Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00572
.11 IIGAARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 10/29/2009
Parcel: 2S111DB12300
Jurisdiction: Tigard
Site address: 15265 SW 94TH AVE
Subdivision: SUMMERFIELD NO.12 Lot: 650
Project: Alsman
Project Description: Replace furnace.
Owner: FEES
ALSMAN, RAMONA Description Date Amount
15265 SW 94TH AVE Furnaces < 100K BTU 10/29/2009 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 10/29/2009 $10.80
PHONE: 503 - 624 -6823 Minimum Fee Adjustment - Mechanical 10/29/2009 $43.25
•
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97223
PHONE: 503 -624 -2704
FAX: 503 - 598 -0270
Type of Use: SFA
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
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 Njoti cafl�fion'6eCer. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di esct questions to 0 C by calling 503.246.6699 or 1.800.332.2344.
Is ued By: dik - �� �� ��� Permittee Si : nature: \ ,. 1
Call 503.639.4175 by 7:00 a.m. for an inspection that busine - day.
This permit card shall be kept in a conspicuous place on the job site un ' completion of the project.
Approved plans are required on the job site at the time of each inspection.
IIIII ECE1,'V r -.t ,z >,, C ,.li ;, L�
Mechanical Permit Applicati '' , . - �/ `.
27 7 2009 Da:e'v� /t7 lay I pacill No : / /LL,ga)? D057
t City of Tigard Re e ive !
i31 5 SW Hall Blvd., Tigazc, OR 9722 OCT Plan Review
Q V.er Pai¢a:
Phone: 503.639.4171 FaK: 503.598.1960 DaceMy:
Inspection Line; SC3.t 39 ! 75 CITY pF T IGARD Date Ready /By'. .�t'S I El See Page z fo
�GAH Internet: wwt~,.tigard- or.gov BUILDIN DIVISION Noil :iedllvt ctttod' ...n6,-- Supplemental Information
1 TYPE OF WORK • COl1RMERCIAL FEE* SCHEDULE - USE CHECKLIST
l '._ Mechanical permit fees' are based on the value of the work
❑ New consuc ddition/ alteration /repiae performed, Indicate the value (rounded to the nearest dollar) of ai
❑ Demolition ❑ Other: mechanical materials, esui merit, laoor, overhead, and profit.
Value. 5
CATEGORY OF CONSTRUCTION
• RESIDENTIAL EQUIPMENT ! SYSTEMS FEES*
[ �•! <and 2- family dwelling ❑ Commerciallindustna! ❑ Accessory bui:C •ng r er special rniormntton use checklist
❑ N4ulti- family ❑ Master builder ❑ other: Description _ Qty. I Ex I To:al
JOB SITE 1I' AND LOCkTION Hcatin ;cooling
/ � r � - Air conditioning or heat pump• /
Job site address: / � 1� , 51„,. , � "j (req. ices silt plan 5hewmg pinesnenll 14 . 0 u _ / /5 ,
Fe rri - 100,600 BTU (deemtveatsl �I I } L'kNt�
CihlSlzte /ZIP: 7 �ZD s Furnace 100,000+ ETC (du- tcwen•s) II 17.90
Suite/bldg./apt. no.: --- I Project name: /q .)_/d1AA) 01.5 heat ountp
1 4.011
Duet work 14.00 ,
Cross s:recUdirectlons to job site: 14.00
Hydnn.c hot water system
Residemial boiler (radiator or
Indronw) 14.00
Unit heaters (fud -type, not electric),
in -well, in -duct, suspended, etc. p 10 00
10.00
_ - - - - F v
lue ent for any of above: I ` .
Subdivision: tot no.: Other: I I 1 10 O
Tax map /parcel no.: Other fuel a 1 slianceS
Water heater � 10 00
DESCRIPTION OF WORK Gas fireplace 10.00 , .
REP /cr. ! J "' r l c , c Flue vent for water healer or gas I
fireplace .0'..)U
Leg lighter (gas) �� I0.00 I •
Woou%pcllel stove 10.00
' Wood fireplace/insert 10.00 1
r Ch•mnc},9incr,'nue /ven: 10'''0 I{ _.-- -.
) ROPERTY OWNER J ❑ TENANT Otl•.cr: 10.01. l _
Nam_. r AI04 / I , Environmental exhaust and ven
�A� f [ " Range Soodfothet kitchen
Address: l�aci ,0 99 TA' equipment I 1000
Clothes dryer exhaust 10.00
CitylStat21ZIP: - f� Single -duct exhaust (bathrooms,
l ` Fax: ) toile: compar men. s, utility rooms) ti.SC l
PY:one: (5a . 1 ) 6";,2 y i,e5A5 I —
Atticfcrawlspaee fans .0.0C
El APPLIC,II+IT ❑ CONTACT PERSON Other. l 10.00
Business name .
rite! p iping
\, 7) / y 55.40 for first four; $1.00 for each additional
i
Contact name(
I J� 1 I t�
Ft.m+ee, etc I
: dd-ess: Gas heat pump
City /State&ZIP: Wallisuspcnded healer - LT____
-, Water heater
Phone: � } �7 7 7D Fax:: ( ) .. J C) I (replace r _ ±
l' Range
E -mall:
! CONTRACTOR ' Barbecue
L 2 f ( Clothes dryer ;gas)
Business name: /i�'� b/C� —✓l /n - (!--0-D// r,,,? � �' Other ! --
� d , o x ) 3 3 o MECHANICAL PERMIT FEES` (�
Address: b :
s ubtotSll
Citv'I'StateJZ1P: R___.10 n 7 �' �� Minimum permit fee l� O • ��
Phone: (5 (3" q - 3- --)10 I F ax: ; 5) y? 0 3- 7d Plan review (25% of penn.t fcc) -&
7 ��"" p r S l a te surcharge (l % of permit "ee) /Q. to -'
CCB lie.: (1r j S ! TO 1AL PERMIT FEE. , e, . 00�
t
This permit applicarian expires if a permit isnot ob at erfr il in 1SC
Authoriazed signature: days after it has brcn acecoted as complete.
/ J ' J . ( I AO � t Fez methodology Set ' � Y Tri- Counl7 5u11d;nb [ndtsv;' Sd n•ue tr��J
Print name: A CU/ ! ��L/!V( //4 9 — I Date: `✓ "'.7_' r
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