Permit CITY OF TIGARD MECHANICAL PERMIT
° - _ COMMUNITY DEVELOPMENT Permit #: MEC2011 -00585
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2011
Parcel: 1 S 133DD13800
Jurisdiction: Tigard
Site address: 11952 SW 127TH PL
Project: SCHMITT Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 175
Project Description: A/C and gas furnace installation.
Contractor: COLUMBIA NW HEATING Owner: SCHMITT, LORI KAY
PO BOX 622 11952 SW 127TH PL
SCAPPOOSE, OR 97056 TIGARD, OR 97223
PHONE: 503 - 543 -3624 PHONE:
FAX: (503) 543 -6285
FEES
Specifics: Description Date Amount
Air Conditioning 12/16/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 12/16/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/16/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $104.72
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: Permittee Signature:
_ mss_ -tom
Call 503.6 -y 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.
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Mechanical Permit Application RECEIVE 1 ►'F ?l; c,hl ,,.. I . r: t►,�l.,
ill _ City of Tigard Reaciverl B
■ Date/By: l /! al i lI
13125 SW .1 H Permit No. /hecen I I - 5`
all Blvd„ Tigard, OR 97223 DEC lan Review / '
Phone: 503.7182439 Fax: 503,598,1960 C 16 2011
DatenSy; OAh Pcrnnit:
F r :;,A h D inspection Line: 503,639,4175
Anin: Internet www.tigard- or.gov CITY OF TIGARD N o 41130 � see PA C 2 to for
BUILDING DIVISI '1, Notified/Method: - so Supplemcnon tnfennntion
` _ '_ 't!( ' '',tl ' a ' . , c'dwiP lr., '±� iI.0 E i ;1$1
['New '''' ' construction Mechanical permit feec�' arc base on the value of the work
Addition /alteral.ion /replacement performed. indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, a ui mcni, labor, overhead, and profit
Atir�
ti tVS�J Value $
® I- and 2 -fpmil dwelling
Y g 0 Commercial /industrial 0 Accessory For special1nJormativn use chetstliot.
0 Multi- family ❑ Master builder 0 Other: Description p - 1 Qty. ( Fa. Total
r' ' O1 t' tidi l Heating/cooling: •
Air conditioning
Job site address: 11952 SW 127 PI (roynirca site plan Awing eteccmcm) 1 46.75 46,75
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C'irylState /7,.,TP; Tigard, OR 97223 '-" Furnace 100,000131'11 (ducts /ocnto 1 46.75 46.75
Furnace 100,000+ (ducts/vents) 54.91
Suite/bldg. /apt no.: Pmject name: Schmitt licat,pump
- (requires silo plan showinpplaccmcnt) 61.06
Cross street/directions to job site; Duct work 23.32
Hyd ronic hot water system 23,32
- - Residential boiler (radiator or
hydrunic) 23.32
Unit heaters (fhel -type, not electric).
. in -wall, in -dud, suspended, etc. 46.75
Subdivision; 11.ot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other Fuel appliances:
... r e' tw o" '•••• • • Water heater
23.32
Install Gas Furnace & Air Conditioner Gas fireplace 33.39 .
Flue vent for water heater or gas
fireplace _ 23,32
^-- Log lighter (gas) • 23.32
'. _ Wood/pellet stove 33.39
Wood fireplace /insert 23.32
..: , 1 tS1 lt>t~'1:OWNiEH Chump /Iincr /fluc
Other
Name: Lori Sehlnitt 23.32
--- Environmental Environmental exhaust and ventilation;
Address: 1.1952 SW 127 pi Range hood/other kitchen
--- equipment 33.39
City /State/ZIP: Tigard, OR 97223 •
_ Clothes dryer exhaust 33.39
Phone: (503 )$1.9 5046 Fax: ( ) Single -duct exhaust (bathrooms,
.,e,, . utility rooms)
;:.,:�: •ip7PLiCCt'; fan
�1� p ce s
�;�� Attic%rawls
_ a 23.32
Business name: Same as Contractor Other 23.32
Contact: name: Fuel piping:
$14.1$ for finct four; $4.03 or each additional
Address: ._ Furnace, eta
• CitylSwlc /LTP; - Gas heat pump
Wall /sus dedhmit.heater '
•
Phone: ( ) Fax: : ( ) _ Water heater
E Fireplace
-
.
Barbecue
Business name: Cnlnmrbin NW Heating _ Clothes dryer (grin)
Address: PO Aux 622 - Other:
City/State/ZIP: Seappoosc, OR 97056
Subtotal 93,50
Phone: (503) 543 -3624 Fax: (503) 543{,285 _ Minimum permit fee (590.00) 0
- Plan review (25% of permit fee) 0
CCB lit .: 61947 State surcharge (12% of penult fcc) 1 1,22
/1 1 _ TOTAL PERMIT FEE 104,72
Authorized signature; ' / � i J j A f / ' Iti permit npplicatlon capirec if a permit is not nlrfn;ned within 184
l 1 ,,�` der niter it iras been rcceptcd AS complet
Print nrunc: Cerri Jacobson IF Date; 12/16/11 ' Fee methodology so by tri- County Baildinyr industry Service Bond
r.l nuoriiiirarorrniumkr :- rcrmiiApp.doc 09/0501n 440. 4617x /COM/WR13)
Installation Property Information
DIRECTION:
Property Line
Fr: 3
(\ Q
Fr: Fr: go
1 P
Fr: lc
Property Line
(F= FURNACE)
(X= OUTSIDE UNIT) STREET
Columbia NW Heating, Inc.