Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00405
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/06/2009
Parcel: 2S111CC10000
Jurisdiction: Tigard
Site address: 15780 SW GREENS WAY
Subdivision: Lot: 0
Project: Torheim
Project Description: Install new A/C. Unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
TORHEIM Description Date Amount
15780 SW GREENS WAY
TIGARD, OR 97224 Air Conditioning or Heat Pump 08/06/2009 $14.00
12% State Surcharge - Mechanical 08/06/2009 $8.70
PHONE: 503- 624 -2590 Minimum Fee Adjustment - Mechanical 08/06/2009 $58.50
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97223
PHONE: 503 - 624 -2704
FAX: 503 - 598 -0270
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �� / Permittee Signature: yAf ff/°'/4L1 ,�
1 �/ /L
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Mechanical Permit ApplicatiRECEIVED /� -.
Received ,.y / / Peen t No �t'�G �� % '[J` ��
City of Tigard Da-/By: ��J ,/IC/2 ! 1 •
li • 13125 SW Hall Blvd., Tigard, OR 97223 A II r o 5 C �'J� Plan Re��e
J Other Permit:
Phone: 503.639.4171 Fax: 503.598.196 Dat&By
Inspection Line: 503.639.4175 Date Ready/By: kris. I H See Page 2 for
Ti . GARD Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method! 77‘... Supplemental information
BUILDING DIVISION --
' E OF WORK COb MERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction r:: Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition a Other: mechanical materials, equipment, labor, overhead, and profit.
Value: S
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
1 - and 2-family dwelling 1::] Commercial/industrial ❑ Accessory building For special information use checklist. .
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. 1 Ea. ` Total
JOB SITE INFORMATION AND LOCATION Keating/coaling
Air conditioning or pump /
Job site address: ! E ?M r h (regrind site plan or he y placement) 14.00
City/State/ZIP: 4 Furnace 100,000 BTU (duets/veins) 14.00
/ Furnace 100,000 BTU (ducts /vents) 17.90
SuitetbldgJapt. no.: ,Project name: Gas heat pump 14.00 _
Duct work 14.00
Cross street directions to job site: 14.00
Hydronic hot water system
Residential boiler (radiator or
hydronic) 14 00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00 T
' Clue /vent for any of above 10.00 _
Subdivision: Lot no.: Other: 10 00
• Tax map /parcel no.: Other fuel appliances -
Water heater 10.00
DESCRIPTION OF WORK K Gas fireplace 10.00
1 /V Jam �� Cr Flue vent for water heater or gas
fireplace 10.00
PM r 7VA 400, 7 Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
`
[�( PROPERTY OWNER Chimney/liner/flue/vent 10.00
❑ TENANT Other: 10.00 _
fff f �' Environmental exhaust and ventilation
Name: b L_ I 4 4 Runge hood/other kitchen
Address: equipment 10.00
Clothes dryer exhaust 1 0.00
City /State/ZIP: Single -duct exhaust (bathrooms,
Phone: ( ) (
> 'ot�. � oi Q O F ( ) toilet compartments, utility rooms) 6.80
2i `
❑ CONTACT PERSON Attic/crawlspace fans
10.00
❑ APPLICANT Other.: 10.00
Business name: Fuel piping
Contact nam j l $5.40 for fi rst four; SI.00 for each ad ditiona
Furnace, etc. I {
Address: '
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
�-}, S C' 67-26 Water heater
Phone ,W3 � )� ^] � j N F ax: ' ) Fireplace
E -mail: Range
CONTRACTOR Barbecue
I / ,1/ !l ( !! ` Clothes Myer (gas)
Business name: (� f ^ �tJ+3 L7 P am ( 1,� Other.
Address: 10 i/ p k ...2-3 0 3 9 1 C/./� MECHANICAL PERMIT FEES` -
Subtotal
CitylStatetZlP: r IL � t?...... � ��/ Minimum permit fee ($72.50) _3 a . 50
Phone: ( 5 1 1 ) y L i - 3" --. 7() T I F a x : ( 5 5 - 2 , ) S - - , 9 ' ✓ d "- '70 Plan rev iew (2 5 % of permit fee) -- �
p a State surcharge (12% of permit fee) iT r ! p
Authorized signature: � /3
COI lie.: �? 3 S / TOTAL PERMIT FEE 4/ 4 2/ /
�'
This permit application expires if a permit In not obtained within leo
I � , days after it has been accepted as complete.
�!% Fee methodology set uy Tn-County Building brewery Se ri« 1J
Print name: .09.-././ .09.-././ Date: /e
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HEATING & COOLING, INC.
P.O. BOX 230397 TIGARD, OR 97281
(503)624-2704
SITE PLAN
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