Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00038
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/21/2011
Parcel: 2S110AD04100
Jurisdiction: Tigard
Site address: 14641 SW 106TH AVE
Project: GALYEN Subdivision: LANG HILL Lot: 35
Project Description: Gas furnace replacement.
Contractor: COLUMBIA HEATING & COOLING INC Owner: GALYEN, SUSAN E
PO BOX 230397 14641 SW 106TH AVE
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/21/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/21/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/21/2011 $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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
ts
I rm i ttee Issued By:. - �/� Signature: _
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 21 11 02:21 p Columbia Heating/Cooling 503-598-0270 p.2
Mechanical Permit Application .
A VVT '1,,, A'• FoR (writ E. INV 1/M.1
.„, 'c,,,N
City of Tigard Received i
Penni:.: -> • . .
li " 13125 SW Hall Blvd., Tigard, OR No
9 ti, i i ,...:- (k \\ _a ..
3, [ay' I ffiriWIMI iA rm.:... • - . 1 ab •
1 1..\) Plan Review
: 1 . pj,c 54;1539 4171 fax: 503.598 196 G% 1. . Oilier Pmmit:
Date/By:
Inine:3.5.394175 0 -9
TIGARD 4ection L.: 5 . r ..42k 1 C1 ..‘ Date ReadyiEy: Juris 21 SIN P
te age a for
Inmer: ■vww.rgaal-or.gire Notified/Method Supplementa. Inform p al u
(1 'C\) ,\I \S \CY4 7 . - 2° _.. _. . _. ...
TYPE OF WO ...ICIASY'' COMMERCIAL FEE* SCHEDL LE - LSE CHECKLIST.
- El Add izionialteratiorvreplacement
Mechanical permit lees:* are based on the value dt' the i• or,
No. eonstruotion
performed. Indicate the value (rounded to the nearest uoYar, oi
;
•,__; l)eir.i)li n 0 Other: mechanical materials, equipment, labor, overhead, ;cid ;iron'.
$
CATEGORY OF CONSTRUCTION. .' .- .:.'. ' : . Value; . . ;
• RESIDF.NTLAL EQL1PMENT / SYSTEMS FEES*
- and 2-family dwelling E Commercial/industrial 0 Accessory building
Ion special inforati
m on USe CileCk!!SI.
D multi - rani*, E Master builder E Other: Descr: piton Qty. 1_1:u. .. .1:
JOB SITE INFORMATION AND LOCATION •••:' • '::;.- . - ' Heating/cooling ._. . . .. . ..
• Air conditioning
• Jol; sitc address: 1 Li 1 i . 1 t..4 , 4 ,4e_k_
(requires sae plan skewinaplacementl 40.75 '
ci, ----r Furnace ID0,000 BTU tduziNveins)
,A oy i 9).2_2
• Furnace 100,000+ BTU (hums:vents) 54.91
Suite/bide...apt. Ito.: Project name:
Heat pump 5, Uo '
I-.
r_ rust; street/doe:al:my to job site: Duct work 2332 l
I Elydronic hot water system 23.32
I Residential boiler (radiator or
. 11yr:ironic.)
-,-
. Unit heaters (fuel-type, nor electric), i •
in-wall, in-duct, suspended, etc. - 16.7:'
Flue/vent for any of above 23 32
1 S.tbdivisir»:: Lot no.:
_ Other: ' 23.32
_ .. ________ ____ ... ....
lN nittp.'pa no: Other fuel appliances
. 1
DESCRIPTION OF WORK .. . •
• . . . Water hearer . 23.3 .
•
Gas fireplace , 33.3';
-.-
A .that rt-Lo-......e.—e Flue vent for water hearer or gas
• fireplace . 23 32 _
Leg lighter (g) 23.2
-- Wood/pellet stove 33.3Y •
_ _ ._ ....... ..
Wood fireplace/insert -)3.3.-j
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ' - TENANT -
Other "__
Environmental exhaust anti n ventilatio
Nw"1. li ly Range hood/other kitchen
i q& g.(. JJ /06"__- equipment .1:;..3C . .. . ..
Clothes dryer exhaust 3'4
tt'ityi8raic./. i d
1- 77/ a ft— 9 oo — - - •
(bathrms. 3..i
; none: :.s 3 ) 4, fy...._ 3 6 fli Fax: ( ) toilet compartments, utility rooms)
23 32 :
0 APPLICANT 0 CONTACT PERSON • Artickrawispace fans
I • •
' Other:
Business nar.:e: fuel - piping
l.'enrael name: 7 ,j ...- Afj2i:2_,M e°()'57e°()'5771 514.15 for lint four; $4.03 fur each additional
-- Furnace, etC.
Address
-- Gas heat pump •
.- - -
Cit)/Stitteil.H. Wall/suspended/unit heater
, I I
' Wate-r neater
:'llonc: (\3) ?„1 F.,:66-3 4 -70 ...._.__ ..
- Fire. lace ,
Litiail: Ran te
. .
CONTRACTOR . . . . . Barbecue t
- Cto..hes 41 er ',as)
13t_SineSs name (l_OL , i ingiA __14, 4771 „,... )6 _,,, j , coot ji , )6 _,
, 11011
__..,.
Addressfb .k - . - • .... MECHANICAL PERMIT FEES*
Uity/Stat.ill.tP: 7--) ,- 0 -„). .
g 1 sub.,
. Minimum permit tee 0;90.01 I q0_0()
l'hutle:6_ ) ( , 9-7 Fax: ( L L : 5 . C3B - 0) I
Plan review i25% of permit fee) 1
1 ----
CCP. he.: <as, 9 State sur:2harge (12% or permit .c.:) 7 .0-...° .. -
TOTAL PERM I1 FEE tdd_t
A signatuniiipl ,
name:l
j r^
I Dale: :14// . / ---I This permit application expirt if a p .;
ernii: is nu; ubtei,cd .■th,,, I .,
days after it bus Uteri accepted as complete.
• Print /2 (yrr)
i • , ei: methocology set. by Tri- B•uilcing, 1.n.1.111 Scr..,, :3...;,:.
I n J11-1,:i.asNIL:-.'e,tni■Appdoc : ',A: ■0`, 440-4o:1 7T :I UU1,COM",'WEI3)