Permit CITY OF TIGARD MECHANICAL PERMIT
1111/ 2 COM MUNITY DEVELOPMENT Pe rmit #: MEC2011 -00552
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2011
Parcel: 2S 104C D04700
Jurisdiction: Tigard
Site address: 13867 SW BENCHVIEW TER
Project: ARMELI Subdivision: HILLSHIRE ESTATES Lot: 47
Project Description: Relocating refridgerant lines.
Contractor: COLUMBIA HEATING & COOLING INC Owner: ARMELI, THOMAS F & TERRI F
PO BOX 230397 13867 SW BENCHVIEW TER
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Other, Heating /Cooling 12/01/2011 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 12/01/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/01/2011 $66.68
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: rmittee Signature:
!I�
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 30 11 04:38p Columbia Heating/Cooling 503-598-0270 p.2
Mechanical Permit .Applieution FOR OFFICE 12SE ()NIA'
City of Tigard 0 Received , 1 f 3 .
, ontG 47 . 7 _ p._,
t s_-
• - ..... q 13125 SW Hall Blvd.:Tigard, y. 1 1 OR 9722' -....1k Plan Review
' Phnne: 5C3.639.417I Fax: 503.5 0
rl%\\ D Citilmi Pettnit.
Inspection :_inc: 503.639.4175 , % f.-
TIGARD Date Ready/By. Jun See Page) for
Inter www.tigard ‘A --. Notified/Method: Supplemental Informs don
,..,..
.c..(S.\C)43\() .... .....
! - 'I'YPE OF WOR . "1, "O F FEE" SCHED111A - USE CHECKLIST
__,
' Mechanical perm fec3* are based on the value of the work
Ncy construction ,,' Aticlition/altcratte -ittiVacemcnt
i)cinotitir,r 0 Other $ perfccmcd. Indicate the value (iounried to the nearest ciellarl of 311
mechanical materials. ecutpmtmt, labor, overhead, and profit
I
vr-- CATEGORY . OF ...CONSTRUCTION.' . ;.: ' . .. - Value. S
l -
RESIDENTIAL EQTAPMENT / SYSTEMS FEES*
1 - and 2-family dwelling 0 Commercial/industrial 0 Accessory building
i or special u?fornmeion use chcckhs)
--7 Nluiti-Family 0 Master builder D Other: '
DescriptInn i Qty. i tt..;1 I eta:
•,__ _ ___ __ .......
JOB SITE INFORMATION AND LOCATION Ilea ti op./cooling
kir conditioning
, I
•
.
Joh , :te adch 13g1 Bendykko 7 1 (r.air.site plan SliOsslk placznirit: L 46.75 ,
I CillSitite./ Tikird i : e - 4 — (2 ‘1"7 .... 0 . 3 ._____ _ I Furnace 100.000 BTU (ducts/vent:5) 46.75 •
•
l—•• Furnace 100,000+ BTI f ftiucttivcaist 54.91
! cilitc.1-i'dgiapt. f10.: 1 Project name:
Heat pump 1 : 5 Of)
_. — ,
, Cross street:directions to job site Duct work i
I i 2137 •
Hvdronie hot water system 1 2132
._._,.
Residential boiler (rarkator cr
I .
hydronic) I 23.32
- '
f — Unit heaters (fuel-type, not electric). I
i
in-wall, iti-duct, sus ended, etc. i 46 75
Flue/vcnt for any of above . _ 23.52 • _ I
' 5 .11Inchvlaron: Lot no.: .)
___i Other: i I =de ket•idilleg: a 23.32 !,, . , '
_
a map:parcel r1 : Other fuel a "liances
i 2_1.32
DESCRIPTION OF WORK . Water heater • , - - • - ii...
- *
Ili ...V., agN
# ,411L g I i Illiat.:W 11)05 I Gas fireplace I
7lue vent for water heater or gas
11 fireplace
-i 23.22
Log lighter (Ras)
l• 23.52
Wood/pellet stove _ i 33 .=`:'
, ---1
Wood fire. lace/insen '.. i P :)?._ ..........
1 Chimne /liner/flue/vent I 23.22 ;
0 PROPERTY OWNER • ' : ' '0 TENANT .
Other: l 23.32
,r.inc- Environmental exhaust and ventilation
—
Range hood/otlour kitchen
Addr(25 'Ll 3 8--tel-C-20-BenChoe-iit ) 7-fl- eruiiment 33.39
----
; C cy'State/l1P: 77 ar d , R ci7cpo.:3 Clothes dr.yer exhaust 33.39
Single-duct exhidus: (bathmoms,
' tThionc53 4 z Fax: ( ) toilet corn iartments, utility rooms) 23 32 .
— 2
i 0 APPLICANT • '. 1 . 0 CONTACT PERSON t Attickrawlspace fans 3 32
■ — t Other _ 1 23.32 !
-i i
nec.c, name: cciumfrc Neeth e C6191 Ini ! Fuel piping i
i
'....0":!PC. name: /n 1 , 2 0 40 4 7 ' IP el ' $ 1 4.15 for first four: $4.03 for each additional
. --:
—1 Furnace, etc
%cicircY:s;
Gas heat pump —
: C:ity,tit-ite.7iP: ) Wall/suspended/unit heater I .
— I -
lknter he ter
.7 j .--. ' m
Fax: : f C/ efR . 0
,__‘ _......_ Lirepinc.....
l
Liras:. i Range
i •
i • -
CONTRACTOR. . • '..- . . .. - . • Barbecue , ,
Clothes drver ( t;., as)
i t
Rimin-cs. dame.
' - — ' • a J,5 , . ... ear, ...i' _
i Addre5sfe0 is30.\,,,719 7 .- .• ,-. • .- •• MECHANICAL PERMTT FEES" . • :' • - •
f.'it 'State/ZIP: ‘7164.p 0 :0 7,-)--gi Subtotal
Minimum permit fee ($90.00) go.03)
l Phone. 613 ) ii Q ii _ai Fax i ( 5 . . s, ... ca- -
Plan review (25% of permit fcc)
--- __ ____
Lccn ii-L: 76z3--9 State surcharge (12% of permit fee) /) . ir0
TOTAL PERMIT FEE / Od .81) ..,
Th13 permit application expires if a permit is not obtained Ty ilhin 1£10
Ala hnri7.ed signaturi_j( - . ..1. alli . ....... 1 in ys after it has been accepted as complete_
P n inc .0 Date /1134 7
• Fee methodology' set by Tri Building industry Scrvicc Heart.
r: [ tt:61-lbera - (571 :
, . . _ _ . ._._ ......