Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00347
TjGARl 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/20/2011
Parcel: 2S 110DD02600
Jurisdiction: Tigard
Site address: 10595 SW CENTURY OAK DR
Project: CALDWELL Subdivision: Lot:
Project Description: NC installation. Unit must meet 3 ft. minimum rear and side yard setbacks.
Contractor: COLUMBIA HEATING & COOLING INC Owner: CALDWELL, MICHAEL RAY & SHERYL D
PO BOX 230397 10595 SW CENTURY OAK DR
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Air Conditioning 07/20/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/20/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/20/2011 $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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. s
,/ 1
Issued By: Permittee Signature:
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.
Jul 19 11 01:06p Columbia Heating /Cooling 503 -598 -0270 p.2
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Mechanical Permit Aimlicati E
C IS FOR OFFICE USE ONLY
IL City Tigard C1. r 0i ! Y l JILL 19 2011
L31_5 SW Mall Blvd., Tigard, OR 97223
` e Plan R CVieu Otlxr i i:
phone: 503.718._439 Fax 503.593.1)60 Dater'l3) i
T(GA -(tD Inspection Line: 503.639.417, �/ TI Dam Reatdyl3y: r for
I EJ S ecPage.
Internet: www.tigard -or. r 5
CITY I ®1 f s iii �® '
e+� £� Notifieditdethed; Supplemental Information
BUILDING DIVISION i I
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...- . :.I. $"�'P ` P; ��Vt;3TtKH f:`t)1NMR ,G1 b'l�� >: E +r SE't.F1ES3FlI:l tJST �7ECICL:IS • R Ti
Mechanical permit fees* are based on the value of the work
❑ New construction . dditioti altcration/replacement performed indicate the value (rounded to the nearest dollar) of all
[] Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
• Value S
Ct.'1EGOR • C}P" CO31 W I W C'rI Q N EIrTIAL EQUIPMENT /SYSTZ A4S
R »S FEES` •
and 2- faintly dwelling ❑ Commercial /industrial ❑ Accessory building Forspeciathtjormnriw: use checklist
Multi- Family ❑ i'./laster builder ❑ Other: r)esaiption Qty. I La. 1 Total
SOB SITE INFORMATION AND LO : 3.leatiir aulirg.
Air conditioning I
Inbsiteaddress: /05 9 C f t 4-.J� ' (requires site plauslwutin 46.75 1 ' , 0 1 7 )
1 �� 1 Furnace 300,000 BTU (clouts/ela::i 46.75
Cit y iState./ZIP: r 1--
Furnace 300.000+ L3'C'U (ductsJ.•ents) 54.91
Suite/bldg./apt. no.: • I Project name: i �J Heat pump .
�Ftt �� frugaires site plan shoa•tngplacement) 61.03
Cross street/directions to job site: Duct work 23.32 i
Hydronie hot water system 23.32.
Residential boiler {radiator or
hydronicl 23.32
1 Unit heaters (fuel -type, not electric),
in -wall, in -duct. suspended, etc. _
i'
Subdivision: Lot no.: , luci ent for any of above 23.32
-- + Other: 21.3_2 ! _
Tae maplparcel no.: i Other fuel appliances:
. Vd t heater ,1'JE&iCltl'!?TIQNO8 WO.RIG
'!e: - - - Water rea er 23.32 I
n �` � ,/�
� I ,r(� as fi lace water heater or 33.39
APg ; � ` f 244r `_< J �v/ ,41 C Ir " / 1e: 1.1 G ue ven t for tuts . 1 � If fireplace 2>.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert . 2132
tuer, fluehnt . 3-3_
imnc il ^•
. Other: 23.32
Name: Environmental exhaust and venrilatton:
Ran8e hood/other kitchen
Address:
equipment 33.39
City /State /ZIP: Clothes diver exhaust 33.39
Single -duct exhaust (ha:brooms,
Fax: ) 2
Phone: ( ) t toilet compartments, utility rooms) 23.3_
0 APP`LICAN`T - •
.. . 0- _CON"'rACT. PERSO;� Atticicrawlspace fans 23.32
... . : Other: 23.32 i
Business name:
Fuel piping:
Contact name: 5 .51_. 0,...0 814.15 for first four: S4.03 for each additional
Fur+tace I
etc.
Address:
Gas heat pump
City /State/ZIP: Wall /suspended/unit heater
Fax: ( ) Water heater
Phone: ( ) Fireplace
E -mail: 0 c. . i . t t ,. v0.-<- - ' Range •
' .:' CCYJVTRACI`Ufi '.. f3erbecue; ;
ILA_ Clothes dryer (gas) i
Business name: ♦ f L.. ts. a - . ' 4 _ R ... ... Ctrl - -
- �� °°¢¢ - Oth er:
D
Address: :.- 4IE:(:HA14l:C?1.LkI:R&LF1'FELS
Ci T. 0 ke- 9 7t2I _ subtotal .
:Minimumpermit fee ! 390.00) j 4)• (TO
Phone: (57 ) ,..Y ,. .a.'i()ri Fax: .3 g -0.2:70 Plan review (25 % ice) I
CCB lie.: 7 & , 3 5 1 : State surcharge (I2%ofpermit fee) ' /0 .17)
�-' P ' TOTAL PERMIT FEE gfi1 ..t�
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Authorized signature: This permit application expires it permit is not obtained width 18U
days after it has been accepted at complete.
+, ,, y� l J Dot I • F ee ntet odoic set by Tri -Coamy iluilding industry Sc :.ice Board
Print name: Jar �.x� Fol. s1'�r~ : '� � 7 q �l i y
t' tiuldinttPeratitt''NEC- Nermi'.0 p.:be 09;Q911q .lO 45i7T CT i:f!.^. /COM'+wa)
Jul 19 11 01 :06p Columbia Heating /Cooling 503 - 598 -0270 p.3
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HEATING & COOLING, INC.
P.O. BOX 23C397 • TIGARD, OR 97281
(503)624 -2704
SITE PLAN
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ADDRESS • I acci S ,) i Om