Permit q
CITY OF TIGARD MECHANICAL PERMIT
s . ° < COMMUNITY DEVELOPMENT Permit #: MEC2010-00635
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/08/2010
• , . —., D' gar Parcel: 2S102CA00938
Jurisdiction: Tigard
Site address: 13450 SW VILLAGE GLENN CT •
Project: Larson Subdivision: VILLAGE GLENN Lot: 38
Project Description: Install gas furnace.
Contractor: COLUMBIA NW HEATING Owner: LARSON, SABIN
PO BOX 622 13450 SW VILLAGE GLEN CT
SCAPPOOSE, OR 97056 TIGARD, OR 97223
PHONE: 503 - 543 -3624
PHONE: 503 - 314 -8232
FAX: (503) 543 -6285
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/08/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/08/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/08/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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, i work i suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N ification Center. T • .: rules are set forth in OAR 952 - 001 -0010 through OA' • -00 1090. You may obtain a copy of the rules
or dire questions to OUN . i callin. 03. 32.1987 or 1.800.332.2344.
Issue By: �� e /
Permittee 'i "/ // /
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.
12/07/2010 15:56 5035436285 PAGE 02
-o
Mechanical Permit A &a 0 ..),,(�1 i.i 1 I s & )'.L\
City of Tigard l . ' 7 /o (D/9 permitNo.: Nee 1 . 0 , 6 6 3 .1
} ' 131 .25 S W Hall %yd., r ice, OR 97223 P lt ,
IN
A Phone: 503.639 -4171 Fart: 503.598 -196CD E 2010 i>�e,}y. Permit; •
''rt,a; A,. l Inspection Line: 503.639.4175 Pete R ems LEM=
Internet: www -ti rd -orgov CITY OF TiGARD Notified/Method:
TYPE OF 54 Di yiSivi` 0jMMERCIALL fP- gpigDU.p = use CtIrCICLIST
Mechanical permit fees'" are based on the value of the work
❑ N construction �AdditsonfalteCB#i0C11xepiat Ytt wed, Indicate the ankle ( dcd to the nearest dollar) of all
0 Demolition ❑ Other. mechanical materials, equipment, labor, overhead, and profit.
C&TWORY OF aim - Itut -rION . . . _ Value: $
.
I . tItcti1?MENT d SYSTEMS FEES"
1- and 2- family dwelling ❑ Comntercia1 industrial ❑ Accessory building spscrrxt information use checklist.
Far ❑ Multi-family ❑ Master builder ❑ Other: Description Qt rEa. I T'cnai
JOB SITE IPik'URNIATION ANI) 11X CATION • $eatt • cool ._ •
-
Job site addtus!+: �f t CT Air conditioning (ipq fires site plan s us/M6 placetncra) 46.75
City /Stalte/ZIP: 7Z� R4) OK 3 Mamma 100,000 'fl (chars/vents) / 46.75 ', #-•
Furnace 100,000+ 13'TLi (ehnets/vems) . 54.9I
Suite/b[dg. /apt. no - : 1 Project name: Heat , , ■ 61.06
Cross street /directions to job site: Duct work 2332
— Hydronie hot wafter system 23.32 ,
Residential boiler (radiator or
hydrooic) 23.32
Unit heaters (fucl not electric),
in.-wall. in-du. au:. - ded, etc. 46,75
Subdivision' Flue /vent for ay of above 21 -32
Lot no.:
Other 23.32
Tax map/parcel no.: O er Tnrl m ftatcres
DESCRD'TlON OF WORK ' • ' Weer healtcr 23.32 .
/ � Gas fireplace 33.39
______ { r Floc vent for water heater of vs
Fireplace 2332
. — Log lighter (Ts) 2332
Wood /pellet stove 33.39
Wood fireplace/insert 23.32
' VPROFER'PV OWNER • 1 ❑ TENANT, Chimney/liner/flue/vent 2332 '
Other: 2332
Name: .- / V&A) •
En,v onmental exhaget an+d veartfatiotr Address: f3�f � u 6v,./.4,8 r� rc CT R � hood/other r kitchen �h�,
Aaar
}. 3339
City/State/ZIP: - &, e az, • '7' 3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: { Pax ( ) toilet eemtertmentq, utility looms) 2332
E A. )<,icA1'QT . 0 CONTACT. PLRSbN Attic/crawls/me fans .. . 2332
Other. 23.32
Business name: Same as Contractor Rod td
Contact name; $14.55 for first 1brt- $4:03 tar each additional
Furnace, etc.
Address:
• Gas heat pomp
City /State /ZlP: Wall /asparded/omit heater
Water heater r
Phone: ( ) : ( ) Fireplace —
E-mail: Rer$Re
• . CONTRACTOR . 1:3mbecue
B sins name: Columbia NW Heating • Clothes dryer (gas)
i
_ _ .. _ Other: _ _
Address: PO Doi 622 IVmt iA1ViG`Air P$Rl�' i? . s.
City /State /ZIP: Scappooee, OR 97056 Sol/total tiA_ 1
m
Mirrinm hermit fee ($90 -00) ,
Phone: (503) 5433524 Farc (583) 543 -6285 plat r y e , (25% of permit fee)
GCB tic.: 61947 state =thotg (12% of permit fix) 1
TOTAL PERMIT FEE_1 .
/1 /i , _ ‘ Thus pe„netspplkettun elm o If permit b not obtained Maio 18'9
Authorized signature: �,{�
.f
j� ora otter it has Keen aca/pAed an enmpteM
I Print name: Gerri Jacobson .�.. J i_ 740 * Feen utrodoloty set by T-county Building industry service }Revd
"Taboo llerm (0AMt:C- Permunpp.doe 10/01/09 440- 161Tr(11r09mOM/Wrts)