Permit , CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00577
Date Issued: 12/14/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S109AB05100
Jurisdiction: Tigard
Site address: 14233 SW 133RD AVE
Project: ADAMSON Subdivision: THREE MOUNTAINS ESTATES Lot: 44
Project Description: A/C and furnace replacement.
Contractor: COLUMBIA HEATING & COOLING INC Owner: ADAMSON, COLBY R & MELISSA A
PO BOX 230397 14233 SW 133RD AVE
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Air Conditioning 12/14/2011 $46.75
Type of Use: SF Furnaces >= 100K BTU 12/14/2011 $54.91
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/14/2011 $12.20
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $113.86
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.
Issued By: ms`s / Permittee Signature: ,
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 14 11 09:22a Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Application r'" '.E FOR OFFICE USE ONLY
City of Tigard Received p
Pcnnit Np.:. /
l
• " 13125 SW Hall Blvd.. Tigard. OR 97223 ,� Pla R e v /y ��/ — �'1 — C- -n?!)� I —Ckjs7
Phone: 503.639.4171 Fax: 503.598.1960 I r � - L U plan Review Date;Dv: Other Permit
TIGARD Inspection Line: 503.639.4175 CITY ReadyiB . w.ir.
ITY OF TIGARD I y ® See Page 2 for
Internet: wN'w.h C
fd - Or.�OV 1*IVt NoOfed•'Method: ��•JJ_ Supplements[ Information
BUILDING DIVISIO � ~Ly
•
TYPE ,OF WORK . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Q New construction %ddition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
_______ CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
- and 2- family dwelling El Commercial /industrial El Accessory building For special rnjormatrcn use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: i w4// Air conditioning
TG ;requires site plan showing placement) f 46.75 10 ,75
City /StateiZIP: `' Q j am`' n& q7 az t Furnace 100,000 BTU (ductsrventsl 46.75
1 I �'y' L Furnace 100,000+ BTU tductsrveeis) / 54.91 >y / '{I
Suite/bldg./apt. /apt. no.: Project name :A� heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hvdronie hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flueivent for any of above 23.32
Subdivision: ) Lot no.:
Other: 0 3 . 3
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water healer 23.32
(�� r JJ � � Gas fireplace 33.39
�.�4r'Ct e e. I 'ctX(/'Yi t (' �t Jr 1, et_ 4_i 5Le Flue vent for water heater or gas
` fireplace 23.32
Log lighter (ass) 23.32
Wood /pellet stove 33.39
Wood ;ireplaceiinsert 23.32
Chimney/liner/flue /vent 23.32
P OWNER , .: .. ❑ TENANT
` - Other 23.32
Name: C vS�I L1� Q� Environmental e and ventilation
' Address: Environmental l exhaust xh kitchen
�- 3 (wJ equipment 33.39
City/State/ZIP: i r,A__ q7.9')-1-1 Single ( b 33.39
Single -duct exhaust (bathrooms,
Phone: (3D3 )e/ 30, e dr' / Fax: ( ) toilet compartments. utility rooms) 23.32
• ❑ APPLICANT_ __ • •. 0 CONTACT PERSON - Attic/crawlspace fans 23.32
Business name:
Other 23.32
Fuel piping
Contact name: $14.15 for first four; 54.03 for each additional
Address:
Furnace, etc,
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) I F :: ( ) Water heater
Fireplace
E -mail:
Range
•
CONTRACTOR . ' Barbecue
Business name: * AiA iii t t f * Ai) . coo j Ali, Mottles dryer (gas)
Other:
Address: _ 1 /, MECHANICAL PERMIT FEES*
City /State /ZIP: 0 7aa , Subtotal /Di, (0
a Minimum permit fee ($90.00)
Phone: (Q F ax: ( ) Pl an review (25% of permit fee)
CCB lie.: �. 4 [] State surcharge (I 2% of permit fee) 1?-,
/ TOTAL PERMIT FEE //_ ,P(i
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: me /ie Date: f a... - 1 f ' Fee methodology set by Tn- County Building Industry Service Board
,. qni 'Ainn�PrrrcitJ.N.7Ff_Po.miArn Art If.:r155
4 17T ■ l l /rI's MAR\•FRl
Dec 14 11 09:22a Columbia Heating /Cooling 503 -598 -0270 p.3
e t , Af t •
HEATING & COOLING, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503)624-2704
S ITE PLAN
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