Permit CITY OF TIGARD MECHANICAL PERMIT
1111 C OMMUNITY DEVELOPMENT Permit #: MEC2012 -00074
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/08/2012
Parcel: 25111 CD05400
Jurisdiction: Tigard
Site address: 15945 SW BRENTWOOD CT
Project: TAYLOR Subdivision: SUMMERFIELD NO.9 Lot: 513
Project Description: Gas furnace replacement.
Contractor: COLUMBIA HEATING & COOLING INC Owner: TAYLOR FAMILY TRUST
PO BOX 230397 15945 SW BRENTWOOD CT
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 02/08/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 02/08/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/08/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
A rm
Call 503.639.4175 by 7:00 a.m. for the n extavailable inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Feb 07 12 12:25p Columbia Heating /Cooling 503 -598 -0270 p.2
0 3'r' ''•
Mechanical Permit Application FOR OFF}CE USE ONLY
City of Tigard "Received p ermit a.
! FEB — 7 201 t�;rcert3y: - I��/ .��a up.: e:...1 a- .4
"� 131 SW flail Blvd., Tigard, OR 972 Plan Ite�ic,.
C . Phone: 503.718.2439 Fax: 503.59$.1960 OtherPemrt: 1
,�, t .L ritelBy:
Inspection ection Line: 503.639.4175 CITY T' t 'Date Ready 3 runs See Pale 2 far
P V 1 iF �+> t y^
Internet: www.tigard- or.gov
Bull_rir f' ,NuiifiedfMethed: ( a Supplemental Information
' - TYP]E .OE' 'WOR,t4. .. COMMERCIAL FEE* SCTIEDULE -USE CRECI{LIST -1 mechanical permit fees* am hared on the value of the work
❑ New construction Or Addition/alteration/replacement performed. indicate the value (rounded to the nearest dollar) anti
❑ Demolition ❑ Other: mechanical materials, equipment., labor, overhead, and profit.
Value: $
;. `A- , - :OF COLV �2C1G7'�ON' RESIDENTIAL EQUIPM[ENT(SYSTEMS FEES"
Si I - and 2- fatnfy dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family 0 Master aui €der ❑ Other: 1 Description Qty. 1 Ea. Total
• JOB SITE INFORM.ATION,AND LOC:ATION': !leafing/cooling:
• / /y / J- Air conditioning.
15(,
Job site ac.idress: :3 5A ./��lt� ) � /,/ J , (recieuiF n S
sue plaJ,r m): ;Placement) 46.75
•
Cit; /S tah:,rZIP: Tiel ii t/ t f 21q CVJ • � ) `•.A Furnace 100,000 fill i (duets/yews( 46.75 r'1!�.
Puntnce 1011,0O(1+ RTI.I (ducu/yent 54.91
Suite :bldg. /apt, no.: Project name: -ray /T'Si/' Iieat pump
`-" `� ( I (requites site plan showing pinecmert) 61.06 I
Cross street/directions to job site: Duct wart: 23.32 • A
I
1 lydronic hot watersysietn 23.32
Residential boiler (radiator or
hydro nie t 23.32
Unit healers (fuel - type, noteleatric).
in- svu11. in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Fluc'venl for any of abote 23.32 ,
I Clther: 23.32
Tax mapiparecl no.: Other fuel appliances:
DESCRIPTION OF WORK ... • Water heater 1 23.32
P ,Q t n ,� Q •
/1 T^ ^�- ^ Gas fireplace I 33.34
f�A }�`L. ( j ' l� Flue Yent for water heater or gas
fireplace 23.32
Lop lighter (gas) 23.32
Wood /Pellet shat 33.39
Wood fireplace /insert 23.32
PROPERTY OWNER ..❑ • ENALNT Chimney/liner/flue/sent 23.32
�i�� �+ ! • T Other: 23.32
1 a7✓ (.... ... —
Nave: t;neironmental exhaust and ventilation: _
Address: j 1 1qf Range hood/other kitchen
�/ l _ equipment 33.39
City: /State/Z1P: 1 l CR / a Clothes dryer exhaust 33.39
T e• III .Single. -duct eahaui (bathrooms.
Phone: ( 6.6 i - 5 47 Fax:( ) toilet COriparILnCttiS. utility rooms) ' 23.32
IR: APPL[CA.I9'T . - . ❑ C PERSON • . Attie /crawlspacc fats 23,32 J
liucine-s name: Columbia Heating and Cooling. Inc.
(}uteri i 23.32
. Fuel piping:
Contact. name: Mariena Mleedorn 514.15 for first four: 54.43 for each additional
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Address: P{1 1301i 730397 97 - -- Furnace, etc.
Cies heat pump
CityfSteIc /2..TP: 97281 Nall /susaendczi' unit heats_
Phone: (503) 624 -2704 Fax: : (503) 598 -0270
w1`a[cr heater —
•
E -mail: rotumbbcti_)telcpori-com Firrpiace
Range
: ' COATRACTOI2 Barbecue • • tiusineis name: Columbia treating aria Cooling, Inc Clothes dryer (;;as)
Other,
Address: P {) Box 230397 I4tECRANICAL PERMIT - FEES* • '
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City :'Sues: /7_IP: Tigard, OR 97281 • Subtotal LiCp
Phone: (503) 624 -2704 Fax: (503) 598 -0270 Minimum permit fee ($90.00) QV
Plan review (25% of permit fee) —
CC$tic.: 76359 I_ S tate surcharge (12% fee) /) ,
TOTAL PERMIT FEE J la)t 816 1
A I 1
'Ibis permit application eCFires if n permit is nut obtained within ISO
Authorized signature:
41 - i „ L . „ ► , _ A• - dads alter it has been accepted as complete.
Print name: Marlena R 11eedom I fate: 2-7- la. - Fee tnerhodoIegv $el by Tri- County Building hidttsly Service Hoard
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