Permit o CITY OF TIGARD MECHANICAL PERMIT
�'1 r COMMUNITY DEVELOPMENT Permit #: MEC2012 -00105
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/24/2012
Parcel: 1 S133DC10000
Jurisdiction: Tigard
Site address: 13135 SW SHORE DR
Project: Vincent Subdivision: WINTER LAKE Lot: 28
Project Description: Replace furnace
Contractor: COLUMBIA HEATING & COOLING INC Owner: VINCENT, MADELINE C E
PO BOX 230397 13135 SW SHORE DRIVE
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 -624 -2704 PHONE: 971 - 221 -7890
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 02/24/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 02/24/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/24/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules •
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 400/si i , - Permittee Signature: Q , v � f o � o L / / ���
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. �-
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Feb 23 12 12:53p Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Applies 1 FOR ()Fri C US1: ()N1_,
City of Tigard CE IVF Rtxased i 43.. r y�c ,2oia ...ea /0
13125 SW Flail Blvd., Tigard, OR 97 -r -, man Remiav e
Phone: 503.718.2439 Fat 503.598.1960 rlatddny: Other Permit:
.
inspection 503.639.417 FEB 2 3 201 DateRends ;Hy: lair: ® SeePate2for
Internet: tvww•.tigard- or.gov No(ifierVMethod: q7�y St/pp4:mental (domination
CAN nr :.. . - .
T PE O)F COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
t "n Mechanical permit fees* are based on the value of the work
❑ Nev t construction g<iditionialteratiortireplaccrnent perfumed Indicate the value (rounded tote ncarca dollar) of all
❑ Demolition 0 Other: ntuchanical materials, equipment, labor, overhead. and profit.
.,.. .
CATS0010:,61„G0N$J tl]GFlON'_., RESIDENTIAL EQUIPMENT, SYSTEMS FEES* •
1g�- and 2- family dwelling ❑ Comtnerciallind.istrial ❑ Accessory building Far specialirtforrni'lon use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORRMAT1ON AND LOCATION Heating/cooling: , ,fir conditbning
Job site address: /3/.1',5- s (,� �hiac iw /I qi44,0 Ircgmnasttc plan Showing placement) 40.75
City/State/Z1P: Ti6A/zp 04 9r7aa'1 F Furnace 100. 000 lie t (rin tiernst . 4
furnece ,UUr1�H'fU (;ti r ldvenal 54.91
SuiteibldgJapt. no.: Project name: V/AI C E,si r frosAL //V 6 • Heat pump
requires site plan showing pinwmmn) 61.06
Cross street/directions to job site: Duct work t 23.32 • A .
l lytlronic hot water :system ._ I 23.32
Residential bc (radiator or
hvdronic) 23.32
- Unit healers (fuel -type. not electric).
in -wall. in -duct, suspended, etc. 46.75
Subdivision: I Lot nu.:
Fluervau for cute of above 23.32
Other 23.32
Tam map /parcel no.: 1 Other fuel appliances:
• . - DESCRIPTION OF: •:•.,c. I Wattx heater 23.32 ,
Gas TZ2N , 4 L & 1E4 Jr . Flue fireplace er 33.39
Z e6/ Flue von fee water kilter Or gas
fireplace 23.32
Log lighter (gas) . 23.32
Wood /pellet stove 33.39
Wood frrcplaceiinsccrt ' 23.32 I
ventilation:
C OPERTY OWNER • :. 0 7ENAkir
tfiimneyilinerlflueivent • 23.32
Name: P2AeDEG //V E ( /4'CE"7
Other: 3 =.32 j
Environmental exhaust and vent
1J1as Sw SNO 0, 4 . Range _...
Address: . kangc hond'other kitchen
equipment 33.39
CitviStalr.7.lP: 7 Ot Paz 9 Clothes dryer exhaust l 33.39
�- 0 N ig)e -duct exhau.;t (bathrooms. .
Phone: Ffl - 790 Fax: ( ) toilet compartments. utility moms) • 23.32
.
2; 32
APPLI• - • .... . ... Ta. PTRSON... :uliccratvlspacelaps __.�
Business name: Columbia Heating and (looting, Inc.
Other i 23.32
—.._. _._._..._....._ Fuel piping:
Contact name: Marten 1leednm — — _ -__ 514.15 far first four W.03f r earl, additional
Address: PO Env 230397 Furnace. etc.
Dias beat pomp
City/State/7,1P: 91281 Wall/suspended/unit heater ,
Phone: (503) 624-2704 Fax: : (503) 598 -0270 Water hearer .
Fireplace I
E -mail: columbhcia",telcport,com
Ramie
•
covirl2ACTOR : .. • 13 u beeue _
Business name: Cnlumtiia Heating and Cooling, Inc. Clothes dryer (gees)
(Nh ct.
Address: PO Km 2311397 • • ' • MEC1LANICALPERMIT:FEES.
City /State /ZIP: Tigard, OR 97281 • Subtotal
e: 1503) 624 -2704 Fax: (503) 598 -0270 Minimum permit fee 390.00)
Plan review (25 %o1permit fee)
CCB lie.: 76359 State .alreharge (12% of permit fee)
_ TOTAL PERMIT FEE Oe •erC
Authorized signature: 1 permit Tait permit applieatina expires if a peit is nut obtained within 1811
JI days after Fe has been occepted as complete.
Print name: Markna R Meedom Date: I • Fes nRdia m,iO% set by Tri- Ccnoty Building btdtetry Senxc Board
41,1.4A171* ii