Permit IL CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00257
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 1 S134BD07014
Jurisdiction: Tigard
Site address: 10800 SW 115TH AVE
Subdivision: ENGLEWOOD NO.3 Lot: 203
Project: Corwin
Project Description: Replace existing a/c and furnace.
Owner: FEES
CORWIN, STEVEN G & JOYCE L Description Date Amount
10800 SW 115TH AVE Air Conditioning or Heat Pump 06/04/2009 $14.00
TIGARD, OR 97223
Furnaces < 100K BTU 06/04/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 06/04/2009 $8.70
Minimum Fee Adjustment - Mechanical 06/04/2009 $44.50
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97223
PHONE: 503 - 624 -2704
FAX: 503- 598 -0270
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notific ' t -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
or direct estions to OU " • , • lint 03.246.6699 or 1.800.332.2344.
Issued y: • / ' 0 ..... 4 4k A
-7 Permittee Signature: f •�
Call 503.639.4175 by 7:00 a.m. for an inspection that businb day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Mechanical Permit Application FOROhru I' USE. ON
City of Tigard 1'' 9 EW 13125 SW Hall Blvd., Tigard, OR 7223 '" P
C Otl et Permit:
Phone: 503.639.4171 Fax 503.548.1 Date/By: U
Tt nt:ta Inspection Line: 503.b39.4175 ,� 1 0 2009 DateReady/By. .1.-.i' RS Sec Page 1tor
Internet www.tigard- or.goV Notified/Method: i/l. Supplemental Information
TYPE OF WORK. .iI\t :. .:;.;_ C011�MEKCIiSL_.) E1 SCHEDULE - ''USE CHECKI1ST' 1
Mechanical permit fees* are based on the value of the work
❑ New construction . .Addition alteration /replacement performed. Indicate the value (Mtmded to the nearest dollar) of all
Demolition El Other: mechanical materials, eq labor, overhead, and profit. 1
k Z Xalue: S 1
CATEGORY OF CONSTRVtt iIOS :.. . , r ,
. ItE$ FiVTI E UIPMEIVT 1 SYSTEMS FEES' J
„ 2 -- (and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Wormaiion use checklist.
❑ Multi - family ❑ Master builder 0 Other. Description I; 1 Qry. I Ea. 1 T otal
JOB SITE INFORMATION AND LOCATION . Healing/keeling 11 1
Air conditioning or heat pump
lob site address: /0.'76 G 6 F t l (requires site plan showing placement) ! 14.00
! City /State/ZEP: 7 '-L N-/l eat_ `/ 7 Z L Furnace 100,000 BTU (ductrevents) ( 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: ,
Gas heat pump II 14.00 '
Cross street/directions to job site: Dud work 11 i 14.00 .
Hydronie hot water system 14.00 .
Residential boiler (radiator or
hydronic) 11 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. ' 10.00
. Flue/vent for any of above 10.00
Subdivision: 4 Lot no.: Other: 11 10.00 _
Tax map/parcel no.: Other fuel appliances 1.
DESCRIPTION OF WORK Water heater 10
Gas fireplace I 10.00
/2tia. 1 S"T , N 4 ? 0-4c,C -t- R - 4 - 0A - Flue vent for water heater or gas
- / firepla „, 10.00
ft / C t�1� J-� �Jl �� Log lighter (gas) 11 10.00
Wood/pellet sieve r 10.00
Wood fireplace/insert 11 10.00
Chimney/liner/flue/veni 10.00 j
PROPERTY OWNER ` TENT Other II 10.00
Name. /` t Environmental exhaust and ventilation
( t-' Rangehood/other kitchen
I Address: equipment I� 10.00
City /State/ZIP: ,_ Clothes dryer exhaust li 10.00 •
Single -duct exhaust (bathrooms,
toilet compartments, U i1ity rooms)
Phone: ( ) Fax: ( ) 6.80 10.00
0 APPLICANT 0 CONTACT. PERSON Atticfcrawlspaoe farts Il
_ Other: II 1 10.00
Business name: Fuel piping II
Contact name..ti� 7) ft 1_6 Y S5.40 for brat four; S1.00 for each additional
Furnace, etc. II
Address: _ Gas heat pump 11
City /State/ZIP: WalVsuspended/unit heater .
Phone: y )3 4 - q r I D q I Fax:: 93)s- 6 D' 7 v _Water heater I!
Fireplace ,
E -mail: Range 1
CONTRACTOR -: ' . J ; ; .,. Barbecue II !! _
Business name:
( 1 (,� - � b %t✓. p... f'/ oli G Ct3lltoersdeer ( ) II I
..: , ME • ICAL PERMIT FEES*
- Address: �Q 1 0 x .2303 } - 7 � V C�Ar1
City/State/ZIP: " / ! v (' R..4i? ) _.. 9 i 2 - ,P1 11 Subtotal .
lylinimum permit foe ($72.50) �
Phone: ( �) (� `� " � p Fax: (5r))5 -0;>- Flan review (25% of permit fee)
CCB lie: � Q 3 / r ` State surcharge (12% of permit ree)
11 TOTAL PERMIT FEE ,
This permit applleation expires if a permit is not obtained within ISO
Authorized signature: _ �rr days after it has been accepted as complete.
Print name: y D� t / 61A4 " Date: 'TM / ' Fee methodology sey by Tri Bulling Industry Service Board
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HEATING & COOLING, INC.
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,,7. P C. BOX 20397 .mGAR , OR 931
(503)624-2704
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