Permit CITY OF TIGARD MECHANICAL PERMIT
s.. COMMUNITY DEVELOPMENT Permit #: MEC2012 -00198
T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2012
Parcel: 25111 DB11300
Jurisdiction: Tigard
Site address: 15280 SW 94TH AVE
Project: Behbahany Subdivision: SUMMERFIELD NO.12 Lot: 640
Project Description: Furnace replacement.
Contractor: COLUMBIA HEATING & COOLING INC Owner: BEHBAHANY, SUSAN
PO BOX 230397 15280 SW 94TH AVE
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 -624 -2704 PHONE: 503 - 701 -5958
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/20/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04 /20/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /20/2012 $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: -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 Application 1••O11 OFFICE 1`sl: u1N1.1
City of Tigard Reodved 8,
• 13125 SW Hall Blvd, Tigard, OR 97 D. Date.By: . i / �1IM Permit No.: u c.....0 la. - A R
' I Phone: 503.718.2439 Fax: 503. Plan Review
Date:By:
Oilier Permit:
• r I G n 1. I) Inspection Line: 503.639.4175 D are Rae B lura:
Internet: www.tigard- or.gov ,, 0 2. Notified/Method: Ready, 13y: Supplemental See Page 2 for
Supplemental information
. .. ,; � i.T]T � �_ �]_r_,.. •1 ' " R L4 �P�ID � i'�CKLIST
. . _ . . . �. .. L''l:" t . , C • C . L ... C„ .- .t... $;, =.. 4SE
••:•. . Mechanical permit fees" are based on the value of the work
ix%tr%
0 New construction dditionfalte ll� men[ performed. Indicate the value (rounded to the nearest dollar) of a •
Zt ❑ Demolition ❑ Other: mechanical materials, labor, overhead, acv equipment, ]a , d, and profit.
' ^" is CA 0104 - tk S _ r� r�l:- Value:$
to B�"' �' ? '�' ;,
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.'C='. " :'.+''I s`a
i := : .. ..- •''�. . ,. _ :' RESIDENTIAL: EQTIIPMENT I SYSTEMS FEES" • ❑,Y 2- family dwell ❑ Commercial/industrial ❑ Accessory building For special Information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total
. 1 . '�+'''t` T ._ Hearin c I•
i r ///��� Air conditioning
I
Job site address: /V 07 ti (3 ,,-c..„) 9 4/'e - (requires site plan showing placement) r� , 46.75
City /State/ZIP: 7 64_
/ 7 's e22 Furnace 100.000 (duets/vents) }� 46.75
Furnace BTU 100.000+ BTU iducucts /asivents) : , 54.91
Suitelb :dg. /apt. no.: Project name: Re AA J y Heat pump
<1 i
( requires site plan showing plac ement) 61.06
Cross sweet:directions to job site: Duct work 23.32 • A
Hydronic hot water system 23.32 _
• Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric).
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 1 23.32 _
Tax map/parce'. no.: Other fuel appliances:
�px ;„,....Rgt. i _. : ., s4, 4 1,;: �; • Water heater 3.32
Gas fireplace 33.39
FielL AC .€ CHANGE ^ GV t • Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace/insert i 23.32
x _ 1:¢;L;{✓ _ f.<OV � „ 1 �- :,° Chimney /Iinertflue /vent
23.32
QYFIYi`1i S? 1V :•. ,,. _ ,.� Lt F`y_ `y -: .� , ii tri: '
oth ther: , 23.32
Name: ��/
QEN�r�/ /AN Environmental exhaust and ventilation:
• Address: /f) SH0 / y T /7r A,e. Range hood/other kitchen
equipment 33.39
City/State/ZIP: 77 Gibe,
ge--- 9962 y Clothes dryer exhaust 33.39
77 - r Fax: Single -duct exhaust (bathrooms,
Phone: (
‘1' , , yf T ( ) toilet compartments, utility rooms) 23.32
. ` > ; r -; :. ,t a a, :
4• ®APimgi r13 ; '' r f �.': p Y ��i ` 01 iiitv � 1 ' ,, , Atticicrawls ace fans 23.32
p
r: .: Other: 23.32
Business name: Columbia Heating and Cooling, Inc.
Fuel piping:
Contact name: Marlena Meedom 514.]5 for first four, $4.03 for each additional
Address: PO Box 230397 Furnace, etc.
City /State/Z1P: 97281 Gas heat pump
Wall/suspended/unit heater
Phone: (503) 624-2704 i Fax: : (503) 598 -0270 Water heater
Fireplace
E -mail: columbhc®teleport.com -
• Range
,py �� t - " •• v.' td�P i. tea'
. _i!�f..t
.... _ .. ., . , . ...: i -, ,? . dFi�ft1; >r• is " : ::!� :F� Y'..'.a :.� i ye'f=`I� �i•r:' : .> B arbecue
Business name: Columbia Heating and Cooling, Inc. Clothes dryer (gas)
-
Address: PO Box 230397 • Other:
rni-; >: ";iY7ECHAN[CAL PERI4IIT FEFS•
City /State/ZIP: Tigard, OR 9 7281 Subtotal
Minimum permit fee (590.00) qo .G0
Phone: (503) 624-2704 Fax: (503) 598 -0270 Plan review (25% of permit fee)
CCB lie.: 76359 State surcharge (12% of permit fee)
TOTAL PERMIT FEE % ,tt
• Authorized signature: This permit application expires if a permit is not obtained within tau
• Jays after it has been accepted as complete.
I Print n ame : M a rietta R Meedom Date: - J � 1 • Fee methodology set by Sri- Counly Budding Industry Service Board
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