Permit 111 CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Permit #: MEC2012 -00278
Date Issued: 05/29/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S133DA06100
Jurisdiction: Tigard
Site address: 12960 SW GLACIER LILY CIR
Project: Heidt Subdivision: AMART SUMMER LAKE Lot: 83
Project Description: Fuel Piping for range, barbeque
Contractor: COLUMBIA HEATING & COOLING INC Owner: HEIDT, ROBERT A
PO BOX 230397 12960 SW GLACIER LILY CIR
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 888 -9924
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Range Hood /Other Kitchen 05/29/2012 $33.39
Type of Use: SF Fuel Piping 05/29/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/29/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 05/29/2012 $42.46
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.,f /f
19 or 1800.332.2344. l
Issued By: t t T (/` Permittee Signature: n /�
>�PPL.L te
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 25 12 01:24p Columbia Heating/Cooling 503-598-0270 p.2 5' r
RECEIVED
Mechanical Permit Application MAY 2 5 2012
City of Tigard „;..„,, ur ,, 1 Recz .. ...1 ,,,.. 1 I , permit No.frtt A....- 0/1411
, Date/13v: n ham ., 4...-- 2.1
” 13125 S1.1.; 1 Intl Blvd., Tigard, OR 07223 Lf 1 r TIGARD ' Pl R P
'''' Other eetrti:
- 1 1. g . Phone: 503.71S.2439 Fax: 503.59&196INC, nhliQi0V 1) ''''' IN:
„ 1 -, 3 ' Inspection Line: 503639.4175 • 4 '''' " "- V Date Reacy(By: June: I Ili See Page 2 for
Internet.: www.tigard-onv,my Nolifiedilviethod: .11 1 Suppl :mental Information
: ' - -- -7 ' - ' ' - - - -- - - - - - - - ' ''' ''' . ' . : : . ' • . L . COMMERCIAL FEE*: SCBEUULE USE CHECKLIST
...
. .... . ..... .. ,...- . ; . . . : . . ._ -
; Mechanical pemitt fees* are based on the value of the work
0 New construction KA.ddilionlaiterationireplacement perforated. Indicate the value (rounded tr the nearest dollar) orall
mechanical materials, equipment. labor, J v e r II e a d , and profit
0 Demolition 0 Other:
,; , . .._. . Value: S
C_AT"ItOORY OF,. ,Fpr:, Z -",-,.:..-: i. ., -.:, , ,..-.,.itESIDENliALtQLTRIVIElir_t 31'STEMS FEES* ' -
Nr1- and 2-fatnilY dwelling 0 Commercial/industrial 0 Accessory building F o r s pedal information us checklist.
0 Multi-family 0 Master builder D Other: Description 1 Qty. Ea. I Total
Heating/coaling: •
. . . .- 404 " SITE INFORtNIATIONi:Al■;D LOCATION ; ' - , i . - ; . '.. •
Air conditioning •
Job site address: j oq
i t o 1
61 k I ( ,=uires site pin. shooing placement) 46.75
', unlace 1 00.000 BTU (ducts/vents) 46.75
City/StaiciZI?: i go . o p , q---1
F.,. 1011,000+ BTU onctsiverns) 54.91 ,
Suiteibldg.tapt. no,: Project name: Ca: Heat pump
(requires site elan ilowing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Ilydronic hot water system 23.32
Residential boiler (radiator or
hy-tironic) 23.32
Unit heaters (fuel-type, not electric).
in-wall, in-duct, suspended, etc. 46 75
-- i
Subdivision: Lot no.: Fluelvent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
. . . - urzcRIPTION' OF; W0141<-;':- " - i --- - "; -• ' - '- - ' ' - Water heater 2332
. . .
611 I In v 4-irt -(anitiefl AtmCdt_ Gas fireplace
Flue vont for water hearer or gag 33.39
C g I I ri 40 66c fireplace 23..32
bug lighter (gas) 23.32
Wood:pellet stove 33.39
Wood fireplace/insert i 23.32
23.32 "
.91 0 - '-71 . ,. ',::'- :-. - .I i. TENANT ' :" . - Chimney/liner/flue/vent •
- ' Other: 23.32
Name: 0
..
i i . 1 bi A .. Ens ironniental exhaust and retail:I ion: __, ..... ,... i
Address: i t a q L 0 6,4 &ait_ , 'firy- Range ipment hood/ether kitchen
equ 33.39
CityiState7.IP: ' cfl a_ Clothes dt-ver exhaust 33,39 .
Single-dud. exhaust (bailurerns,
Phone: (5 At6 _ no .
Fax: (, ) toilet compartments. utility rooms) 23.32
1- . .
- ' • ' Et 'APPLICA.NT " ii- - .; - , - ... . . ; 0 _ c o NTAcT - na sos ,.• .: - Attictrawlspace fans 23.32
-- "-- "------ Other: 23.32
Business name: Columbia Heating and Cooling. loc.
.... _ ._____ ... _................ _ ..___....._...._ Fuel piping:
Contact name: Martens Meedorn S14,15 for first four; 54.03 fo • each additional
Address: PO Brix 230397 Furnace. etc.
Gas heat pump
City/State/ZIP: 97281 Wallisuspendedunit heater
Phone: (503) 624-2704 Fax: : (503) 598-0270 Water heater
Fireplace _
E-mail: columbherdtteleport.cont Range 1
CONTRACTOR ; - i- - : ' ; - ' " "- : ; • ; ' - " - .., -; Barbecue I
s )
Business name: Columbia heating and Cooling, Inc. Clothe dryer (gas
Other:
Address: Pt) Rot 2341397
MECHANICAL pERMITTEW:: I: . ." '• - - "
filyiStaieLZ1P: Tigard, OR 97281
—7 S
Minimum permit fie ($90.00)
lO)
I Phone: (5'03) 624-2707 Fax: (503) 598-0270
I Plan revieu; (2S of permit fee)
CCU lie.: 76359
State surcharge (12% of permit fee)
--- TOTAL PER)IIT FEE I aD Lico
Authorized signature: ■ k This permit a isplica tin n e epiros if s pmnit is nut obtained within 150
days after it has been accepted as cnmplete.
Print name: Marlene R Mecdorn • Datei5 26 - i cD'" • Fee inethadolugy set by Tel-County Bin 3ing I.:1441517y Service Booed
.1:14.4S111 1'1 1iC111(MIIWP0I