;: r.;: Attidcrawlspace fans 23.32
Other: 23.32 .
Business name: - •
Fuel piping
Contact name: 7 / (3 k rn QPri�rn S2 4.15 for first four; S4.03 for each addirionat
I Address: , / I Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended/unit heater
•
( Phone: 00 3) 4, a 7 /,L I Fax ::663 5 l g _o cD 7O Water heater
Fireplace • , _
E-mail: ( _g i
. . .coNr ICTQL : '` '.'y _ . .. . . i :. . Barbecue ,
Business name: r I 'tt f r A J' � i / 1 )/Y Clothes dryer (Ras)
Address: f0 frig �!' )( { 2 � O 7 ` v Other: � ,' ", •7= .0i. NICAL PERT FEES` 1
716 Cily!StateJZ[P: Q ! Y7 f Subtotal ` •
{ Minimum permit fee (S90 00) '
Phone: 603 j '1 I Fax: 5 9 t - a O Plan review (25% of permit fee)
CCB tic.; 7(r) 9 i State surcharge (12% of permit Ice) •
TOTAL PERMIT FEE I ) _
Authorized sig/tatur : This permit application expires if a permit is not obtained witbia 110
days after it has been accepted as complete.
Print name:l / ti.ar t /JJJ !/ 6 Date; .,4 2) 1 • Fee methodology set by Tri County 3uild nu lhdytry Sery c Bout
I: lBuildia�?enniti ,MEC•PanicApp.do 10 / 440