Permit CITY OF TIGARD MECHANICAL PERMIT
_ COMMUNITY DEVELOPMENT Permit#: MEC2012 -00231
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2012
Parcel: 25111 CC18400
Jurisdiction: Tigard
Site address: 10415 SW GREENLEAF TER
Project: Baker Subdivision: SUMMERFIELD NO.5 Lot: 243
Project Description: Replace Gas Furnace
Fuel Piping for Water Heater, Fireplace, and Barbeque
Contractor: COLUMBIA HEATING & COOLING INC Owner: SEXTON, BEVERLY
PO BOX 230397 10415 SW GREENLEAF TER
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/10/2012 $46.75
Type of Use: SF Fuel Piping 05/10/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/10/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 05/10/2012 $5.78
Stories: Water Heater 05/10/2012 $23.32
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. , I /� / I A /�/
Issued By: Permittee Signature: 0�W A.p1 .-J 4 / T / QAl.
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.
May 1012 02:01p Columbia Heating /Cooling 503- 598 -0270 p.2
Mechanical Permit Application, FOR OFFICE LS (JYL.l
g nat
City of Tigard I CEIVED R "`i' : ( v 1 ?/
Permit N o : L4E O1 c)• c1
eBy
13125 SW Hall Blvd.. Tigard, OR 97223 Plan Review
0 Phone: 503.718,2439 Fax: 503.598.1960 DateiBy: Other Permit:
T l G A R n Inspection Line: 503.639.4175 I , AY 10 2012 late Readyrgy: OM El See Page 2 for
Internet: wtivw.dgard- or.gov Notified:Method: Supplemental Information
CITY OFTIGARD
TYPE alilitticiaN6 Div 'NON COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees' arc based on the value of the work
❑ New construction pio Addit ion /alteration/replacement performed. indicate the value (rounded to the nearest dollar) of all
❑ Detnolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: $
CATEGORY OF COIYSTRU RESIDENTIAL EQUIPMENT r SYSTEMS FELS"
• 1- and 2- family dwelling ❑ Commercial industrial ❑ Accessory building For special ieformaflonerseched ist •
❑ Multi - family ❑ Master builder ❑ Other, Description I Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heattttg/cooliuR:
Air conditioning •
Job site address: f / '4 1 1 1 r �� 4/ 4 • r/ a (requires ate plan showing placement) 46.75
Furnace 100.000 BTU (duns/won) daets&ent 46.75 )
Ci tY ISIate21P . 4.4 t Furnace 106,006+ BTU ldaecs/ventsl 54.91
Suite/bldg./apt. no.: I Project name: r� i 1 t Heat pump
`/ (menthes site tan showing ptaee:nen() 61.06
Cross slrocl/directions to job site: Duct work 23.32 • A _
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit healers (fucl-type, not electric). ,
in -wall, in -duct, suspended, ere. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Outer: 23.32
Tae map/pareel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater / I f 23.32
/j/� /� _Gas fireplace 0 k•L�th, 33.39
�� _ �/{/�/� Flue vent for water heater or gas
fireplace 23.32
Log lip (gas) 23.32
Wood//yellet stove 33.39
Wood fueplacc/inscrt 23.32
PROPERTY pwriER 1 ❑ TENANT Chimney /liner /flue/vem 23.32
Other:
— ,r 23.32
Name: Environmental exhaust and veoSlsNo -r
Address: VI er-I�.. Range hoodr'other i itchen
,��� �� equipment 33.39
City/State/ZI Clothes dryer exhorts 33.39
Single -duct exhaust (bathrooms. •
Phone: ( as 4! $5 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic /crawls. ace fans 23.32
Business name Columbia Heating and Cooling, lac. Other: 23.32
Fuel piping: •
Contact name: Martens Meedom 514.1511w lint four. $4.03 far each additional
Address: PO Box 230397 _ Furnace, ete. i
Gas heat pump
City /Statc21P: 97281 WalUsuspendedfunit heater
Phone: (503) 624-2704 I Far : (503) 598-0270 Water heater
Fireplace
E -mail: colulnbbc:s.teleport.com Range •
CONTRACTOR Barbecue J
•
Business frame: Columbia Heating and Cooling, Inc.
Clothes dryer (gas)
Outer:
Address: PO Bel 230397 - .
MECHANICAL PERMIT FEES'
City /State/ZIP: Tigard, OR 97281 Subtotal
Minimum permit fee , (S90.00) '
Phone: (503) 624
I ��l ‘ 'ji Fax: (503) 598-0270 Plan review (25% of permit fee)
O
CCB lie.: 76359 1 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a pertuil�.s not obtained within tIP
days after it has been accepted as complete.
I Print name Martens R .Meedom 1 Date: 5 -10 - I a. I - Fee methodology set by Tel- County Building lydustry Service Board
,. 2.,: u _.„u,,.. o,.,.r.,_,.w n0 ec'411 .145.4AtTrr1 I :m.,rnv