Permit a CITY OF TIGARD MECHANICAL PERMIT
4 � COMMUNITY DEVELOPMENT Permit #: MEC2011 -00394
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2011
Parcel: 2S103AA01917
Jurisdiction: Tigard
Site address: 12440 SW 106TH DR
Project: SHELLEDY Subdivision: COTTONWOOD PLACE Lot: 3
Project Description: Furnace replacement.
Contractor: COLUMBIA HEATING & COOLING INC Owner: SHELLEDY LIVING TRUST
PO BOX 230397 BY SHELLEDY, RODNEY F & JEANNINE B
TIGARD, OR 97281 12440 SW 106TH AVE
TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/06/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 09/06/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/06/2011 $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.
Issued By: Permittee Signature:
/ I
l ,11-at
Call 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.
Sep 06 11 01:58p Columbia Heating/Cooling 503-598-0270 p.2
: ... •
Mechanical Permit Application FOR OFFICE I SI: I.)NII.V
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Dateilly: 4. her permit
Tiamto [...s.,),,%,,,. L:.1,. :03 ,:, 39 4 I -.; 5 {(1 le Reo
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.....4\ Dady/By• I hms 81 S er: Pig 2 fur
1 iticrr.c. .■'.,-, ii.6,..a.1-Qr Vy C-33 1. ,, s f,61 .1. NoecliMt..thk: I -- 7„- soustIetneutsil Inrorniunuo
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I . - TYPE OF WORki.-0,c\7%CV1' COMMEFICIAL':FEE* SCHEDULE - LISE CHECKLIST
Mechanical permit fees* are based on the value uf the wurk
. c-, ..k/ISI1_111 [g"I i'.it.miaitcraliutT;elsitit ent
b-P perfbrrr,cd Indicate the value (rounded to Cr nearest culitur 0; .3.
D Othor: mechanical MEitCrlitiS, equipment, labor, overh an
ead, d protit
Value: $
CATEGORY OF CONSTRIJMON '' • ''' - •;•'.:-;••!..' i' ...i':-" I .
RESIDENTIALEQUIPMENT'I.SYSTEMS FEES'
2. l.anils (:,1ing ' Ccrrimerciallindustrial E Accessory bJilding
F :p informer! on use vilet•kftst.
_____ .....li..,..,•Ittiti.: [11 tvta.stcr builder 7 Other:
Description
JOB SITE INFORMATION AN]) LOCATION .' - .': ": • v. ,!.'....'', ' Heutingicooling
At condoning
(r .Jires siie ist.o stcwia. .4sceir.en.. ' I
L.4::,..Sta....:./..1- Ti ac q'r1 12,11 Femace 100,000 BTU ducis.;vents) ",„'"411111 4ci 75 I ___ _ .
Furnace t 00,000* BTU (eucts.tvenisi NMI 5-.91 '
01;:. ' -I k. 1 ire.rne.:
Heal own
C. fu,:, ,::_ire....'...q., il, l):) SRC , Cum work 2.1 3.2
-- - --- - - - • ---- •-• - ---- -•• ----- ---------------- _._ — I , . - •
---- H vdronic hot water sYstem i )3 3) •
Residential boiler 'radiator cr
'
hydrcroc) i :3 3:
Unit heaters (fuel-type, not electric",
, in-wall, in-duct, suspended, etc. 46.75 •
c.:0t 2332
Fluent for any of abe
ov. !
1
Lot no.' e/v
I -- -- . .
Other: 2:4_32
I,....[L.:1 :..,.[..:0 1,...
Other furl applixacus
r DESCRIPTION OF WORK • . . .
Water heater
I 23,32
Gas fireplace
33.3-) . _.. ___ ....
i , f- R..CeP LAC) C- Arte-is.,1 , Flue vent for water heater or gas
r- , — --- - - -
--- -
. I 23.32
- - -
- Lug lighter (gas) 23 32 ________
Wood/Rellel stove I 23 3
Wood fireplace/insen 23.32
Chimney/lineritlueivent 23 3?
OWNER E TENA.NT ..
-
Other.
1 ri,..r.k, goo S Enviro u menna I exhaust ba nd ven n tilatio huodiother kitchen - .--- --- ,
A ior c s, i /t
oc.
equipment I : 34 ,
.-• . - -7-1 a ot qr7=2.2(1 Clothes dryer exhaus. : i' .I
'
T — Single-duct exhaust (bathrt.xsips,
F 11 toi ,c , 573 3 _Licac) - 5 6 Fax: t I toilet compartments, utility rooms; 23.32_
c APPLICANT I 0 CONTACT PERSON Auicicrawlspace fans .
2 3.32 '
Other: . 22 32 •
Fuel piping
1 :. - ,:'1113;_ . !1::.:1■L . f i t:),/ - / ,--. ./...,..-, ,e),/) e r ppdw,
s. ,... s. s14.I5 for first four; 54.03 for each uddit am,
Furnace.
.etc.
,1jr
1 --- Gas heal pump T
Wsuspend t s
ahrediuni heme
-- _
Water healer 1
____..... .
, Fireplace
r-znar I .
Range
CONTRACTO.R ' . .. . Bar , becue
__ _
Clothes dryer (gas)
Busmess na.ne. ( 4 1 171 .--7,9_77-7',\:)&47L,
- _ Other: f
• t 2 \ .
7 :. - ....: MECHANICAL PERIvrir FEES'
Subunal
--
I Minirn_im perm]; roe (1:90 ULF' eiVii6
1 (. .- A-1-- I 1 ' — • ---- . . - 7D F
Pho review (2 St% of pl:177111
CC Li I IL . '7/ 7-7 C?
State surcharge (12% of peenit feet
....,...,-2_,......„..._,,....___
I
TOTAL PERMIT FEE 1
, ,„..
A 51110 '1'.::.:....! r!:,11..thirc:,,( A(illil 4 ,%/117-V1 'This istrnsit .pplicatica eapir.,ir a permit is nor. Iibtained I, ithii .5
^ e / L days after it bus beer s cc:4m ed at complete.
rf"rini ittune fi,/ • 7/•••••• fig I Date: 7•::1 — i I , Fee irethecology set by 'fri-Ccurity Building ilicItsir: Service [Ler.:
1 . A II: 3.”. (.:1•1,,*