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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2011 -00434 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued: 09/30/2011 Parcel: 2S109AD03400 Jurisdiction: Tigard Site address: 14547 SW 130TH AVE Project: Hirschman Subdivision: WOODFORD ESTATES Lot: 26 Project Description: Install gas line to range and BBQ. Contractor: COLUMBIA HEATING & COOLING INC Owner: HIRCSHMANN, GUNTHER JR & MARISOL PO BOX 230397 14547 SW 130TH AVE TIGARD, OR 97281 TIGARD, OR 97224 PHONE: 503 - 624 -2704 PHONE: 503 624 -2514 FAX 503 - 598 -0270 FEES Specifics: Description Date Amount Fuel Piping 09/30/2011 $14.15 Type of Use: SF 12% State Surcharge - Mechanical 09/30/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/30/2011 $75 85 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 - i work i uspended for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utilit Notification Center. hose rules a - set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or erect questions to OUNC by calling 503. '.19: or 1.800 332 2344. , Is - ued By: r , i 1 /- / ( � / Permittee Signatu e: /1 4 Call 03.639.4175 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 30 11 01:40p Columbia Heating /Cooling 503 -598 -0270 p.2 Mechanical Permit Applic t ,rt1ED JOR( 1r i vv R eceived / City of Tigard 9 J, �/ Penntt /� 7 j .. 13125 SW 1JaIl Blvd., Jtgard, OR 91223 I P lan R, ,,, , Phone St13.718 2439 Tax 503.598.1 P D 3 p 2011 titter Perim inspection Line. 5f)3 639.4 5 C ` Date Re TI G: LR D Date Ready:RI. )y Suns- H See Page 2 for Internet. www ttgard- or.gov T IGARD hot %Method 1 Supplemental Worm mien CITY DIV ' ` `1 "YPE f R7# . COMMERCIAL FEE* SCHEDULE— USE CHECCLISf ' Ntleehattical permit fe are based on the value of the work ❑ New construct:on 12q, Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar; of all I ❑ Demolition ❑ Other: mechanical materials, c.ui .meat, labor. overhead. and rotit ' ---- - Value: S CM' G(3RY OF CONSTRUCTION ______ RESIDENTIAL l:QUIPMF;R'TISWFE4tS FEES* El I- and 2- farnih dsvci:ina. ❑ Commercial /industrial ❑ Accessory build • ' �, _ Forspecintutjnnrtnrinnused :eckfisr. ❑ ML:11- Tamils ❑ Master builder ❑ Other l)cscriptinn 1 Qty. I Lx. 1 total JOB SITE INFORMATION ANTI LOCATION I[cntia;icooling: 1 4547 J p _ ` Air quires conditioning p plea 1 Job silo .xldress. �� l � � , �� (requires si 3 n shon,n�� placement) 1 �G.7< ! gi Furnace 199,()90 B (duet. - .rots) 46.75 City/State/ZIP. City/State/ZIP. Furnace 100,000-1-13 F Ft (ducts(,cnts) 54.91 Suilc/bld',iapt. no . Project name r `/'' il i t pump t � he uucs site Dien showing f lactrna_t) 6 1.06 Cross streeL'directions to job site: Duet work 2332 Hydronic hat water system 2332 Residential boiler radiator or hrdronic) 23.32 , ° L _ Unit heaters (lttel• ype, not electric). in -wall, in -duct, suspended, etc 46.75 Subdivision: 1 Lot no.: Flueivent for any of ahoy:: I 23.32 Other. 23.32 _ Tax map /parcel no,: t Other fuel appliances: !ASCRIPTION OF a t)TtIC ' . - Water heater 23.32 C:305,- r ' ,^ i �^M n l S! • Gas :ircj 33.39 . --. !�(f � (.�/ f r ( � a" � Flue vent for water heater ur ,,!..ti, fireplace 23.32 Lo_ lighter (aril 23.32 III Woodlpelkt stove 33.39 Wood fit eptacefinser•, 23.32 $LF1tOPIt k OWNER - ©.TENANT Chimnevtl finer/ fluevent 23.32 Other: :::: wank: I f Environtncntal exhaust and vent•.lation: Addl css: 1 t; #. --7 f Range hood /ether kitchen / equipment CitylState(ZIP: t' I Clothes diver exhaust 33 39 ( � y � a i Single-Coot exhaust ( bath rooms, Phone: ).e� I o6 I Fox: ( 1 toilet compartments, utility roomsl 23 32 ❑ APPLICANT Q CONTACT PERSON Attia`crawvhpace fans 23.32 Other { 23 32 Business name: I Fuel piping: Itt Contact name: A Lain......) 314.1S for first four; S4.03 for each addition! Address: Furnace, etc 1 . Gas heat pump City /StatefZJP: l' allisuspended/min heater Phone: ( 1 Fax: : ( ) I Water heater I Fireplace E -mail: t Range i G 4 -__li k� -± CONTRACTOR - - - llarbeeue t L / any �, Clothes dryer (gas; Dimities& name' t TV` N_�4 1 - + f.r-' -" Address: pG t.3 0 V i ` .xhcr. { MECHANICAL PER X13 f7 L" City /Slate :Z1P: 7 0g.... 9 7t„ / - subtotal i _ . Minimum permit fee (S90.00 9.0101 P1:one:(SS ) 4 a. 4( Fax• I .5�-r7F_ .2.7 0 Platt review (25% uroernmrt ltd • -------- C'('B tic._ '7/ �'Q S tate surcharge (12% of permit l'ee) I �� , go: - ' / TOTAL PERMIT FEE ✓d .10 Authorized s :gnatu, e' (' t� y �-,t._,,,, U ,� }n .p� d' -- - Thi:r permit ap ys after ti exptrcs it permit is cet , �i u,;., ISO � - V + �[ .NCJ t ',1" CY -! days Crcr it has been n accepted at. .. coo mpplete e. �j Print name: ja } . e t ..,.,+ 0 / f Date: 9 /� � m t 11 . Fee ethoTi de logy set by T-Count Btnldi,.g Imhrstrs Son, ice Board a I - ,ulca,spmain'MEf . P.^rmuArt' de, O N 0 . 1411.3 ��� 7 I i 1 •l"Il5f'WE31