Permit i
CITY OF TIGARD MECHANICAL PERMIT
1 1 = COMMUNITY DEVELOPMENT Permit #: MEC2009 -00153
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/10/2009
Parcel: 2S112CC12000
Jurisdiction: Tigard
Site address: 15676 SW 82ND AVE
Subdivision: `LANGTREE ESTATES Lot: 52
Project: lundberg
Project Description: Install a /c.
Owner: FEES
LUNDBERG, RENATE J & ROBERT L TR Description Date Amount
4150 GLACIER LILY Air Conditioning or Heat Pump 04/10/2009 $14.00
LAKE OSWEGO, OR 97035 12% State Surcharge - Mechanical 04/10/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 04/10/2009 $58.50
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97223
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 $81.20
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
1 \
Issued By: , , ` I Permittee Signature: ( • 1 , �ce 1
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 1
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.
J ,'
•
Mechanical Permit Applic Cr IV FOR OFFICE_ USE ONLY
City of Tigard Received �• f`
13125 SW Hall Blvd., Tigard,OR 9722 PR — 7 2 009 ' �� : , �► • i
1 C Phone: 503.639.4171 Fax: 503.598.1960 Plan Renew Other Permite ICZCOCZ , O O
Date'By:
Inspection Line: 503.. rarm
T I G AR D 6394175
CITY OF T IGARD Date Ready/By: See Page 2 for
Internet: www.tigurd- or.gov Notified�Metltod: l Supplemental Information
BUILDING DIVISION I
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - .USE, CHECKLIST
❑ New construction ❑ Addition /alteration/replacement Mechanical permit fees* are based on the value of tireworlt •
performed. Indicate the value (rounded to the nearest dollar) of all '
❑ Demolition ❑ Other. mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value. $ 6 D e -
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. ] Ea. Total
. JOB SITE INFORMATION AND LOCATION Heating/cooling
7 l . Z Air conditioning ho or heat pump
Job site address:
/ S � 7 / 3— ( a �� (requires site plan showing placement) 1 14.00
City/State /ZIP: Furnace 100,000 BTU (ducev'vents) 14.00
Furnace 100,000+ BTU (duds/vents) 17.90
Suite/bldgJapt. no.: Project name: �,(,(,n(1k be y-40 , Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00
Hydronic hot water system I4.00
Residential boiler (radiator or
h•dronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water healer
10.00
Gas fireplace 10.00
-/ /1/,___.5 , a / / 4 C Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
[:PROPERTY OWNER I ❑ TENANT Other Chimney/liner/flue/vent 10.00
0�� 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen 10.00
equipment
CityiState/ZIP: Clothes dryer exhaust 10.00 _ '
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other. 10.00
Business name: Fuel piping
Contact name ?' 'D A / b ) $5.40 for first four; $1.00 for each additional
Furnace, etc. I 1
Address: Gas heat pump 1 i
City /State /ZIP: Wall/suspended/unit heater .
Phone: 73 )6 2. 7 N Fax: : 93 )S -( e7 OD. 6 Water heater
Fireplace
E -mail: Range
CONTRACTOR . Barbecue 1
(l7,0 l w b N ,�. , 1, e?,c phr �, Other Clothes drier (gas)
Business name: , / (� /
Other:
Address: (?0 13 c x) 3 0 3 9 7 MECHANICAL PERMIT FEES
City/State/21P: c , r ) ,/ t 12_, 7 Subtotal
Phone: (,l) 6 i q -- .3- / y - Fax: ) d� Minimum permit fee ($72.50)
�� 7d Pl an review (25% of permit fee)
CCB lie.: 7 t' 3 9 r State surcharge (12% of permit fee)
TOTAL PERMIT FEE 1
1
Authorized signature: This permit application expires if a permit is act obtained within 180
g t ��f / days after it has been accepted as complete.
• Print name: / e/52.1,0/ �� f � Date: ���7 9 ' Fee methodology set by Tri- County Building Industry Service Board
11tt,, leino,VMmnetWC.P,neit4 -n dne f 414iOS 440 - 15171 (1 t 2/COM/W 1
Z OLZO 869 - £09 ONllV3H ` iewniOO B£0:60 60 LO ldy
HEATING & COOLING, INC.
P.O. BOX 230397 'TIGARD, OR 97281
,(503)S24-2704
c:d
SITE PLAN
ADDRESS: (,
0LZ0 ONI1V3H viewmoo , e£0:60 60 LO JCIV