Permit ',, CITY OF TIGARD MECHANICAL PERMIT
` "' ' , '-- COMMUNITY DEVELOPMENT
71 Permit #: MEC2011 -00033
TIG D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2011
Parcel: 1S134ACO2645
Jurisdiction: Tigard
Site address: 11030 SW COTTONWOOD LN
Project: Konsten Subdivision: ENGLEWOOD NO. 3 Lot: 211
Project Description: Replace furnace
Contractor: COLUMBIA HEATING & COOLING INC Owner: KONSTEN, ARMIN & HUBERTINA
PO BOX 230397 11030 SW COTTONWOOD LN
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704
PHONE: 503 - 590 -3321
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/19/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/19/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/19/2011 $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 direc estions UNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: Le Signature: A' _
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.
Jan 18 11 02:28p Columbia Heating /Cooling 503 -598 -0270 p.2
Mechanical Permit Applica in l ' ' rot ti lric'l': l tit:
1 `a M 2
City of Tigard D eceiv e 1. l S 11 Permit Nu " Mtct�bfC'oa
7 Reeeived
• 13125 S W Hall Blvd.. Tigard, OR 97223JA N 1 2011 Plan Review
Phone: 503 639 417 1 Fax: 503.596.1960
BUILDING DIVISION Date/By: Other Permit:
Inspection Line: 503.639.4175
T 1 G A R I) CITY Date Heady/13y: runs: RI Sec Page 2 fur
Internee www.ligard- or.gov OFTIG {�D Notified/Method: Supplemental Information
- 1
TYPE'OF.WORK : 1 , COM1�tER L4.L.'1'E[ °'SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ blew construction [ ddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of e l
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF .coNsTRUC'L10N ;' ` .,.
Value: S
RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory budding For special information chzeklisr.
❑ Multi- family ❑ Master builder 0 Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION - • Head rig/cool ing ,
Air conditioning
Job site address: i j 036) 16. ( 0 ,rA/ai4 4 (requires site plan showina,place:nent) 46.7:
City /Stale /ZIP: Furnace 100,000 BTU (ducts/veats) + _ 46.75 _
Furnace 100,000+ BTU idects/vents) 54,91
Suite/bldg. /apt. no.; Project name: Heat pump 61.06
• Cross streelidirections to job site:
Ductwork 23 32
Hydronic hot water system • 23 32
Residential boiler (radiator or
hydronic) L
Unit heaters (fuel -type, not electric),
in- wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: I Lot no.: ,
Other: 21
Tax mapiparcel no.: Other fuel appliances
Water heater 2 2 3 32
DESCRIPTION OF WORK • 33.39
Gas fireplace
Flue vent for water heater or gas
f��i�ir v�-L fireplace 23.32
i
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32 •
Chimney /liner /flue /vent 23.32 '
[l- PROPERTY OWNER ' I - ❑ TENANT . Other: _ 23.32 ,
Name' �/ / Environmental exhaust and ventilation
rr7s vt (l OR l Li. Range hood/other kitchen
Address: / / li 3 a 5 (, exe I-`- -3 equipment 33 39 ,
Clothes dryer exhaust 33.35
CityiState /ZIP:_ ��Q a ,..... e � 7 2.4 , Single duct exhaust (bathrooms,
Phone: (9 g - 9O - 33 L t Fax: ( ) ' toilet compartments, utility rooms) 23,3
Atticicrawlspaae fans 23.32
❑ APPLICANT . • ❑ CONTACT PERSON Other: 23.32
Business name: • Fuel piping
Contact name: 4'20 r /��/z /7`) PP� $14.15 for first four; $4 -113 for each additional
` f r Furnace, etc. _ _ ,
Address: Gas heat pump _
City /State.!ZIP: Walllsuspended/unit heater
Phone: a3) ' p� 7 o 4 Fax::5 �� g _ba7C7 Water heater
( � j r Fireplace
L -wait: Rang
CONTRACTOR . • Barbecue
�
y't r I LI I � L-�7_ A 1 y��.. �(��F�j � / /' �
Clothes dryer (gas)
Business name: f / 1 d=1/ �( ' D TI r ! 'V `-"�- 'll � V Other: ) i' '
_
Address:- ' L ' n�i r , 3 2 , - , x ..„3 9 7 : MECHANICAL. PERMIT FEES*
City/State/Z1P: 0 7 g j Subtotal l ^
1 ' � ] �- 7 �' Minimum permit fee (590 00) 9 Li •
Phone: ) 61 Fax: (J t��( - ) _ OoL.J l,/ Plan review (25% of permit fee) ,,�-
1
I CCB lie,: '7(o fn 9 State surcharge (12% of permit fee) /0 .qc
TOTAL PERMIT FEE: /( • gQ
! , �j.�� r This permit application expires if a permit is not obtained within ISO
Authorized signaturQ� J { v / days after it has been accepted as complete.
Print name: 'r�� Date: , � 1 -0 ' f methodology set by Tri- County Buitdtng Industry Se vice Boa -d
, o...ie...ao- .- .,,;,.,uer_oa.,,' it n.... nnr INnt /os 440 - 44I Tr (1 I /02/C041/WEB)