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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2012 -00004 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/06/2012 Parcel: 25111 CB01303 Jurisdiction: Tigard Site address: 14870 SW 104TH AVE Project: DEVERS Subdivision: DEL MONTE SUBDIVISION NO.2 Lot: 17 Project Description: Furnace replacement. Contractor: COLUMBIA HEATING & COOLING INC Owner: DEVERS, JAMES R & SUSAN M PO BOX 230397 14870 SW 104TH AVE TIGARD, OR 97281 TIGARD, OR 97224 PHONE: 503 - 624 -2704 PHONE: FAX: 503 - 598 -0270 FEES Specifics: Description Date Amount Furnaces < 100K BTU 01/06/2012 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 01/06/2012 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/06/2012 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: 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 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. %) r � P �'Z" cv'-f/Y! Issued By: _ •ermittee 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. .... ., ,, ... Mechanical Permit Appl IA - FOR OhFICE LSD € NEY ' Received y ��, �- \�{ - City of Tigard • ..,- N O 5 2012 17ate.By: 1 ''T /I err— Perlin' No • / / r 11(, )'? - e'xVt✓ 1 13125 SW' Mall Blvd -, Tigard, OR 9 Plan LJ m Review r Phone: 503.718.2439 Fax: 503.598. Date'By. Othe/ r corn{: FlG.'Alit] lnspccdputins; 503,639,4175 D Date Rea+: >:0v: saris SI See Page 2for w• Internet: ww.tigard- or.gov� CITY OF TIGA t" NotilieruvI t1toe. � ^- Supplemental Information BUILDING DIVISION J YPE .1D> : WORN COMMERCIAL FEE* SCHEDULE - I SE CHECKLIST Mechanical permit tees* are based on the value of the work ❑ Newcons:ructicrn X lacement A performed. Indicate the value (rputided to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical material:, equipment, labor, overhead, and profit. - m- .. value: $ . CATEGORY OF CUh 3CR TI ©N:: -_: RESIDENTIAL EQUIPMENT /SYSTEMS PEES"' V 1• and 2- family dwelling ❑ Commercial /industrial 0 Accessory building For special information tesethec/dst fl Multi- family ❑ Master builder ❑ Other: I Description I Qty. Ea. Total . JOH SITE INPORMAIr0N:_AA - D LocAtiOA1 lleatingicooling: I c h A r itionatg l .lob site address: / Li 70 / 7 -� J �}y ,r rc ,Ice t >I.u} sho:vtltE }tE,n,:tnent) 48.7: // �� ~ ~~~� i Furnace 100,090 BTU (dnewventsl i 46.75 Gitit, City /State /19a ZIP :7ni 0 q 7 r'1 a q I /;� ff v{ Furnace 100,000+ R'Pi) (dlrctc:crntc} 54.91 Suite /bldg. /apt. no.: l Project name: i-Teal pump (requires site plan sl:o•.eatgp€sr..nent) 61.06 Cross street/directions to job site: Duct work I 23.32 • ' A Hydronic hot haler system ...._ ... I 23.32 Residential boiler )radiator or hydronic) . 23.32 - Unit heaters ftuel -type, not electric). in -wall, in -duct, suspended, etc, 46.75_ __ ' — Subdivision: Lot no.: Flue /vent for any of above 23.32 - Other: 23.32 Tan map'parcel no.: i Other fuel appliances: ., . -. :. DESCRIPTION OF..WORK -: . Water heater 23.32 replete", e 7Y f . ri Gas fireplace 33.39 23.32 Log lighter (gas) 23.32 Wood /pellet stove 33.39 Wood tireplacerinsert i 23.32 Chirttnevfhinerillucivent 23.32 X PROPERTY -OWS 1 -' .:❑ TEtNAlirl -_ - Other i 23.32 Name: j . e . rC Environmental exhaust and ventilation: I Address: 1 Li S7U 164 Ran,e hood;ather kitchen ..te equipment 33.39 City /State,2,IP: , 1 J ani q "7,22 Clvlhesdr 33.39 3 t 434 Single-duct exhaust (bathrooms. Phone: Fax: 4 ) toilet compartments, utility rooms) 23.32 ® APPLICANT - ' - a .CONTACT • PERSON A1tidtcratvlspace fans 23.32 1 - ._..... I Other: 23.32 Business name: Columbia Heating and Cording, Inc. Fuel a to Contact name: Martens Meedom S14.15 for first four; $1.{I3 for each additional ! Address: PO Dux. 230397 ():trace etc. ! Gas heat pump City'Statel2..1P: 97281 _Wullrsuspendcdiunu hearer Phone: (503) 624 -2704 , Fax: : (503) 596 -0270 Water heater ` Fireplace I E -mail: columbheAteleporl.com Range CUI4TRACIUR . -.. Barbecue I Husineis name: Columbia Heating and Cooling, Inc, Clothes dryer (gust , Other: Address: PO Env 230397 MECHAN1E:ALPERM1Tr'EES* • Ciry /Stnte'2,IP: Tigard, OR 97281 Subtotal G Co ,'Z. t Minimum emit fee ($90.00) c( 0 , c. v ' j Phone: (503) 624 -2704 Fax: 4503) 598 -0270 — p 1 Plan ms Ittit (125% ol•penult feel --- CCB lie.: 76359 Slate aurehnree (12% of permit fee) IU,,itIJ I _ TOTAL PERMIT FEE Ito. g 1 Authorized signature: 1 f t / t ��� ✓ Thi4 perm application haires if a permit 'i1 nut obtain within ISO _ A ,l , - 4 , - days after it t hat been asepicd a3. complete. Print name: Marlena R Meedom onto: jr,C12 - roe u:cltwdvhngy ma by T: i•Ccvn, 3uildim, htdttitry Scnicc aonni .r.m.fro,rii iic,:rnsI.'tvenI • Z'd OLZ0 6u!Ioopi6ui}eeH eigwriloQ e9Z :60 Z 6 90 uer