Permit CITY OF TIGARD MECHANICAL PERMIT
11111 ' COMMUNITY DEVELOPMENT Permit #: MEC2010 -00525
13125 SW HaII Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
TIGARD Parcel: 2S111CD10000
Jurisdiction: Tigard
Site address: 9825 SW KIMBERLY DR
Subdivision: KEVINGTON Lot: 1
Project: Foley
Project Description: Replace gas furnace
Owner: FEES
FOLEY, THOMAS P Description Date Amount
9825 SW KIMBERLY DR Fumaces < 100K BTU 10/26/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 10/26/2010 $10.80
PHONE: 503 - 577 -4022 Minimum Fee Adjustment - Mechanical 10/26/2010 $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 $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: /f / to Permittee Signature: el/ /1-71 /C 70 �
��� YYY CaII 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Oct 22 10 12:57p Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Application 1:012 /01:11( l: 1. Si: ONLY
C
N.- ..1„, City of Tigard 22 ` / 24�o Per®r Nq/. f Coo /0 -eos2
13125 SW Hall Blvd., Tigard, OR 97 3 Plan Review
a Phone: 503.639.4171 Fax: 503.598.1960 Dale/B it:
y: Other Penn
Inspection Line 503.639.4175 ‘,4 L o f
I It; A I:1_) CO Data Rea dy:B y: ES See Page 2 for
InterneInternet www.tigard or.gor li k �tFplificd/Methad: /( Suppkmcatal Information
• . . TYPE. OF WORK G IB o rt Q S. COMMF`ACIAL' FEE*. SCHEDULE — USE CHECKLIST
❑ New construction tAddition/alterationhepl t � O 1 C � Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
E Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. • CATEGORY OF.CONSTHUCTION • •' ', • Value:$
RESIDENTIAL EQUIPMY2 TC / SYSTEMS FEES*
"R and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder E Other: Description Qty. 1 Ea. I Total
JOB SITE. INFORMATION AND LOCATION . =- -.: • Heatitrg/cooling
Job site address: a � Ii Air conditioning
7
� F i (require res site te plan showing placement) 46.75
City;State /ZtP: Furnace 100,000 BTU (ducts/vents) / 46.75
Furnace 100,000+ BTU (ductvvents) 54.91
Suite/bldg. /apt. no.: l Project name: Heat pump 61.06
Cross streetidirections to job site: Ductwork 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or •
hydronic) 23.32
Unit heaters (fuel -type, not electric), 1
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above , 23.32
Subdivision: ( Lot no.:
Other. 23.32 j
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK' • ' Water heater 23.32
Y' _ _ /� „ R ^ Gas fireplace 33.39
-- ; f - a (�Q - t (S t Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner /flueivent 23.32 •
ig PROPERTY OWNER Q. TEST Other. 1 23.32
Name: 7 -, Environmental exhaust and ventilation
Address: 982.5 S� > �, / ( �-��N Range hood other kitchen
` V / equipment 33.39
City /S :ateiZlP: ( ® tvx( ,a et Clothes dryer exhaust 33.39
� Single -duct exhaust (bathroos
Phone: r l , _79 J Fax: ( ) m i toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Atticicrawlspace fans 23.32
. Other: 1 23.32 I
Business name: Fuel t
P p
Contact name: m(2 r /70)-20..._ /7') ') ee(Y)7 l 5 14.[5 for first four; 54.03 for each addltional
Address: Furnace, etc.
Gas heat pump
City /Seate!ZIP: �7 ,sue Wall/suspendedlumitheater
Phone: 33) (" 70 �L Fax: 5 l q 8 -VD-70 Water a eater
E -mai I: Range
.. . • .CONI'RACIOR - , Barbecue .
Business nam zi 1 m r,I R r7 c l A .1/ Clothes dryer (gas)
` �� �1 / ` V Other
Address: 9 ,8,,,v
2 ( > 9 7 . • MECRANICAL PERMIT FEES*
City/State/ZIP: _ ZIP: � g ) Subtotal t
^ r p Minimum permit fee ($90.00) '?Cl 1 Q'C)
t p/Phone: r _� „I,
r (
Fax: .13) f _ 0.:01.70 (25 %of permit fire) 1
Plan review �i
CCB lie.: 7(n � 9 � State surcharge (12% of permit fcc) /0 ■ d ' O1
9 TOTAL PERMIT FEE V QD,fij ` ,..---
Authorized SignatUr
���� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ( q / /0,33:. 1 / l ' Fee methodology set by Tri -County Building Industry Service Board
X7,7 Date; [ �./ 1r /
l! $uildintigemuteMEC- PermitApp.doc 14'01109 444 -itITt (1IrO2/COM?1V ^a)