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Permit 4 _, CITY OF TIGARD � MECHANICAL PERMIT III yR , .1 ` _� COMMUNITY DEVELOPMENT Permit #: MEC2010 00615 , f 1 ,A.' Date Issue: 11/24/2010 TIG 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 b„ w : Parcel: 1S136CA90121 Jurisdiction: Tigard Site address: 10900 SW 76TH PL 12 Project: Wischmeyer Subdivision: TIGARD WOODS CONDOMINIUMS Lot: 12 Project Description: Replace furnace. Contractor: COLUMBIA HEATING & COOLING INC Owner: WISCHMEYER, SARAH M PO BOX 230397 10900 SW 76TH PL #12 TIGARD, OR 97281 TIGARD, OR 97223 PHONE: 503 - 624 -2704 PHONE: FAX: 503 - 598 -0270 FEES Specifics: Description Date Amount , Furnaces < 100K BTU 11/24/2010 $46.75 Type of Use: MF 12% State Surcharge - Mechanical 11/24/2010 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/24/2010 $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 Notification Center. 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344. issued By: Permittee Signature: r or/ x / /970 661. -7Q,\/ 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 23 10 04:38p Columbia Heating /Cooling 503 -598 -0270 p.2 Mechanical Permit Application �� I oI(I)rri i I Sr. 0:S1,1 City of Tigard *> ; r �� ,Received •J . i� DaterB: �/� a2 (� 0 1re Permit N°./1/6-e-010/0 - ©© / 4 III :3125 SW Hall Blvd., Tigard, OR 97223 i? �� , , e�ew' `.' • Phone: 503.639.4171 Fax: 503.598.1960 \\` G. ' IZ> ;Y Other Permit: 7I.:n1w Inspection Line: 503.639.4175 O � S l� a � R y /a tars.. ® See Page 2 for • • Internet: wwh.tigardor.gov (SS's `G. NotificNMCttad: 716.- Supplemental info rmatioi Yt 411.* 0 WQ1#0.;. , I; ,.4 c4 ,'i r 24014 A�' Et 'SC E 4.E - USE CHECKLIST ❑ New construction ❑ Addilionfalteration !replacement Mechanical permit fees* arc based on the value ot'the work performed. Indicate the value (rounded to the nearest dollar) or ail ❑ Demolition ❑ Other: mechanical materials equipment, 'tabor, overhead, and pruti, Value CA 'I QE � c9.l`iS.1144 ,,,, � r X 1 •and 2-family da'zllin ,- RESIDE .04LEQUIPMENT /:SY FEES* ❑ y g ❑ Commercial/industrial ❑ Accessory' building Q Multi- family ❑ Master builder 111 Other: rorspecial Information use checkli t Description Qty Ea. Totter . JOB SITE INFORMA77ON :ANIt LOCATION: . '!` Heating/coolin • 3 ( o site address: / Air conditioning l (�(: Q(� S lit) � � i �Z c - . .- (� . • (requ res site plan showing placement; 46.75 1 c cm- S» z. CitvtStatetZlP: ..- Furnace 100,000 BTU (dictstvents; 46.75 f ect name Suitebldg.,'apt. no.: Proj �! Furnace 100, BTU (duets/vents) , 54.91 CO LG / � /�-- Heat pump _ 61,06 I Cross street/directions to job site: Duct work 23,32 Hydronic hot water system 23 -32 Residential boiler (radiator or hydronic) 23.32 . Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc 46.75 I Flue/vent for any of above , 23.32 Subdivision: I Lot no.: Other: f 23.32 Tax map /parcel no.: Other fuel appliances ... ... .1¢ESCRIYFIQN ©F* l - t: ; : M); l i Wate heater 1 23.32 I ' Gas fireplace 33.39 f-A- x-t. tr%irsia--f----C- Flue vent for water heater or gas d/ fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet Stove 33.39 i Wood ftreplace/insen 23.32 Chimney/liner /flue /vent 23.32 0 PROPERTY OWNER - . 0 TENANT : :' ,, . - •• • Other: 23.32 Name: ,z.4.41.4, (x.), L ,a / • 04 t , Environmental exhaust and ventilation r" . t- � / Range hoodlother kitchen I Address: (0 '7G:: a w` 7 6 (4 /�l t - e ui ment 33.39 Ci:yiState /ZIP: j , .r , ! !! 9 7 Z z 3 Clothes dryer exhaust 33.39 1 Single -duct exhaust (bathrooms, Phone: (57), }) yz . 3 5 / Fax: ( ) toilet compartments, t;tiiity rooms) 23.32 0 APPLICANT, , . i i : � if0� ] CQNTAGT 1?FR$QN t 4t t>I i Attic /crawlspace fans 23.32 - Other: 1 23.32 Business name: - Fuel piping Contact na--ne: M P �f $14.15 for first four; 54.03 for each additional • Address, Furnace, etc. Gas heat pump City'State /ZIP: r� � f� -� Wallisuspended/unit heater Phone: a ) ( / Q ..,,,,. Fax: :5 C -l1 - O Water Fireplace ater E -mail: Range - .CONTRACTORi : - Barbecue Business name: 0 � i m �� l r'r-rt, X ' , cc-,0,/,,,,c,--- Oth er hes dryer (gas) liTt t Other: .3 Q 7 MECi9ANICAL PERMIT FEES' 1 City/Stote/Z1P: 7ti � O 9 7c- f Subtotal 1 re, o'. 1 ` i� ' 7 J ! �} � �7 Minimum permit Yee (590.00) n : ) }{�� 1 Fax' s -�7 .5 N al -(� Plan review (25% of permit fee) le CCB lie.: '7/„ C? State surcharge (12% of permit fee) I /( J , �d l V f J j / / f TOTAL PERMIT FEE / • r�I e...--" Authorized si gnat ur.: !I A A 1 /f /f 't-hiu permit application expi ifs permit i5 not obtained within l00 "``./Ill . t' days after it has been accepted as complete Print name: al---!0 i C J/ / l Date: * Fee methodology set by Tri County Builcing industry Service Board In auilding '3ermits11.4EC- PerirtApp,d c t0/01/03 440- 46I7r( t 1/02'COM/V,'EB)