Permit ill CITY OF TIGARD MECHANICAL PERMIT
.. Y COMMUNITY DEVELOPMENT Permit #: MEC2011 -00513
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/15/2011
T6CaARD Parcel: 25112CAl2800
Jurisdiction: Tigard
Site address: 15610 SW 76TH AVE
Project: Scherer Subdivision: RENAISSANCE WOODS NO.2 Lot: 52
Project Description: Replace gas furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: SCHERER, JANET K
PO BOX 230397 15610 SW 76TH AVE
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 830 -3130
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/15/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/15/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/15/2011 $43.25
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
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: ;; 0 _ 0- Permittee Signature: D/ //O ir -77 /
�' ((�� Call 503.639.4175 by 7:00 a.m. for the next available inspection date. v
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 13 11 02:12p . Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Applic i ; EIVED • FoK ,H'>'ic :rw I SE ONLY
City of Tigard
Recci:ed
114 r Pt rn,it xe
11325 SW Hall Blvd., T,gard, OR 9 ' 2 )V 1 4 2 011 Date''" / /S // �C' %DUS
Phone: 5(13'13.24.39 Fax: 503.598.1 )h) Plan Rc ic,ti 0, lie.: Peanii'
Date
TI GA D
Inspection Line: 503.639.4175 kris CI'I'I' OF TIGARD Date Rd- e rhn: 81 sec Page 2 far
Internet: wSYW.Ii rd -0f,GOV Nontiedlleth.,d: „ rL E Supplementallafnrmation
BUILDING DIVISION
CnhlMI.R±erAL• tDUL>u - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction X Addition /alteration /replacement performed. indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Olhcr: mechanical materials, equipment, labor, overhead, and profit,
- -- - -- Value: S
CATEGORY - OF CONSTRUCTION ..... .
- RFSIDE:T1AL FQI)IPNI ENT / SYS'rEms ti ES' • )
psf 1- and 2- family dwelling 0 Comtnercia] /industrial 0 Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder D Other: Description r Qty. Ea. I Total
.XOB SITE INFOl MATION AND LOCATION Heating /cooling:
Air conditioning I
Joh site . ddress: / Y} A trequires site pia') showing placement) 46, 75
C'!ty/StaleiZ1P: J
i ��� CI ) � �1� F urn ace 16o,;')t10 67'U(ductswcnisi � ti.76
' ']�'� q a
9 �/ Furnace, ]L'o, �Otl +r31'rJ ;ducLv nisi 46 .91
Suite/bldg. /apt. no.: Project name: re g `leaf pump
�--i Irequ :res silt On shcxing placement) 61 06
Cross s:reet/directions to job site: Duct work 23.32 -�
Hydronic hot water system 23.32
Residetuial boiler (radiator or
hwdronie) 23 32
Unit heaters (fuel -type, not electric),
in -wall, in-duct. suspended. etc. 46.75
Subdivision: Lot no.: Fluc/vent for any of above t 23 32
Other: j 23.32
•Iax map/parcel no.: Other fuel appliances:
: .. ': . ; D1;5}C:RIP'C[QY O,E 1�' ` �, � ' - - Wale r treater 23.32.
//�� / Gas r he ater 3:.39
1� . C 1 5 c ci/U I , Gas vent a ce water leaton or gas U fireplace 23.32
3 _ Log lighter (Ras) 23.32
_ Wood /pellet stove 33.39
Wood fireplace/insert I 23.32
Chimney/liner/flue/vent � 23.32 • A. PROPERTY OWNER b TENANT .. -
Other: l 23.32
Name: I\. , / , ' A t /1 / L Environmental exhaust lend v'entiiation : ....
MI Ra nge hoodfother kitchen
L _gun
-intent • API • t
•
ument 1 • 33.39 Chy!Stme/ZIP: d Clothes dryer exhaust I 33.39
'" f • -- - �lm+ s . w �__ i Single -duct exhaust +;bathrooms
Phone: („ �1 zi Fns: ( ) toilet compartments, utility rooms) 23.32 •
0 APPLICANT. El, _CORT CT PERSON Attit /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping: •
Contact more: Ste_ C�..A ,. S14.15 for fi »t friar; S4.03 for each additional
Address: Furnace, etc -
Gas heal pump
City State /'LIP: Wal 'suspended/ unit heater
Phone: r ) Fax:: ( ) Water heater
Fireplace
F-mail: t'j s 9- / co itisw„.b t`A44J as_ - #'e Range •
• CONTRACTOR- - - Rarbecue ,
Business name: i . f l� u a a 4... u A { '4' C/y j Ocher: dryer (gas)
Address: s c 2 3 35 - L1ECHANI AL- PERMIT :I+E:ES'
l
C'ii },''State `Zll'c Subtotal l
. - r c . 0 9 T Minimum permit fix (S90.00) y0 . t7�
P ne: (9)5) _e2-7® C,{
o V Pao; i lt) � &Z' . 0 Plan review (25% of permit feej
CC'R lie,,; — ! �"C? State surcharge (12 %ofpermit fee) : /0 . k(J
7t Z! TOTAL PERMIT FEE . /Da , k ( 1 ' -
This permit epplicatten exp ire pit o urncd within 1SO
Authorized signature: r r a n G ``� day aft it has b ires een acce is ac c em
Print name: J t ([ } t � (..y _ (/,„/" Date: 1 1 -J 3 _ I Fee utett,vdotugy set by - Tri- Cc,ne nuildi,s tuducUy. Scr, ice Board
I �&nldin5,Pgerms'.!t ,- .,;:AAnr.duc 445 -A 11 r (11.ea(as1.Wsa)