Permit y CITY OF TIGARD MECHANICAL PERMIT
l l Ii i COMMUNITY DEVELOPMENT Permit #: MEC2011 -00122
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2011
Parcel: 1S134AD08600
Jurisdiction: Tigard
Site address: 10553 SW WINDSOR CT
Project: Goodman Subdivision: WINDSOR PLACE Lot: 23
Project Description: Installation of gas line for new range.
Contractor: COLUMBIA HEATING & COOLING INC Owner: GOODMAN -
PO BOX 230397 10553 SW WINDOR CT
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Fuel Piping 03/23/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 03/23/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/23/2011 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.
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 suspend-d for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. `'cation Ce T. .se rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a •py of the rules
or dire. questions to OUN .y call g .'.232.1987 or 1.800.332.2344.
Issued = : Permittee Signat ?( tam • , •
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.
Mechanical Permit Application l OR c,FFU 4: i ,F ()NIA
City of Tigard Received
111 I • 13125 SW Hall Blvd., Tigard, OR 97223 Date/BY: ' / Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 an Rene"
ection Line: 503.639.4175
Date/By: Other Permit:
Ins
'I 1tiAItt) p Date Ready/By:
Internet: www.tigard ocgov y y: tuns. 12! See Page 2 for
Notified/Method:
Supplemental Information
TYPE OF WORK COMMERCIeU,,.PF,E* SCHEDULE — USE CHECKLIST
El st Nev construction ,,.,:.Prep ition/alteration/replacement Mechanical permit fees* are based on the value of the work
❑ Dentuli performed. Indicate the value (rounded to the nearest dollar) u( ail
❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY Of CONSTRJCT[ON '_ ,w0 . $ V Value: S
artd 2- family dwelling ❑ Commercial/industrial . RE$ 1UEN1'IAI+.EQiJIPMEIYT/.aYaTEMS FEES*
❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. La. 1 Iota.
JOB SITE INFORMATION AND LOCATION " « S' ` t!:, : Ilea ting/cooling —
Job sue address: / 0553 StiO I/O{ NJ 1J Cr, Air conditioning
(requires site plan showing placements 46.75 i
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) 46,75 _
Suite /bldg.lapt. nu.: l Project name: a�7j 1`1 RI O Furnace 100,000+ BTU (ducts/vents) 54.91
Heat pump 61.06
Cross street/directions to job site: Duct work 2
Hydronic hot water system 23.32 I
— Residential boiler (radiator or
hydronic) 23.32 I _
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: _ Lot no.: Flue/vent for any of above 23.32
Other 23.32 _
Tax map /parcel no Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
j - _ s 7 10 Gas f vent for 33 39
Flue vent for water heater or gas
I fireplace 23 3
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insen 23.32 --
❑ PROPERTY OWNER ❑ TENANT
Chimney/liner/flue/vent 23
•
Name: — Other: 23.32
Environmental exhaust and ventilation
I Address: Range hood/other kitchen
equipment 33.39 ___
City /Statei % I N: Clothes dryer exhaust 33.39
Phone: ( I Single -duct exhaust (bathrooms,
Fax: ( )
toilet compartments, utility rooms) 23.33
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 ^ _.
Business name: Other: _ 23.32
Fuel piping
Contact name: 7)'20 r / /..2n /'y) e • -,l may $14.15 for first four; $4.03 for each additional
I Address: "� / „ (/ O ' „ Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
—
Phone:
3 6 ,Q70/./ a70 I Fax: : 66 3, X98 _6;70 W a t er h eater —
E-mail: Fireplace
Range
CONTRACTOR Barbecue /
Business name: l 4 (gym n i �j /,...,� --', ` c a, , i ') Clothes dryer (gas) __
Address: y � x.J �c D �� iY-i7 / !!W `T C�� (r Other: • x 1
9 7 • :. MECHANICAL, PERMIT FEES * -
C ity /State/ZIP: 6.-fi z J 0 / 7
1C N F
I/ '' J D Subtotal
Phone: 633 ) i r ,
l/o c.
Fax: t A Minimum permit fee (590.00)
., aa Q
o _ �`— Plan review (25% of permit fee)
CCB lie.: r 7/
lU � �� �l State surcharge (12% of permit fee)
�` ,/�
TOTAL PERMIT FEE
Authorized signatur� This permit Thi application expires s if if a permit is not obtained within 180
r -- days after it has been accepted as complete,
Print natne:1 pro /2� Tyy, Date: , ,
t) i / J . ., Fee methodology set by Tri- County Building Industry Service Boca
fUl uildinaWermits \MEC- PermitApp.do 10/01/09 '
440 -4617T (11 /02/COM/WEB)