Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00235
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2012
Parcel: 1 S134AB01800
Jurisdiction: Tigard
Site address: 11329 SW BASSWOOD CT
Project: Price Subdivision: ENGLEWOOD Lot: 75
Project Description: Replace furnace
Contractor: COLUMBIA HEATING & COOLING INC Owner: PRICE, LARRY
PO BOX 230397 11329 SW BASSWOOD CT
TIGARD, OR 97281 PORTLAND, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 703 -2686
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/11/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/11/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/11/2012 $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: /i tJ Permittee Signature: 0[ ( 4f°47
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 11 12 12:16p Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Applic CF FOR OFFICE i e C)%I.1
City of Tigard Receiv d Permit No,: ) (i /a Q/
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I 13125 SW
I Blvd., Tigard, OR 9722 Pbn ftevie&
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- Phone: 503.718.2439 Fax: 503.598.1 Ay 1 1 2012 Pbn R .•: (
Other Permit:
i, n Inspection Line 503.639.4175 A kris- H See Paget for
Internet wtvw.tigard -0f.goY C1 1 t Or ! T IG�,^Z Dale ReadylBy
; _D Notified/Method: �F 1� I Supplemental tnformauon
BUILDING D!VISI.O ' 1
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit tees` are based on the value of the work
❑ New construction tg Addition/alteration/replacement performe Indicate the value (rounded to the nearest dollar) of all ,
Demolition 0 Other: mechanical materials, equipment. labor. overhead, and profit.
Value: S
,CATEGORY OF CO:WM.1CT!<* RESIDENTIAL EQUIPMENT /'SYSTEMS FEES*
`it 1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building For speefal info rmal# erwe checklist
❑ Multi-family ❑ Master builder ❑ Other, Description I Qty. I Ea_ I Total
Heating/cooling:
JOB SITE IN • • CATION AND LOCATION Air conditioning
Job site address:
I. ' r„�� -� �1 ` dire:. r Irequires site plan showing placement) 46.75
1 ` � �--A� ' Furnace 100,000 T nt 46.75
City /State/ZIP: B (daces/vents) Furnace 100,000+ BTU (dactsweots) 54.91
Suite/bldg.apt_ no.: Project name: f71/7 i
ee Heat pump
I a "�� (requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32 ' A
Hvdronic hot water system : 23.32
Residential boiler (radiator or
hvdronici I 23.32
Unit healers (fuel-type, not electric). I
in -wall, in -duct, suspended. etc. , 46.75
Subdivision: I no.: : Flue/vent for any of above 2332
I Otter_ 23.32 _
Tax map /parcel no.: I Other fuel appliances:
DESCRIPTION OF WORK Water healer 23.32
- Gas fireplace 3339
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) : 23.32
Wood/pellet stove 1 33.39
Wood fireplace/insert , 23.32
gistROPERTY OWNER l Q TENANT Chimney/liner /flue/vent 1 23.32
Y Other: 23.32
Name: Environmental exhaust and .•entilatic n:
Address: t 1 W LJ . L43tJfJXYT1 _ Range hood/other kitchen
^ ^ equipment 33.39
(!
CilyiSlateJZlP ' 974 Clothes dryer exhaust 33.39 1
1W O 3 ••• r toilet Single-duct compartments. (bathrooms.
Phone: Fax: ( ) toilet compartments, utt7iteri tr, r rooms) 23.32
• ei APPLICANT J CONTACT PERSON Attictcrawlspace fans 23.32
Other: 23.32
Business name: Columbia Heating and Cooling. Inc,
Fuel piping: .
Contact name: Marlena Mecdons 514.15 far first four, 5.1,03 for each additional
Address: PO Box 230397 Furnace, etc.
Gas heat pump
City /State/ZIP: 97281 Wall/suspended/unit leaser .
Phone: (503) 624 -2704 Fax:: (503) 598-0270 Water heater
Fireplace
E-mail: col ambbc.attelepomemo Rangy
CONTRACTOR • Barbecue
Business nam e Columbia Heating and Cooling. Inc.
Clothes dryer (gas)
Other:
Address: PO Box 230397 MECHANICAL PERMIT FEES'
City /Suite/7.1P: Tigard, OR 97281 Subtotal
Minimum
(503) 6242704 I Fax: (503) 598.0270 Plan review v "emit fee (590.0
cw (2i %ofit Feee) )
i ttC B Iic.: 76359 ( o(vl f I v State surcharge (12 %of reran fee)
TOTAL PERMIT FEE J
Authorized sI ture: nix permit application expires Ira penal is not obtained within 180
e°� days after it has been accepLd as complete.
I Print name: Marleaa R 3.leedom Date: ' Fee methodology set by Tri- Colmty Buil 'cap Industry' Senire Board
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