Permit q CITY OF TIGARD MECHANICAL PERMIT
* COMMUNITY DEVELOPMENT Permit #: MEC2011 -00178
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2011
Parcel: 25111 BD00414
Jurisdiction: Tigard
Site address: 9705 SW MARILYN CT
Project: Sorenson Subdivision: DARMEL NO.3 Lot: 28
Project Description: Replace gas furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: SORENSEN, JEROME H
PO BOX 230397 9705 SW MARILYN CT
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 639 -5080
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/26/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/26/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/26/2011 $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
issuan - • • k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili Notification Ce - . Th• e rules are set forth in OAR 952- 001 -0010 through OAR 95241 e You may obtain a copy of the rules
or • irect questions to OUN w • calli g • !3.232.1987 or 1.800.332.2344.
•
I sued By: 1 \ _ 0.....44/LAilLf
Permittee Signature: I i `r I , � • ��
V _
\ � 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.
Apr 22 11 05:38p Columbia Heating /Cooling 503- 598 -0270 p.2
1VIechanical Permit Applicati v olt Orel( 11 t tit: f»1.,'
city Of Tigard ° DECEIVED Received
1 .111 1111 1 3125 SW Hal Blvd., Tigard, OR 97223 q Datday. ym,� Permit Nu AI de)/ 7 g
Phone; 503.639.4171 Fax: 503.598.1 960 APR 2 6 2 011 Date,By 1Ew Other Permit •
l i G n It o Inspection Line: 503.639.4175 D� R� Jars_ la Sec Pa 2 for
Internet: vvww.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental information
BUILDING DIVISION
.. TYPE. OF WORK' - COMMERCL�IL'•FE,E *'SCHEDULE — USE CHECKLIST
❑New construction Addition/alterationireplacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of a]! '
[] Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTIIIUCT IOP1 Value: $ • RESIDENTIAL EQUIPMENT!! SYSTEMS FEES*
5 ;4 and 2- family dwelling ❑ Commercial/industrial El Accessory building •
Multi - family ❑ Master builder ❑Other: Description For special information use checklist. Qty. Ea. Total
JOB SITE INFORMATION AND Q ry LOCATION Hea dig/cooling
� Air conditioning
lob site address: J / I o wy-7 (requires site plan shouting placement) 46.75
it /State(Z1P. { 1j Fu rnace 100,000 BTU (ductsivents) t ) 46 -75
C y �' ?r �i tJ�` Furnace 100,000+ BTU (ducis'vents) 54.91
Suite /bldg. /apt. no.: w Project name: V , A MP ..... - 4jil Heat pump 61.06 •
Cross street /directions to job site: t Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or 1
hydronic) 23.32
Unit heaters (fuel -type, not electric), • •
in -wall, in- duct, suspended, etc. 46.75 I
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Otter: 23 -32 ,
Tax map/parcel no.: Other fuel appliances ____
DESCRIPTION OF WORK Water heater 1 23.32
Gas fireplace 33.39
i I At i t ' / •1, _ � J `�� . _I Flue vent for water heater or gas
fireplace 23.32 `
Lo; tighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insen ' 23.32
A PROPERTY OWNER ❑ TENANT Chimney /liner /flue'ven[ 23.32
Other: 23.32
Name: ts. kh9 j `sl 'i n k s . Environmental exhaust and ventilation
Address: i • T 4 (--1— Range hoodlother kitchen
e. ui. merit Mil
City /State /ZIP: 1 JI Clothes • er exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: `�` ` I ) ( e1:. CI Fax: ( ) toilet cons“ r ents, utili rooms) 23.32
0 APPLICANT • Q CONTACT PERSON Attic /crawls r ace fans ®_
Other.
Business name: Fuel riot
Contact name: ma 7 r Ad h /) ? eP (i� $14.15 for first four; $4.03 For each additional
"� / ' Furnace, etc.
Address: 1212M1
City /State/ZIP: Wall/sus • dediunit heater
Phone: 3) ( :665 �cjg - bp;./O Water heater
CMIIIIIIMIIIIIMIIII
E -mail: � Ran :c
CONTRACTOR Barbecue —__
�} in /� (� /� �-� ) �('�� � / )6.--• Clothes d Cr (: •)
Business name: _
t bzi . �r / f ! T _ /4 , -. T r. r,06. t7 co '1J�4 F
Other:
Address :: k 3 9 7 MECHANICAL PERMIT`FEES*
Ci ty /StateJZIP 7 716_ 0 77 . ' / Subtotal
r Minimum permit fee 139{7.00)
Phone_ ) ,� Q Fax: (j) 9.8 - p� Plan review (25% of pemr it fet)
CCB lie.: 77CD C� State surcharge (12 %ofpermit fee)
(( TOTAL PERMIT FEE
Tbie permit application expires if a permit is not obtained within I so
Authorized signs A ` / .0 ,',t days after it has been accepted as complete.
Print namc:ii /JLS � a. f 117/11 Date: ', . Da ! / ` Fee methodology set by Tri•County Building Industry Service Brat d
I: Ulu iIdintnPermltsNEC- PeemiApp.doc 10/01109 440-4617T ni/021CO VE9) •