Permit •
, CITY OF TIGARD MECHANICAL PERMIT
'' : COMMUNITY DEVELOPMENT Permit #: MEC2011 -00520
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2011
Parcel: 1S134CD06900
Jurisdiction: Tigard
Site address: 11758 SW SUMMER CREST PL
Project: Karbstien Subdivision: BURLWOOD NO.3 Lot: 29
Project Description: Replace gas furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: KARBSTEIN, PETE
PO BOX 230397 11758 SW SUMMERCREST PLACE
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 424 -4454
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/17/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/17/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/17/2011 $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 b calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: , M/ "970,4 /e.i9 /a"/
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.
Nov 16 11 05:19p Columbia Heating/Cooling 503-598-0270 p.2
'4C)1
Mechanical Permit A) lical,.. FOR OFFICE USE °NIA
II , r \.. ° Receiv 1/4 / 41100 —Permit •
...- A 1 312:i SW Hall Blvd Tigrd. OR 223 Dalciliy /
.. a, 1 r" . \- 0 No 4 -i - ..." -
r,:t ,\._... - 1 / ow . r ,7 e
:2
I. : • Plan Review
- . Phone.: 503.639.4171 Fax: 503.598,19/. _.,S Oilier Peirriii.
\ ' Dateity.
TIGARD Inspectior Line: 503.639.4175 ON S)\.'' Date Rtni.dy,'By. Jail RI Se Pogo 2 for
Internet: www.tigard-or.gov V •5 Notificdimeiliod_ ,..-7 )6 Stipple-mental Illforrnation
C \ 4 )
TYPE OF wolb ___, _........___..
COMMERCIAL FEE SCHEDULE - USE CHECKLIST
-- — _
Mechanical permi are based on the value o
t fees' f the work
C,011,:tTlIction Z. AdditiOrl/filtaalierlireptaterriellt Mech
performed. Indicate the value (rounder:1 to the nearesi dollar) or alt
2 Dernolitior. 0 Other mcc...hanical materials, equipment. labor. overhead, and p•roBt
-- 1
CATEGORY OF CONSTRUCTION .., - . ; - • - . Value: S
• RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
. 1
VI • and 2-family dwelling 0 Commercial/industrial D Accessory building
For special affirmation use cherA(Ist
\lulti-f'anfily D N4 .11f...iter budder 2 other: i ,
; Dcsen plant i Qty. . ra. 1 cital
JOB SITE SITE INFORMATION AND LOCATION Heati iWeetal lag .. ._. -..
1 Air conditioning ' :
job , ..ite address: (it , cy (requires site plan showing placementl i 4 6 75
C i:■I'Staie.i.t.IP. Tigard tpit g-..__.a-'-f Furnace 100,0D0 I3TU 0u:it/rents) r
,--- LLom.ace 100 31
,000+ Il (euctvverast 54.91
ii apt no.: ! Project name: arh.47ffer) 1 Heat puma
, 61.06 •
i ---
CTros strectidireetions to job site: - Duet work 23,32 i
i
___. —. ........... ___
Hydronie hot water system 23.12 1
Residential boiler (radiator or
hvdronic) • 23 32
— Unit heaters (fuel-type, not electric). . .
in-wall, in-duct, sus nded, etc. 45 75
_
Flue/vent for any of above 23.32
! L:::!,( ,. islop: I I Lot no.:
Other: _._ ..... . , : 23.32
• I a ri itri,: Other fuel a iii2IICES .
DESCRIPTION OF WORK Water heater 23.13i ..--.
. ' -. - • :
V Ga.s fire.lace
___!ii-s-LHIJima.- Flue vent for water heater rir gas
fire lace r 1 23.32
— I Log lighter (sas)
1 Woodigelic. stove 33.39 _ ,
______. • .._
• Wood fireplace ;insert 23.32
l--- Chimne: iliner/flueJvent 23.3 •
i X PROPERTY OWNER - :. - , • - . 0 . TENANT . IEIIIMIIIIIIIMIMI 23.32 ,
• - - '
Environmental exhaust and ventilation
Range hoed/other kitchen
----(
e tii men! 33.39
----
k. ty'State/2;W: p or en q - 7 aa2-1, Clothes dryer exhaust 3339
....
Phoric:t) 7.) Lt• .... 2149(4 Fax: ( ) Single-duct exhaust tbathrooms.
toilet corn I artments. Loa I it • rooms) 1 23.32
0 APPLICANT . 0 CONTACT PERSON I Attielcrawlspace fans L-- 23 32
i • 1
Othe . r 21 32 • _
_...
Buc.. na.mr.: I Fuelyiping
Contact nanic: i t i r ,---- - _ Al P i. 111P. •Ari S14.15 for first four: 54.03 for each addition&
_.... _
Furnace, etc.
Gas heat pianp _
---- -
City.S1ate/Z1P: Wall/suspended/unit heater :
4 - - --.• ---, - .----
. Ph onc k_DCII Q.. e 70 Fax ..- - l‘ 5518 _c),.....7c.,, Water heater
—.... . ..__ —
Range . ■
Eittrhecue . --
I
Clothes dryer (gas)
Business name: I LS I ii .. git i .,.. 111.40... . _ other: — r
•.cdress:F0 , P 'y 1 , 3 2 , 3(V-3 9 . 7 - . :. - MECHANICAL . PERWr vErs*. . • . :
(.i,-'State./21P: 716 0 9 .--. 7 „. s , / Subtotal I
Minimum permit fee ($90.00t , 90 , crt
MCMC: ) l () l' - (D3 Lr5 _
9'8-ea-7.10 Plan review (25% of permit fee!
CCB lie.: 76) Z..r59 State surcharge (12% of perm it fee) /0
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO 1,
A i:thoriacct signanirtL jt,L,ail,v days after it has been accepted as complete.
i Pr:ni narrie:ir N
---19- ,r ),(1, • ..... 67)--) . _
Date: 1.1-14 . fee methodology set by To -County Bui 'ding induiu Service Board
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