Permit CITY OF TIGARD MECHANICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00169
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/04/2012
Parcel: 2S103DB10600
Jurisdiction: Tigard
Site address: 13225 SW GENESIS LP
Project: LUKEY Subdivision: GENESIS NO.3 Lot: 69
Project Description: Heat pump replacement.
Contractor: COLUMBIA HEATING & COOLING INC Owner: LUKEY, GLENN W & KATHERINE R
PO BOX 230397 13225 SW GENESIS LP
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Heat Pump 04 /04/2012 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 04 /04/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/04/2012 $28.94
•
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: / Permittee Signature: O
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 09:03a Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Applicatio FOR Dirk' USE ONLY
City of Tigard Tigard, li \�- N �i)• Pernir No.: v• - _ _ - is ,'•
13125 SW Hall Blvd.. T igard -
OR '• 4 ex � .. y
Phone: 503.718.2439 Fax: 503.59'. ' $ u • Other Permit:
r t G n t: t) Inspection Line: 503.639.4175 PQ \ " Dale Reatlyltiy: See Page Z for
Internet: www.tigard- or.gov \� 0� s
��S\ Nei icut 4viethod Supplemental Information
G \ .• ` CQMMERC2AL:. FEL .sa 1EDILE - ISEt HECKl.lsr 1
' "' �" ;P>�:;�> -, WO x � ., : 1 Mechanical permit fees" are based on the value of the worn;
❑ New Construction MAdditioniallerationfreplacement performed. indicat the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equipment, labor. overhead, and profit. j
c:... F�C:oBX_OF- 3'J4ilN' ` -.- YTiSYSTEMS;FEE6'
Value: $
�:: ltF�ll)�'�"I7AL EQll1PME: .
`12, 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For'pedal kfentiation use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. 1 Ea. I Total • d0$WE 1190. tMATiO .AND1.dC414;:gF. lieatiaPa'cooling
Air conditioning
Job site address: j 3aa5 c at) ((�no � l (raisins sae plan showing Waccntentl 46.75
S r•� "- ' n�lll "Y Furnace 100.000 BTU (duetivennf 46.75
City/State/2R: ��tY cA qi Q3 Furnace 1011,001;- BTU (ducts/vents) 54.91
Suitelhldg /apt no.; BU J ' Project name: Pump
(me itt:a site shaving �
(rt:qu plan shing placn neat) 1 61.06 !o /, 0
Cross street/directions to job site: Duo. work 23.32 • A.. I
I lydronic hot water system 23.32
Rcsidcmial boiler (radiator or
ironic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct. suspended etc. 46.75
Subdivision: 1 Lot no.: , Flueivent for any of above 23.32
Other 23.32 ,
Tax map/parcel no.: Other fuel appliances:
: :: :.:;.9if>aSGIi1MI0- 0 **olue -. - .........
Water heater 23.32
Gas fireplace
WC& F Flue vent for water heart+ or gas 33.39
fireplace 23.32
Log lighter leas) 23.32
Wood/pellet stove 33.39
Wood fireplace.'insert _ 23.32
i . Chimne.Ainer/iltxhent 23.32
:FROPE1tTY . !.r...:71 . _ 23.32
Name: Environmental exhaust and ventilation:
Address: 1 3 ^ Range hood`othtx kitdten
OC 1 equipment 33.39
. City/State/21P: 17 ` d fit' () 6170,„,13 Clothes dryer exhaust 33.39
7 4 .�" I, A' tin8tcom1cement(util
Phone: ! ■ i! `! i Fax:( , ) toilet compartments, utility rooms) 23.32
I aP1P1. 11TL!'.. :_ .„ { r.: [: C01VL4CI . GRSO�� Auic/crawkpace fans 23.32
Business name: Columbia Heating and Cooling, Inc. t)lhe 23.32
-. __.._..._.. �._.....- _..__. -__ Fuel piping:
Contact name: Marietta Meedom 514.15 for first four; $4.03 for each additional
' Address: PO Box 230397 Furnace, etc
Gas heat pump
City /State /ZIP: 97281 WulVsu.spended/utit heater
Phone: (503) 6242704 I Fax: : (503) 598 Winer healer
R 'lace
E-mail: columbhc(a.,,telcpart.com
CfkFRACl QR : ..... Barbecue - -
tsusincsa name: Columbia Heating and Cooling, Inc. Clothes dryer(gus)
_ --- Otltta.
Address: PO Roc 238397 ' - .
A (EC B.INIC4L 1'ERM7I FEES«
City /State / /ZiP: Tigard, OR 97281 Subtotal G/ Ms
ivlinimum permit fee (590.00) efra Lk)
Phone: (503) 624 - 2704 ' Fax: (503) 598 - 0270 _
Plan review (25% of permit fee}
! CCB lic.: 76359 State surcharge (12%ofp2rmit fee) ti Jo
i
TOTAL PERMIT FEE f ie
Authorised signature: jAa.i2/1e. Tltc permit spplitation expires if a pessaic in not obtained within ISO
- slays crier it etas Lees accepted as completes
Print name: Marlena R Meedom Dale' ,.a.., ' Fur tne1Lutolr. y set by Tri- Cennuy Building :a S.nice Board
Apr 03 12 09:03a Columbia Heating /Cooling 503 - 598 -0270 p.3
aZ
HEATING & COOLING, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(593)624 -2704
SITE PLAN
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ADDRESS: I3a . Loop