Permit Iii ,� CITY OF TIGARD MECHANICAL PERMIT
'.. COMMUNITY DEVELOPMENT Permit #: MEC2011 -00557
Date Issued: 12/06/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S114BA03500
Jurisdiction: Tigard
Site address: 9685 SW SERENA WAY
Project: Grace Subdivision: PICK'S LANDING NO.2 Lot: 105
Project Description: Replace gas furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: GRACE, JERRY L & GLENDA E
PO BOX 230397 9685 SW SERENA WY
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 624 -2704
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/06/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/06/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/06/2011 $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
issuanc , or if work • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit Notification Center. Those ru - \ are set forth in OAR 952 - 001 -0010 through OAR 952090. You may obtain a copy of the rules
or erect questions to OUN � call ,, 50 .232.1987 or 1.800.332.2344.
Is ed By:
ee 0 / Permittee Sign. re: ,
P, `, , 4„
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.
Dec 01 11 04:52p Columbia Heating/Cooling 503-598-0270 p.2
.
Mechanical Permit Application 1 fOiR oFF It E L'ML:- ()\I
' City of Tiga rd
SW RATignrrl
c.,:CA
Received
Dateliy; 0 P'it No /Zeol.e/Pee,
: ... q !3125 Hall S. , Ol \ Plan Review
. ' Phone: 503 6304171 Fax: 503. i 98.1960 N. 11-%\ Ontriliy• Oilfa Petrnit: 1
TIGARD Inver:tier, Line 503.639.405 t\'°) Date Ready/By. lens: .. RI See Pe 1 for
lotcroct: v. ' ‘\ C) SX(3 NotifiecIlMethod. ' , SuppIrmenial Intntination I
. OV 1,N\ .1
C
TYPE OF ' '4 • . ] COMMERCIAL FEE* SCHEDULE - USE CTIECI-GLIST 1
_ i
-- ----- -- •
1 Mechanical permit fecc• are b ra 0 ased ci value atilt: work
.__.1 NC“. :;or3,truction T ArlditiOniaitcrationireplaCemcnt performed. Indicate the value- (tuuntied to the nearest dollar) of nil
7., Demolition 0 Other! I t mechanical materials. equipment, labor, overheat% and profit
i Value: 3
CATEGORY.. Or ,CONSTRUCTION. t - . t., : - - 7 - . . : •
.---i .
• .. RESEDENTIAL EQUIPMENT /SYSTEMS FEES*
,
1- ttnd 2-family dwelling D Commercial/industrial CI Accessory building
For si.. mforma. use chentlisl
7 \IIiiti-farnl; f: Master builder 0 other: '
Description : Qt l ! l ron
_ ..
- __.. . .
JOB SITE INFORMATION AND LOCATION . Heating tconling
' fl IT corditioning ! :
,Idb cite address: C sv j 5.. k ,„,„,,,,res „Lc plan showInulacctnenl:b
t. gic 0 Cil?,.. Furnace 100,000 BTU (dueis:vents) 1 46.75
--;
Suitelbldg.;'apt. uo.: Project name: &ref ' 1 Furnace 100,000- Br..1 iducts/vcntsY
.._.
Heat pump i 54.91
el I 06 i
C r - .s5 Sireetldirections to job site: Duct work .1_ I 23.32 :
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Z.Init heaters (fuel-type, not electric)..
in-wall, in-duct, suspended, etc. ! 46 75 1
H -- -- 1
- 1 1 i'lt:c/vent for any of above i 23.32 I
' k.libt-1-,:is on Lot no
Othr: e _ ,.... _ _._ _._ i 23.32
.
lux mdpiparcel r50 .: - Other fuel Ippliances
l DESCRIPTION OF WORK • ---. - . • - • • • . Water heater i
- 23.22 - "1
_.l
• 1
Gas fire lace 33 39
f ii Jac:A(1UL_,
Flue vent for water heater or gas
fire.p1ace 23.32 :
Log lighter (ips) 23 32
wood/pellet stove 313(1
.. --__, _..
Wood fireplaceinsert 23.32 j
C'himney/liner/flue/vent j 21.32
. 17i PROPERTY OWNER • 'l • . ' - - ' '0 TENANT
Other 23.32 I
i
: ".:.inc.
,_. ......_ _ _ ... .. ......CMCCA.C.2.-... Environmental cabana' and ventila inn_
rcs..5. Range hood/tither kitchrn .
Add
SAO ciuiiment 1 3.39
1 Cisy'StateillP: - 1 - 1 c (AT oy a cn SE e c.- ` e Clothes dryer exhaust
Single-duct exhaust (bathrooms.
: Phonc:Wi3 Fax: ( ) toilet coin : eras. unli( rooms) 23.32
I
\A_ APPLICANT ' • - . : . .0 CONTACT PERSON : 1 Attic/crawlssace fans
Ruci name:- i i , • J
F Ill #1 .. in _.-.1 if , 6 -illtO. -All 1 Other ,
Fuel piping
•
-::
,
Cur, sac' name: / j /( /--- /- /-20 meed i S14.15 for first four: 54.03 for each additional
Furnace. et:.
Address:
Gas heat Fume
Cll.. 'State/7.1P. , Wail/suspended/on it 1.e-i ter • -
: Phalle: a - 3) t 14 Q70,-/ i Fax: 06 --j -, 7 O r i 1 _1 1 /_fater heater
147 ' , i Fireplace
Range
.
l '
• - • CONTRACTOR.. . . : : . .,- - • i Barbecue
• r---- ._. .
• • • Clothes d - cr .as
Business name:
Address:63 (-) ss 2-.7. ) a":3' 9 : •- MECHANICAL PERMIT FEES* .
,....
:. 776 0 ,.._ T7 Subtotal : 6
Minimum permit fee (S90.00)
1 Ptmac: 6:3 ) (Daft - 1 a
1 Ftoi: ( .... 1 c 5C?fi _ - ,)70
.
Plan review (25% of permit fee)
i CCP hc.: '76)&3:9 __ State surcharge (12% of permit fee) I /0- • a -
TOTAL PERMIT FEE 1 # .O
This permit application expir if ti permit is not obtained within 18;)
Aui heri7Cti Si L f f .
gnatur-L)../LA Wi, days after ii has been accepted as complete.
rint nainc
D fa Til . Pee methodology scf Fly 7ri Building Industry Service 3card •
P:jeal/--(gilia .... 17i)
. . ._ ._ _ . . .... ....