Permit CITY OF 'TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00238
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/14/2012
Parcel: 2S111CC16600
Jurisdiction: Tigard
Site address: 10100 SW HIGHLAND DR
Project: Boyle Subdivision: SUMMERFIELD NO.4 Lot: 217
Project Description: Replace Furnace and Water Heater
Contractor: COLUMBIA HEATING & COOLING INC Owner: BOYLE, DICK
PO BOX 230397 10100 SW HIGHLAND DR
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 524 -9258
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/14/2012 $46.75
Type of Use: SF Water Heater 05/14/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/14/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 05/14/2012 $19.93
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: J462/1— Permittee Signature: Oki /�{-f'Ir't f ' / / oki
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 1412 07:37a Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Application FOR OFFICE USE ON LYY
Ci of T' and E RCCe „ .d Pamoi
tY (,� uatesy: S /l41(Y /4e6 .via 00c13
III • 13125 SW hall Blvd., Tigard, OR 97 Plan Reviet•
Phone: 503.716.2439 Fax: 503.598.1960 a tsennil: 1
f:ar„ •8y: Olh
i nspection Line: 503.639.4175 N Ig 14 201 1: ate Rerdyiliv: Aunt '- 55 See Page 2 for 1
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Internet: n�vw.UgarJ- or. gov l: olit;edrlvtphnd. .fl � Supplemental Information J
CITY OF T AR 1 ll
• TYPE_ Of *li L D1Vi -O COMMERCIAL SCHEDULE - USE CHECKLIST
Mechanical permit fees' arc based on lint value of the work
❑ New canstrurtian iti/:atlalteratioro`renlacemenl performed. Indicate the value (rounded to the nearest dollar) of all i
❑ 1)emotition ❑ Other: - mechanical materials. equipment, labor. cvcrhead, end profit.
Value: $
......- _ : - CATEGORY OF .CONSTRUCTION :•:. `
. RESIDENTIAL EQUIPMENT YSTEMSFEES* 4
Grand 2- family dwelling ❑ Commercialiindustrial 0 Accessory building For special infornrarlonrisethcrk1irr.
❑ Multi- family ❑ Master builder ❑ Other. Description I Qty [ Ea. I Total 1
JOB 'SITE 119F.OB141AT1011:AN13. LOCATION - .. Ileatiti:�rcootintt:
//'' Air conditioning I I
J'
Job site address: /0/00 5 hit DR. . ( rcrryuesa p;
teplanshossinobeeuxmy 46.75
City /State'2IP: �/ ����� CT2 n
Furnace lon.eo fiTl.'(a1xm'versst � ( .
Poe 10(1,0(01' Ii RI (dl, 54
emventcl 54.91 91
Suitebldg. /apt. no.: Project name: flea pump 11
(requires site plan showing plauam cart 61.06 1
Cross shcel/directions to job site: Duct work 23.32 • A.
l lydronic hot water system
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -t pe. not electric).
. in -wall. in-duct, suspended. etc. 46.75
Subdivision: l Lot no.: Ftuelvatt for ans above 23.32
Other: 23 12
Tax map/parcel no.: Other fuel appliances:
DEW::801'10N • OE WORE :- Water heater l X I 2332
Gas fireplace t 33.39
/'V/�/v�CE 6-#17 N & 6-Z Flue watt f r voter borer ar gas t
f L - A- - ./P) &"', 7-- fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet srcve 33.39
Wood fireplaccrinsert ; 23.32
[P - OWNER . .. •❑: TENANT Chimney /lincr/0ue/vent 23.32
Other: I 22.32
Name: 1)f C'C CO e Environmental exhaust and ventiletiur :
-
.Address: I 01 00 5"'cJ j-f f 6 ti t A/L 0Z- Range hoodiother kitchen !
equipment ' 33.39
City /State/ZIP: 1-16 1:7/C-- Clothes dryer exhaust . 33.39
Phone: 6'a, - 'r);J <5 Fax: ( ) Single -duct exhaust (bruhroo . 2_.32
toilet compartments, utility rooms)
® APPLICANT - ❑ CONTACT PERSON Aui /crawlspace tans i 23.32
Other i 23.32
Business name: (:nlumhia Heating and ('online. Inc.
- --- - - - -- -- - --- .......- -,._._ ._.. -._.. Foci piping:
Contact name: Alarlena tfeednm 514.15 for first four S4.03 fa—troth additional
Adaress: PO Bar 230397 - - -° I:mnace, etc.
Gas halt pump
City Sute:7-IP: 97281 Wa!lisuspendcdluuit beau- i 1
Phone: (503) 624-2704 Fax: : (503) 598-0270 Water heater L
I Fireplace I j
E -mail: columbhc!a>teleport.com Rang I
COYY'I:R • . _ ., 0arbecue •
fiusincss name: (:olltmtlta fleeting and Cooling, Inc.
Clothes dryer (gas)
— - Otter:
Address: PO Bow 230397 - 51E(HAN!CAL PERMIT FEES"
City;Stnte ZiP: Tigard, OR 97281 Subtotal
Phone: 15031624-2704 v k`v Fax: (5031598 -0270
Minimum permit fee permit f ee )
Plan review (25 % ui - ptinrtit fee►
�CCB tic.: 76359 A State surcharge ((2%ofptrmi: fee) I
F _ _
TOTAL PER IT FEE 20 .6d I
Authorized signature: p 'nib permit application cypher ifs permit s not nbtaine within 1.130
Jays after it tun been accented us complete.
Print name: Marietta RMeedom I Dole:, - V- /2 7 ' Pee mcdmdul ng y set by'Iri•CountyBuildirgladsoti Sertiiec
aart awt?r r1 r.n",,r0,•1lVimt