Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: MEC2012 -00170
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/05/2012
Parcel: 1 S134DA02200
Jurisdiction: Tigard
Site address: 10850 SW NORTH DAKOTA ST
Project: Nelson Subdivision: NORTHERN PINE Lot: 6
Project Description: Furnace replacement and a/c addition. Placement of a/c unit must meet minimum 5' side and rear yard setbacks.
Contractor: COLUMBIA HEATING & COOLING INC Owner: NELSON, ED & STEPHANIE J
PO BOX 230397 10850 SW NORTH DAKOTA
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 701 -9815
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Air Conditioning 04/05/2012 $46.75
Type of Use: SF Furnaces < 100K BTU 04/05/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 04 /05/2012 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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 Notifi - - - ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direc estions to O C • • c. in. 03.232.1987 or 1.800.332.2344.
Issu= d By: , _ `� _�� � `_ / Permittee Signal
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.
Apr 03 12 03:27p Columbia Heating /Cooling 503- 598 -0270 p.2
REcEI'vED
Mechanical Permit Application FOR OFFICE, USE. ONLY
111 City of Tigard APR 3 2012 Receive d Sl /a /,� peril' Nn.: He c � m �/ ( /7o
• 13125 S W hall Blvd., Tigard, OR 97223 Plan Renew
0 ' Phone: 503.718.2439 Fax: 503•598.'9f0>v`ITM OF TIGARD Date ir.. Othet Permit
l I i .A I;1� Inspection Line: 503.639 • Date RcaEy,u,: r+�+• See Page 2 for
Internet: tww.tigard -rn.gov BUILDING DIV NatiftedTle :lx+d: Supplemental Information
. ft OF °WORK I COMMERCIAL FEE" SCHEDULE - USE CHECKLIST I
•
Mechanical permit tees" arc based on the value of the work
o New construction 9ddiLion/ alteration /replacement performed. Indicate the value 'rounded to the nearest dollar) of all '
❑ Demolition ❑ Other: mechanical materials, equipment. labor, overhead, and profit.
- :
VNuc• S
, _. CATEGORY OF:CO.O.Sitcntn:,i .;.; . :•,'° .: .,
• . :
� . . .. • RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
d 2- family dwelling 0 Cornmercialiindustrial ❑ Accessory building For special information use cneralist
❑ Multi - Family ❑ Master builder ❑ Other. Description t Qty. I Ea. I Total • • • JOB ME JN 4A.'fTON ANND LOCATION Ilea tinp/coolirtg:
Air conditioning 414 � s
Sob site address' )065'0 .3-1.5 D µ /CrT� (mimic. rite plan shoving placement) 46.73 J
A `� Furnace 100.000 BTU tduUsiveni) 46.75 ` c o.7S a
City /Stale/21P: f /(j4 € V aR Furnace 100.0011- BTU (dnet f eats) 54.91 I
SuiteibldpJapt. no.: I Protect name: A jc. L raN Ilea pump
(requires site plan showing placement) 61.06
Cross street /directions to job site: Duct work 27.32 • q_
I lvdronic hot water system 23.32
Residential boiler (radiator or
hvdroniel • 23.32 ,
Unit heaters (fuel -type, not electric). '
in -wall. in-duct. suspended. etc. 46.75
Subdivision: I Lot no.: Flue vent for any of above 23.32
Other. 2332
Tax map /parcel :w.: ; Other fuel appliances:
DESt^i2iPT10N ; OF .WORK •.... ' Water healer I 23.32
� /� - Gas fireplace 1 ! 33.39
, vJ U e REAL oCE., Age / • 1 7" if A/C AetQ/W M( Flue vent for ua:er heater or gag I
fireplace 23.32
Lop lighter (pas) 23.32
Wnnrt!nellet stove 33.39
Wood fireplace-Insert 23.32
DiRA.
PERTs OWNER I • - O' TENANT Chimney/linerllucRent 23.32
/7 Other. -3.32
Name: E O /11 e L$C Environmental exhaust and ventilation:
Address: /o4/c5 eS CO ND1H QA KO s( Sr. Range 'o her kitchen .;: ;.:iy
Cit 16'4440 OR Clothes dryer exhaust 33.39 __ . Single duet a hausl ihnthmnrns. roo
Phone: O) ! •- ggi� Fax: I. ) toilet compartments. utility ms) 23.32
® APPL1CAi`F 0- CONTACT' PERSON• • Anil:lcmwlspace fans - 2332
Raciness name: Columbia Heating and Cooking, Inc. Other 23.3E .
—. - -.. �_....... -.._ _,__... Fuel piping:
Contact name: Markus Meedom SI4.15 for first four, 54.03 for each additional
Address: PO Box 230397 Furnace etc.
(ices heat pump
City/State /ZIP: 97281 Wall /suspended/unit heater 1
Phone: (503) 624 - 2704 ' Fax:: (503) 598 -0270 water healer
Fireplace
E -mail: eolumbhc®teleport.com Ranee
CON LRACTOR ` - u
Barbee
t
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Clothe ; dryer races)
housings.: name: Columbia Hotting and Cooling, inc. Clot
Ocher: r :
Address: PO Box 230397 • • :KECIIANNICALPERMIT FEES•
City /Statu'ZIP: Tigard, OR 97281 Subtotal 93• SO
Minimum permit fee (S90.00) :
Phone: (S03) 624 -2704 I Far.: (503) 598 -0270 —
i / Plat nwiew (25%ofpermit fee)
CCB tic: 76359 / State sureharga (12% of permit fee) 1 /I. A 2
TOTAL PERMIT FEE iQy, 71(,
I. Authorized signature: k This permit de)lt atio 11 has been p e as comp tained with:o 1 gal
Prnt name: Alarlena R Meedom Date: ._ 9., --/ T 7 • Fee trteihu.lolog set by Id- County Building II:dusny Service Huard
N. u.,:,,.- „•.u.......•..,.N•.Na..,.xe�.. •n. mNma.m
4s4t4RlTT rl u't'YY1VAVe1RN
Apr 03 12 03:28p Columbia Heating /Cooling 503- 598 -0270 p.3
ar
HEATING & COOLING, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503)624 -2704
SITE PLAN
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ADDRESS: 10b5o �� f 0 - /kerirA