Permit � CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00048
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/28/2011
Parcel: 2S115AD03700
Jurisdiction: Tigard
Site address: 10878 SW DOVER CT
Project: White Subdivision: Lot: 0
Project Description: Replace gas furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: WHITE, DAVID R AND RENEE J
PO BOX 230397 10878 SW DOVER CT
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/28/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/28/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/28/2011 $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, 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: Z — Permittee Signature: 1 t , /
' /O/OZ../(', 77O/1/
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 28 11 11:20a Columbia Heating/Cooling 503-598-0270 p.2
. . .
., •
5.)
Mechanical Permit Application
tiECFIVED R..y.,., . FOR OFFICE l NI: ONLY
City of Tigard
.4 :3125 SVI1 Hail Blvd , 'Tigard, CR 97223
rr
Ph p, ie. fi 03.63.1 17 Fax: SIDI 598. 196ii JAN 28 2011 •
Date/By: / ole / Illiice
Plan Review
Date/By• 4 Pt"" Other Permit
Permit:
inspection Line: 5'33.63 ';.4 I 75
'TIGARD Date Re.ady/By
I me not: WWW. Taro-or. Nv CITY OF TIGARD i N,tiBedim.1,&:
U." nf,== r i ( ronnvflvo
ANL DING DIVIRION
•
- TYPE OF WORK .COMM.E , M* SCHEDULE - USE CHECKLIST •
Mechanical permit fees" arc baste on tile value of die ,, oil.
i El Net •urnJt:n.lLt;on
„. .21cddit iunial LI:ration/replacement
performed. :ndicate the value (rounded to the :le:trust do:lar i Lii
I Demolition E Other: mechanical materials, equipment, labor, ovcrhead, itid prolit._ .. . • CATEGORY OF CONSTRUCTION • ' ':: .:,:...•.:::: '-......‘ ..,..'.
re ya - 1 - 1.::d 2-farniiv dwelling 0 CommerciakindJstrial 0 Accessory building
Value: S
• • • RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
For .v;tritil inforrnalion ,4se chEckIrsr.
i D muiti-faniii, 0 Master buikkr El Other:
Description ' Qi I:a. t.•!.,:
L JOB SITE INFORMATION AND 'LOCATION.' :'.' - ... ''':',,,:. '....'!''-.. ' fixating/cooling
Air conditioning
' Jo:, site acdress: /0s 5 ,--6,,,.._ c 7
Q:equires site plan showing placem 46.75 ent)
Cir■ /Stater/11P: Furnace 100,000 BTU -(ductsiveresj ( 46.75 I.
— ,
Furnace 100,000+ BTU (ducta/verns) 5 4 .ci i 1
SuitelblciLt :tip:. i■u.: I Project. name.
. Heat pump 6 1 . 0 6
_ I
i C-oss sruet,directInis to job site: Duct work 23.32
--- —
Hydronie but water system
Residential boiler i,radiator or
ycronic) 22.32
-
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended etc. 46.75
--
Flue/vent for any of above 23.32 • ___ ___
Subdis islun Lot no.:
.... Other: 1 3.32 I
i ---
i I :IA titzp. parcel 0(1 . :
Other fuel appliances ....._-- - - -
DESCRIPTION OF WORK' , :.•... - . . • ' - - - :.::'... Water hea 23.32 .
•
Gas fireplace 33.3
•
_ /c eit_i---E'..---' L.-, Fu vent for water heatet or gas _
r
fireplace
t--
Log lighter (gas) 23.D2
. , Wood/pellet stove 33.30
—
!
Wood fireplace/insert , 23.32 :
. • , i Chimney/liner/flue/vent . r 23.22
0 PROPERTY OWNER 0 TENANT r '
Other 1 23.22
Nipile: Lit}-/---j ( i ---."
' Environmental exhaust and ventilation
r —
Range hoodlother kitchen .
Address:
I e ui paten: 33.3 ,
L';t Sii.ho7 P Clothes d er exhaust 333)
):
__........
, .
Single-duct exhaust (nethluorns,
.
l'llone: : ! lox: ( i , toilet corn.arynents, utilii rooms) I 23.32
0 APPLICANT E CONTACT' PERSON • Autcicrawls s ace fans . 23.32
Other: '
• I 23 •
1-i ,sess .7anie:
Fuel piping
,
514,15
Coma::: name. l'or first four; 54.23 for rue!: additiwiai
Th ..- L. p- - e
I
Furnace, etc.
:v
Gas heat pump .
C. t yiStu:eit. P:
Wall/suspendediunit !tearer '
Phone: ai3) ( ,.. ,c. '' - '. 704 F.,: :663 ci 8 -70 Water heater
Fireplace
E-mail:
Range
-- —• - -
CONTRACTOR :.'. - ',.' _. - . . - - • .. • . - • Barbecue
. Clothes dryer (gas)
Busines :lame! /1 . . '11.e....41 am■ 2 ... ..... .0.. .. _ Other:
I Ad , . 0 . ' i . , • ' • '
. • • - - •-'-MECHANICAL PERIVIITFEES*
' Allt. . ...
, - I y/SttitiZ : ) : _7;66 o T I Subtotal i
M :ee )
Phone: 5213 !7-i 7()!7-i , ...L.: .._-„,-- ,,,.5(7 _ 000
I inimum pernit (S90.00 ?
plan review (25% atter/nit ti..iet
._
CA:LI 1‘...: 1 7(0 Z-5 9 State surcharge (12% olpermit lee) /0
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained nithie Iu
Authorized signaturcLit.(./C/1.Wc/ i
days after it has been accepted is complete.
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! WLIICiligTerrnit, IC,'C 1),Y)