Permit CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00289
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012
Parcel: 2S102CB06000
Jurisdiction: Tigard
Site address: 10435 SW GRANT CT
Project: Wollett Subdivision: WINSOME TERRACE Lot: 4
Project Description: Replace furnace and venting
Contractor: COLUMBIA HEATING & COOLING INC Owner: WOOLLETT, THOMAS S
PO BOX 230397 12700 SW 231ST PL
TIGARD, OR 97281 HILLSBORO, OR 97123
PHONE: 503 - 624 -2704 PHONE: 503 - 519 -1224
FAX: 503- 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 06/05/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/05/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/05/2012 $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. ` 1 / /�
Issued By: C�/� Du Permittee Signature: API CSI 6411pl
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.
Jun 01 12 09:38a Columbia Heating/Cooling 503-598-0270 p.2 /
> ij
R giC Elwin
Mechanical Permit Application FOR OFFICE USE. ONLY
• JUN 0 1 2014 I R ,at ec e43) eived i it i 0._ 1 pasoirpoliEti)40 s DA- •
City of Tigard
111 ' 13125 SW Hall Blvd., Tigard, OR 97213
OF TIGAR 9 D
• CITY O
' 2 Phone: 503.718.2439 Fax: 503.598.1960 Other Paned':
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISI c fgare ReadyfEly: Aim: 1 ill See Page 2 for
Internet: www.tigard-or_gov Ildotiiird .11 Cets Supplemental Information
_ . .
r - ' . • .. ::-.: • ' . . .;TIE•:.60..*(it'oc,,. .•., ..,..- '..: :- :;,......',;; - - . 1 '.,.:05*RciAir'0.' scirgt 4
. j .. .... . ..
Mechanical permit fees' are based on the vaine of the work
El New conStruction rp.1dditionlalterationireplacement perfomted. Indicate the value (rounded tc the nearest dollar) of all
Ej Demolition El Other: ntechanical materials. equipment. labor, cwcthcad, and profit
Value: $
•
' -:. -. 6.A.TtlGORS' , -Or EON§TRI.lerioN....'• t. ;','... :-..: l i. ....5... - T',.. - - i ' - ''':.
., i • : -• - -. • , --:,..r. :.. • .... _ '-. , - ,_,-,,,,.:- -::1 r-,-,.i'--- • 4 -.:-.;, r ' •-• !..-.,...:-..i.,.. AggmliasTriALOpip/v20.7f r'SYSTET15PERS' . .
'i- and 2-family dwelling 0 Commercial/industrial 0 Aemssory building For specie information use checklist
Ej Multi 0 Master builder 0 Other: Description I cy. I Ea. I Total
. . . : jcpB fl , . .... ;.,, : Ileathig/cootim:
- Air conditioning
Job site address: tor..f?5 s Grart..1- Of; (TCQUITCS SIM Plan 1410%. placement) 46.75
rn
Fuace 100.000 Bill (duos/mins) 46.75
City/StateIZIP: Tir tr ., ,. op. i "7 za 3 Furnace 100,003+ B11J (dners!venrs) 54.91
Suitebldg.lapt no.: Project name: 7:14AA W- (t.E *1-1 -- Ileat pump
(requires sire plan showing placement) 61.06 .
Cross street/directions to job site: Duct work 23.32 • A..
. tlydronie hot water system I I 23.32
Residential boiler (radiator 07
hydronic) I 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 I 2332
Tax map/parcel no.: Other fuel appliances:
. i .: ......': - ::.:',,',...'. :.: • ,..., Avej4k • • ,:",--:', . !--.: Water healer 23.32 • Gas fireplace 33.39
re pt.A.C. 42_ gjAr tA_D.. Ca2_ f. ve v1/4_41 Flue volt for %valor heater or gas
fircplaix. 23..32
Log lighter (gas) 23.32
Wood/pallet stove 33.39
Wood liteplacermseri 13.32
.. . , s4 c i wis/ 0.. - - .. -s,...., ‘.s. •-,..,. [:: ..,::.,, --..: :..,.. ,-..,.. f-, ..,... .. :...._:. . .• : Chimney/liner/flue/vent 23.32
• . . ., tt ......17. • . - • .. . . . . Other: 23_32
Name: ' W91 ,1 " 1A.S&C) lie . 14" -- Envinmmental exhaust and ventilatioqL
Address: la7(y-, Range hoodiother kitchen
equipment 3339
City/State/ZIP: II Clothes dryer exhaust 33.39
C si ...... i Fax: ( )
-7 al.i. ! Single-duct exhaust (bathmoms.
Phone: D3) marn
Ailu.r.-.A.Not.. ..::' -] . I. - : J.:-. : .-, - .: 0 CO? .•-•.: • •., '• toilet cop sents. utility rooms) 23.32
: Ani:/crawlspace tans 23 .32
Other: 23.32
Rusiness name: Columbia Heating and Cooling, Inc.
i ......... ......... ..... ...___________ Fuel piping:
I Contact name: Marietta IMeed4Un 514.15 for tiro four; 54.03 for cacti addittanat
...__
Address: Pt) Hox 2311397 Furnace. etc.
Gas heat, pump
City/State/71P: 97281 Wall/suspended/unit heater
Phone: (503) 624-2704 Fax: : (503) 5913-0270 Water heater
Fireplace
E-mail: columbhicaltcleporLcom . Range
-S - . . .- .7 -: ' -- • - -- ':-:: ..•': : -' CONTRACTOR- :.- ' ::- •-.., ,;---!;, ,!-:-:.-;:: : I: , --,:_.' : .:: Barbecue
Nosiness name: Columbia Heating and Cooling. Inc. Clothes drier(us)
Other:
Addrss: PO BO's 230397 I i ... ':':.'' '-
------ ---- .-------- -- _
c ny/Stoic.21P: Tigard. OR 97281 Subtotal
• 1 I Minimum permit. fee (S90.00)
,
Phone: (503) 624-2704
i t
-
CCB lic.: 76359 ' Fax- i503) 598-0270
I . Plan review (25% oilarmit fee)
State surcharge (12% of ptrmit fee)
TOTAL PERN 1T FEE lop . wo vir
Authorized signature: AttAittlit k This permit application evirim if a permit s not obtained within 180 ././
days after it has been accepted as complete.
I Print name: Marietta R Meedom D ate: 6 _ i _ (1_- 1 • ,ee macillutlulo set by Tri-County Building Industry 5171ACC 130.111.1
a...M.11.177 It um /ram/twin