Permit ,, CITY OF TIGARD MECHANICAL PERMIT
s '� COMMUNITY DEVELOPMENT Permit #: MEC2009 -00424
Date Issued: 08/14/2009
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103BB12700
Jurisdiction: Tigard
Site address: 12305 SW ANN CT
Subdivision: LAKE TERRACE NO. 2 Lot: 20
Project: Hand
Project Description: Install gas line for range
Owner: FEES
HAND, ROBIN R Description Date Amount
12305 SW ANN CT Other, Fuel Appliances 08/14/2009 $10.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 08/14/2009 $8.70
PHONE: 503- 341 -6609 Minimum Fee Adjustment - Mechanical 08/14/2009 $62.50
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:
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 Notification Center. 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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: F Permittee Signature: ����� 7 - 7 �� 1
O1 ✓ Call 503.639.4175 by 7:00 a.m. for an inspection that business 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.
Aug 13 09 12:14p Columbia Heating /Cooling 503 -598 -0270 p.2
•
Mechanical Permit AI , Iica 'o r City iz arm• icE I'sE ONLY
of Tigard Per�tNO. y
hr 'ii CEIVED g Received oa r /y 0 !41 :4 EC 0Rr' /
13125 SW hall Blvd,, Tigard, OR 97223 Plan Review Other Permit:
' k ' Phone: 503.639.4171 Fax: 503.598.196 'r 1 3 2009 Date/By:
T1GAKD inspection Line: 503.639.4175 a Ready/By: luit: BJ See Page . for
Internet: ww� V. tigard- or.g❑v FTIGARD Notfied/Method: - Supplementa Informati
CITE' OF
r it _ 11,.. ,
r
TYPE 0 '' s i • • .. . ... .1‘:: :
' ; ';,C�,Oi11111143c4. L =..0 . c. ECKLLST
Mechanical permit fees* are based on the value of the work
❑ New construction [ddiiionlalterationlreplacement performed. Indicate the vtJue (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
. • .:.. value: S
. CATEGORY OF CORSTRU1ION ', . ; .... ..:_ - ::: { � 'r ,,;; a t. ,; ; _ ......
R E.S J p4NT 14 i EQUIPMENT / SYSTEMS FEES
21- and 2- tainily dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. ` Ea. I Total
JOB SITE INFORMATION AND LOCATION . . . Heating/cooling
q Air conditioning or heat pump
Job site address' ' 2_- 0 S >--,,) ! 3yt- - s; . (requires site plan showing placement) 14.00
City /State. /ZfP: Furnace 100,000 BTU (duets/vents) 14.00 �T` S 4 � � O 7Z 3 Furnace 100,000+ BTU (ducts/vents) 17.90
Suiterbldg.rapt. no.: Project name: Gas heat pump 14.00
Cross strecudirections to job site: Ductwork , 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 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: Lot no.: Other: 10.00 .
Tax map /parcel no.: Other fuel appliances
I .
Water heater 10.00
DESCIiIP CIO Y OF WORK 10.00
•
Gas fireplace
4 tt_4t ,40.1.4.. „ (s Flue vent for water heater or gas
/� fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove _ 10.00
Wood fireplace/insert 10.00
Chimne /liner/flue/vent 10
❑ PROPERTY OWNER I ❑TENANT Other, 10.00 1
Name :' 0( /-.9' Environmental exhaust and ventilation •
Range hood/other kitchen 1
Address: ( 2- 3 0 s s c.,..) f(, ek S i equipment I 10.00
City /State/ZIP: \ � 6 (.� c 2 z 1 Clothes dryer exhaust : 0.00
; Single -duct exhaust (bathrooms,
Phone: (5 -3q/-660 C! I Fax: ( ) , toilet compartments, utility rooms) 6.80
Attic/crawlspace fans 10.00
❑ APPLICANT ❑CONTACT PERSON 10.00
Other:
Business name Fuel piping
Contact name. (4.. $5.40 for first four; SIN for each additional
Furnace, etc.
Address: G heat pump
City /State/ZIP: Wall/suspended/unit heater ,
Phone:
O 7 "7l� Water heater
s- )63 -� Fax.. )s � Fireplace
E-mail: Rang! 1
CONTRACTOR • .,,' >`.: Barbecue
,1 c....2-(1(_, Clothes dryer (gas)
Business name: l� 1j t /t i b. 0., !'t/ tirr l ether: 1
Address: .& ;3 0 A. „2-3 0 3 i r MECHANICAL PERMIT FEES*
, City /State/ZIP: ,, /'� d , 7 1
Subtotal
( �) Minimum permit fee (572.50) 703 •5 0 Phone: ✓ 7.)0 Fax: 563 ) ��f g 0 :)- - 70 Plan review (25% of permit fee)
/ t
CCB l: c_: tr2 ,./ State surcharge (12% of permit fee) f , 7c)
TOTAL PERMIT FEE , A C1 ] t/
Authorized si ature: . This permit a pplication expires if a permit is not obtained within 134.) � � d a ys after it has been accepted as complete.
Print name: b0Aa, > t . Date: / i) 5 ' Fee methodology set by Tri Building tndu;try Service Board
a,,. :.,__,__ ,.,,,<,.., aan..dxiTr