Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00260
T [GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012
Parcel: 2S112CA11000
Jurisdiction: Tigard
Site address: 7633 SW ASHFORD ST
Project: Livengood Subdivision: RENAISSANCE WOODS Lot: 36
Project Description: Gas lines to dryer, fireplace and BBQ
Contractor: COLUMBIA HEATING & COOLING INC Owner: LIVENGOOD, TEDD D
PO BOX 230397 7633 SW ASHFORD ST
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Fuel Piping 05/21/2012 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 05/21/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/21/2012 $75.85
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: ��G ` 111 Permittee Signature: Oki fl PP0/� 1 WAL
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 17 12 03:35p Columbia Heating /Cooling 503- 598 -0270 p.2 S7
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RECE1 '-- f O R C FICl: l'SF: O,NIY
Mechanical Permit Applicatioe
City of Tigard , 5 /fit � 1 2- u Pa-ait N A .• , (a D Q.Z4T)
I II 1 3125 SW Hall Blvd., Tigard, OR 97223 7223 MAY 1 � � � Z e Review C ' Phone: 503.718.2439 Fax: 503.598.1960 CITY /�[ /( � D • ate/By: Other Permit:
1 i G RI) Insp Li n e: 503 CI 1 = Air ! IGA LS'ate ReadylBy: ter ®S Page 2 for
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TYPE OF WORK COMMERCIAL FEE" SCHEDULE — USE CHECKLIST
Mechanical permit fees' arc based on value of the work
❑ New construction fa Addititmiahetationireplacement performed. Indicate the value (rounded t the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor. . ahead, and profit.
Value: S
'CATEGORY; OF CONSTRUCTION. • RESIDENTIAL EQUIPMENT / ' YSFEMS FEES" •
Erl- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Fee specfd iafonneeon acs checklist.
❑ Multi - family ❑ Master builder ❑ Other: r Description I t'ty. I Ea. I Total
JOB SITE LNFORMATION AND • CATE N Heating/cooling:
' Air conditioning
Job site address: 7433 � a • fceauires site plan showing placement) 46.75 I
■ q-/:t - � rn Fuace 100.000 BTU [ducts/eins) 16.75
City /StatelZlP: / ` Furnace 100.0004 BTU (dual.rn -
sts) 54.91
Suite /bldgrapt. no.: Project name: Heat pump
Requires site plan showing placement) 61.0E
Cross streetidirections to job site: Duct work 23.32 • A
Hydronic hot water system 23.32
Residential boiler (radiator or
liydronie) 23.32
Unit heaters (fuel-type, not electric).
in -wall, in -duct, suspended. etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above ` 23.32
Other. 23.32 ,
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32 ,
r a J G a s tvepl 33_39 •
66 I r � fi (i�� Flue vent for water hea er or gas
i, ^, fireplace 23.32
� Log lighter (gas) ■ 2332 •
i Wood/pellet stove 33.39
i Wood fireplace/inscn 2332
1 - PROPERTY OWNER . I . ❑ TENANT Chimnerliner/fluc/vent 2332
c Other: I 2332
Name: ftto • L "`,+ a Environmental exhaust and ventilatio :
Address: LI. Range hood/other kitchen
r L, tI equipment 33.39
Issmi fi, �rir, m Clothes dryer exhaust 3339
Single -duct exhaust (bathrooms, •
Phone: ( ) Iv Fact: ( ) toilet compartments, utility rooms) _ 23.32
® APPLic r I ❑ CONTACT PERSON Attic/craw/space fans 23.32
Business name: Columbia Heating and Cooling, Inc. Other 2332 "
Fuel piping:
Contact name: Marlena Meedom 514.15 for that four. 54.03 for h additional
Address: PO Box 230397 Furnace, eta
Gas heal pump
City /State /ZIP: 97281 , Wall /suspended/tmit heater
Phone: (503) 624 -2704 I Fax: : (503) 59S -0270 I Water heater
Fireplace 1
E -mail: columbhcgteleport.eom Range
CONTRACTOR Barbecue
Business name: Columbia Heating and Cooling, Inc.
Clothes dryer (gas) ,
Other.
Address: PO Box 230397 MECHANICAL PER. I FEES*
City-State/ZIP: Tigard. OR 97291 Subtotal
Minimum permit f- (S90.00)
Phone: (503) 624 -2704 Fax: (503) 598-0270
1v I I Plan review (25% of • emit fee)
/CB tic.: 76359 10k I State surcharge (12% of . rmit fee)
/� i TOTAL PE • IT FEE j O .V..)
`
Authorized signature: it This permit application
days after 6ss been accept • as c plete. d within ISO
Print name: Marietta R Meedom Date: 5.. l 7..1 . _ • Fee methodology set by TriCotmtp Build tp Industry Sertice Baud
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