Permit - :. CITY OF TIGARD MECHANICAL PERMIT
' " l " =,• COMMUNITY DEVELOPMENT Permit #: MEC2009 -00502 •TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2009
Parcel: 2S112BB13000
Jurisdiction: Tigard
Site address: 14384 SW HALL BLVD
Subdivision: Lot: 0
Project: Reveal
Project Description: Replace furnace.
Owner: FEES
REVEAL, BETTY A Description Date Amount
14384 SW HALL BLVD
TIGARD, OR 97224 Furnaces < 100K BTU 09/23/2009 $14.00
12% State Surcharge - Mechanical 09/23/2009 $8.70
PHONE: 503 - 620 -6906 Minimum Fee Adjustment - Mechanical 09/23/2009 $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 suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility`Notification Cenir \ 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 .24 6699 or 1.800.332.2344. — '
Issued By: u A 1 fd,//1/'LKLA Permittee Signature_/ ) A 1�Oar'?
1
/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 Application -,?,:z.:,,,- _ i�!t FNtc EY E.uNL•�
REC
Re ,,vcd 9 Permit No �� a� 50
City of Tigard �ate:Hy: i{.� 09 M
Ili
• 13125 SW Hall Blvd., T igard, OR 97223 play. Review Other Perm.t:
_ Phone: 503.6394171 F ax: 503.598.1960 SEP 2 2 2009 Date`dy: {
Inspection Line: 03.639 4175 Dale Ready/Ey: ■ Yarit� { L See Pile 2 for
T`Cn1tD Internet: www.ttgard or.go' CITY OFTI *' Plo:i!ledMethod: (I { Supplemental information
TYPE OF r b DING DIVIS
1 N : . COAMINIERCIAL FEE* SCHEDULE - USE CHECKLIST •
Mechanical permit ices' are cased on the value of the wo; K
New construction Addition /alterationlreplaCement perfcrtted. Indicate the Value. (rounded to Lhc nearest dollar) u ::dt',
Demolition ❑ Other: mechanical maserials, equipment, labor, overhead, and pr3fit.
Value: £
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES"` '
TI- 1- and 2- family dwelling ❑ Commercial /industrial [ Accessory bui,ding For special informaricnuse dleck list
❑ Multi - family ❑ Master builder ❑ Other: I Description I Qty. , Ea. Total
JOE SITE INFORYIATION AND LOCATION l Heating /cooling
�? '_ ` r �Ij` ` �,.r eondiv.oning or heat cum" i , 1 4,00 1
lob site address'. V �� $ t-( �` U1�( � (: equirs . •
I P omace 100,000 BTU (ductslvents) I 14 CO 1 .
•
City/State/ZIP: 1' O 7,, Furnace 100,000+ BTU (duos/vents) 17 00 I
Suiteroldg.apt. no.: ( I Project name: `�, C�k, Gas t- pump 14.00
l Duct cork la 0" ____
Cross streeUdirec:ions to job site: 14.00 3
( al i g �-t f 1:ydronic hot water system
I / J -tL- Residential boiler (ra'd'iator or
itydrenic) i .
Unit heaters (fuel - :ype, not electric),
in -wall, in -duct, suspended, et:. i 0. _.
F Iue/vent for any of above i 0 00 _
~Su'odivision: Lot no.: .
Other: 10.00
Tax map /parcel no.: Other fuel appliances
Water heater I 0 00
DESCRIPTION OF WORT: Gas r heater
10 00 - ,
�j r F'ue vent for water heater or gas I
1"�'�iuLe O,replace 10.0t.) —_-
LoE lighter (gas) I 10 00 ��
. Woocldpellet stove 10.00 _
Wood fireplace/insert :0.00 '
L
Chi
mneylliIreriflue.rvent 1 10 00
PROPERTY OWNER I L7 TENANT Other i0.ou
I Name. . e
e ,4. Environmental exhaust and ventilation
Y Rargc hood/other kitchen J DU
I Address: /`/ / ��� I eqt ipmem _
O � 9 7,� 2J Clothes dryer exhaust ^� I1.00
City /StateIZIP: f Sirgle•duct exhaust (bathrooms, -
C - t I I e.xo �..
Phone: ) � � gyp!/ Fax: ( ) ;eiiet compartments. ul(hiry rooms)
A t :idcra �tspaCe fans If 10.01.) ❑ 1PPLICANT I CONTACT PERSON ;
Other: 10.00
l
Business name: Fuel piping
�
. r .� $5.40 for first four: $1.00 for each ddit:0nal
Contact name.�� ! G Furnace, e1.c.
Address: "
Gas heat pump I -. --
CitylStateiZIP: Wali.rsusoended'unit heater r 1
I , Irax :: ^� CJ water heater I
Phone: 9 3 ) � c) l � � � rJ 'T / ) � f 7 �' U ! I Pirepfacc 1 I � �-
E -mail: Range 4 I '
CONTRACTOR ( Barbecue I I
rr ` •1 I s dryer (
Business name:
��� l uJt7 D / c,.,„,„ c,.,„,„ /'r .L �t/t ! n, f Clothe
� ij l r"`3 Other. -
t4ECHANICAL PF.RMIT I EES'
Address. q c x .,Z 3 0 3 1 1 1 ,
/u Subtotal
1 City/State/ZIP: 2� I �' p Minimum, permi: tee (572.50)
Phone: (M) �o ›' — — 7iD I Fax: 1 &-1-7() ) ,(9? — D Plan review (25% of permit tee; 1 ..69- 7 (!r /
J S p 4 State surcharge (l2% of perm t toe) 1 • 70
CCB lie.: TOTAL PERMIT T F 1 . / • ,
Authorized signature: This permit apu0cxtion expires if a permit it nat ahral wl tlilu the
- / c a3•s after it has been accepted at CO m plete.
S a e. cLy '�/ • fee methodology set lip "Fri Saw [ding lnd H
uctry •serviee our
Print name: .44,0 G 1 r
_ - ..._._.:..,Runt- n..,,,nArn tae 0496a) 44O-46 I7T (I liDVCOt.L'VrTB)
Z• 0/20 bugoo0 /6ui}eeH elgLUnloo etiZ :80 60 ZZ deg