Permit CITY OF TIGARD MECHANICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: MEC2010 -00571
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2010
Parcel: 2S110DB92011
Jurisdiction: Tigard
Site address: 15486 SW FOUNTAINWOOD PL
Project: Perusse Subdivision: Lot: 0
Project Description: Furnace change -out.
Contractor: COLUMBIA HEATING & COOLING INC Owner: PERUSSE, LAVERNE
PO BOX 230397 15486 SW FOUNTAINWOOD PL
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 530 -8071
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/09/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/09/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/09/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
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 Notifi r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct estions to OUN b > • Ili • ' 503.232.1987 or 1.800.332.2344.
Issued y: / Permittee Sign ure: / gfi
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Nov 08 10 04:52p Columbia Heating/Cooling 503-598-0270 p.1
Mechanical Permit Application ..()Ii orrici.: csr oNLY •
City of Tigard
• 13!25 SW I lall Blvd , Tigard, OR 97223
Pr
3 / !Thom. 503 639 417l I.a..x. 5C3.5Y8.195u cF
a ATED eceft ived 17 4 Permil No.: „
dip
patesy: A
nlan Review
Date/By: ii • ....
Other Permit .
ir.pectiun 503629
i.me: . 41'75 Juris 45 e PEc
TICiARO 9 z olp . D St a 2 fur
d:
!menet. WW11:*.ligard-i_ii.gUV NO \i SUppiernefAtil lafornia:iur
• TYPE OF WORKC1TY 01 T N COMMERCIAL • FEE* SCHEDULE - USE ciik.ch .
lim DivISlu
Mechanical permit fees* arc based on the value ul tre work
0 New construon Ef<id
performed. indicate- the value (rournled to the nearest dollar;
1)Mt)!:::0:1 E Other: mechanical materials. equipmerK, labor, :/verhead, ancz
S
CATEGORY OR CONSTRIWIION ' •:. :: ••••..- .. ..r. . • Value:
: RESIDENTIAL EQUIPMENT / SYSTEkLS FEES`
[tr i.‹d 2-family dwellirg 0 Commercial/industrial 0 Accessory building
For special informaiitui use check,';i: _
. 0 Vlulti-family• E Master builder 0 Other: Description Qty. 7 .:a r-
1..:.1
JOB SITE INFORMATION AND LOCATION ' : ': • •• :.••;• • • .!.. • ' Heatingkooling
i
Air conditioning
• Job site pddicss 1 fy g c 5_.j rouivrpr-r cavoo ,t..., fregnifes site Plan showing Plugcnivni% 46.75
• (..ililtitertil' 77 Ccittoed Ot 90t& I 1 Furnace 100,000 BTU tducts•N-enist )(,. 46 75 i
Furnac• e 100,000+ BTU .:duetvvents) 54 91 ;
' Suittlibldgiapt. co.: Project na:r.e: - I -
lieat pump 61 tx,
_ . 2.... _ .... ._..._. ,
• Cr...ss sue:L.' diXClitill lo jot. tiit: Dtitrt work 1 .--
- Hydronic hot water system .2S 32 !
. Residential boiler trathutor or
. hydronie) • ' 3 32
. I./nit heaters (fuel-type, no: eleetr.et.
• in-wall, in-duct, suspended, etc. 46.75
t- Flueivent for any of apuve i 23 32
L.ot no.: I .
Other. ; 23 32
I I ax !IL:pip:III:CI :1C.. Other fuel appliances
I DESCRIPTION OF WORK - .
.. . Water heater 2..: J... .
Gas fireplace 3339 1
... Fv/ZNA'CA CeMtNfie -our-. Flue vent for water heater or gas
. ..
l fireplace ' ''i 3' -
- . _ •
,. •
I Log '.ighter (gas) 23.32 ,
Wood/pellet stove .33.3v :
Wood fireplace/icsen 23 3?
- r
i ,, „,
ROPERTY OWNER 0 TENAN
I T O
. . Chimneyilinerftlueivent
ther -J i - .
, 2 7
' '': J4111 _ Pe 2- vAre . Environmental exhaust and ventilaritm
Rettig,: hcxxliother kitchen
1
l Addre"'
J5 C Si") f.,c.. cquipmer.t • 13 ';-,
___
' ..'it r , , Aim og_f_zuszr Clothes Myer exhaust 23.3
• - - •
Single-duet exhaust (batrifixint.. ,
PliJiic: „-. 570 epi7r Fax: ( / toilet compartments, utility rooms/ 2332;
_
3: .
[ 0 APPLICANT 0 CONTACT PERSON •• Atticierawispadc :-is 23
i Other:
I ii ['Jain::
1 Fuel piping
r
S14.15 for nrst four; S4.03 ur each additiotral
! Contae: "Ltille: II r i e , r /77 pp() / (52 - 71 .
.r- . Per:lace, etc. I
•
H:alres
1 Gas heat pump
-
1 C.:y:Siaiel/IP: Wall/suspendeeVunli heater
Phone la 3) (,),Q 4. Q 701,Z Fax: . Er6 538 -e);-70 Water neater
4 Fireplace
• L-rneil: Range i
.. CONTRACTOR. . .
Jusiness name: , M,4 1 .. i m i g//3_14c4-7-7 1‘... 6 4 * a- 04... i /, -16_,. BarbcCile
*
Clothes dryer (,gas) -I-
I 7
Other:
—
I Address: 60`x 6 - .. 9 •7 MECHANICAL PERMIT FEES*
...
Mi f ... .. . .
i City iStateIZIP: . 7-76,.F r i2f) otec T7,--)g i Subtotal
1— , • . .
nimum permii ee ..39 I 19•
1 Ig.lo:le : .6'3 . 1 , fit (7) .1-f- 1 l'ilx: (• ,......5(3.F
Plan review (25% of perm ii :Ue..) i ----”
. CCI3 c : , ( ....,
/r),--...5-1 State surcharge (12% of pemc: sec) .
TOTAL PERMIT FEE _1106 . /f)
This permit application expires if a permit is not obt ,,
ained 1*.hin 1: •
Atillofited signattirci:J/L/W)
dup after it has been acct.:pled a, cvmplete.
i Prim munotra (T Date: ik-;15 - i 0 j • Fee methodology set by 7ri,Contry IsuiChn Iniuse) Ser.i., C. .., • LAP
1 .13,1iinr2o dua 10101 44G-45171" '1 .;02,C01,VV+1,111