Permit CITY OF TIGARD MECHANICAL PERMIT
1114
• • COMMUNITY DEVELOPMENT Permit #: MEC2011 -00284
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/21/2011
Parcel: 25111 CB02800
Jurisdiction: Tigard
Site address: 10023 SW LADY MARION DR
Project: Gardner Subdivision: MARION ESTATES Lot: 1
Project Description: Replace existing a/c unit. Unit must meet minimum 3 foot side and rear yard setbacks.
Contractor: COLUMBIA HEATING & COOLING INC Owner: GARDNER, JOHN D & DENISE A
PO BOX 230397 10023 SW LADY MARION DR
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 670 -7961
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Air Conditioning 06/21/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/21/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/21/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 Notifi - '. tier. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -00 - You may obtain a copy of the rules
or direct . estions to OU . by c- ' t : .232.1987 or 1.800.332.2344.
Issued By. • Permittee Signa ' / / left"
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.
. .
Jun 19 11 10:46a Columbia Heatint n . tittrur 503-598-0270 p.2
.; V .1-4L/
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Meetiliiiielil Permit Application
rottorricr um:
JUN 2 101 ' . ,- . .
City of Tip rd
- 4 , :), 2i SW t-1.1.11H1 , Trd, OR 97223
?I la.N. A(.3.:. 1961: Bu s 111111=Si e .
, itisirrEfffin _ Permit Ice,: kle6
thilcr Pcrum.
1:■,..(c..ul. l.i.v.: 30'3 6:) 4;75
TIPARD , Dgle Ready/By: .4(4 i21 Sec Page 2 fur
I me 'net •.....,',.; LItIvtl-Y lr'- ' Not i fic,V.ki cal ad: S upplcLnLra. I litio,r1.t.....
-- — . .....
f FE OF WORK COMNIERCIAV:FEE*, SCHEDULE - USE CHECKLIST -
Meciutmcal permit fe based the es* arc b on yalac uf die ...1,t
i 7 .\....%, S011iSM110t1 ,/,.(2kiiti(xialierLilio.t/replaceineni
performed. indicate the value (rounded to toe nearest doll.u:,
:mechanical maierials, equprnert, labc• owrlicad, Ino Droll
Value: 3
CA'12EGORY OP CONSTRVcgoN ••• .:.,...........-',..,:::. :,.-.:'
• . RESIDENTIAL /. SYSTEMS FEES'
- ''.1::11): :, dwellin 0 Cornrnercialiindustral D Accessory build:ng
F infarrnatio cheekiiil ,
. Mu.11•1:111•.11: n Master bi.ilc...er 0 ether:
Descriptiorl I
JOB SITE ENFORMATION AND LOCATION ' 1- '''''': . : - ., - ..'''''...'.':, - kleiringieoeliq
10021 sTc......) LM ; '.' JO it. Air conditiumng
. . .
(requires 41IC Ow stownig plat:einem) clo 7S ,
—
---
Ci:■..'S;'ate:;..i': 7 - 1 6,440 • , . 72. 'f Furnace 100,000 BTU (dLetaivenrs: 46.7S I
, ...... ..
:Furnace 100,000+ BTU (duets/ye:Ito 5 t 1 __ ... ,
Su.tciu....0 . opt. ;,t.. • Protect tGth.rne:
. pump 61.....1t) •
___
(....,:s , .i.,._- _ _.rectimis ..,,b sau Duet word 233?
— — — --- •
riyarolic hot water system
2332__
:5 -___ ........
Residential boiler (radiator or
.. ..
1
nydronicl 25 .] 2
'
— .— Unit heater (fuel-type, not elear.c),
in-wall, 1n-ducc suspended, etc.
. ......
. Puelvent for any of above 23.32
Lot no.
------5---- Other 23.r
•,. :11.1;.•. i•Lir ..:J •, • 1 1217er fuel appliances
DESCRIPTION OF WORK • . .. ..:.: . • Wilier heater 1) 3.; - : .
- - ------ -
Gas ttreplaze 1 33 39
._ _..._.._ A /C.. ._. _. .....26/L4C607 CA/7 Flue vent for water heater o' gas 1 '
i.ireplace :3 5 :
________ ..... . ___ .
...og liartter (gas)
Wood/pellet stove 3) 39
___ ............ .... . ..______ ____
Wood flreplaceinsen 33.32
—
Chimneyikiner/fItieivent 23.32 _____
0:
0 PE RT V OWNER 0 TENANT •. • .
• 5 ner:
,- 3:
1 s, a: t -- pe■i(.1(_,,. 6 Etwiruumeatal exasiust and Yentrialiuri
r
Range hood/other kitchen 1 ,
0 a ..3 ..cv hilov frbitio/ tcuipment
i ---- r . ••
..i..
.r OM __ 0/2, c,r2 ,A,2 ti canes dryer exhaust
Single exhaJo; (bathrooms, -r
.5-0..r .. 6 -'• r7 ■'l ii [ Fax: .,. 1 toilet compartments, uti.ity rooms; I 33 32 .
L APPLICANT D CONTACT PERSON ' AttiMoraw.soace fans
I 2 a?
Other I 23.32 _
i t.t..Sille:.SL :13 : I.
. Fuel pipits
,- „-- ,, ,- ,,.:, /
---- ---- -
S14.15 for hi four; 54.63 for each aaditiullat
, ,.;. 0-2- p e d, 377)
FunlaCe, dt.C.
• ..,.,!..:;-.::,
Gas h:f.at puny
V11'
Wall/suspended/unit heater
_
17,---- - ,_.,--
Fax: . co 3 :a7 8 .0,:).70 Water heater
I ' „*"..:1123) (/),,,,,, , /v " F
.,,
Fireplace
.
:111..ii.
Runge -
,
CONTRACTOR ...• ' - . .
' Barbecue _
. Clothes dr;+er (gas)
i •
•
Liti. -am:: ,.../1 ,,, .--, i ,
L...._
A(jdrs'■ 4,-.:\,, „23Tv3 97
C:tyiStaft.-111-' 7-1,..7-741,<„0 OICS i7CV ) Other
_...
- .-.- :MECHANICAL PERMIT FEES*
Subtotal I
oe
Minimum perrnit lee (S90.001 1 -------
vtv._,,,,: (5;-_- . t , c - -- , ...17 ()-`1-- Fux: (5_, , _ c --- - --
.._
Plan review (25% of pet It:c; , -----
. r— ,
CCI31it• /, c . : -. , - 9
State smcharge (12% or perma feel
• (1) ,......L.
TOTAL PERMIT FEE /A
AuLlie rf.ei: sig:iiitiii ) I / ,/ .1 This permit applied tic's expire, if . permit is [IA ubtkin a
:_-/ L t /
days after is bas peen a cetp(ed as compiete.
-
F ri:); nanl.:In'IU- 470 ire . D 6" 11 — I 1 1 , 1:„ rictudology set by Tri-Cour IS BLikilq 111. Serti,.. t3,....:
' • . .1 V r
____--------
Jun 19 11 10:46a Columbia Heating /Cooling 503 -598 -0270 p.3
r I i •
, i- a I
HEATING & COOUNG, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503 }624 -2704
SITE PLAN 6At,o,v £11-
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