Permit CITY OF TIGARD MECHANICAL PERMIT
11 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00368
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2012
Parcel: 2S 111 BD02200
Jurisdiction: Tigard
Site address: 9735 SW PEMBROOK ST
Project: Schuck Subdivision: CLOUD CAP Lot: 4
Project Description: (1) A/C replacement Must be within 5' of side yard setback and approved rear yard setback
Contractor: COLUMBIA HEATING & COOLING INC Owner: SCHUCK, JAMES E AND CHRISTINE M
PO BOX 230397 9735 SW PEMBROOK ST
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 -624 -2704 PHONE: 503 - 819 -6204
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Air Conditioning 07/17/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/17/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 07/17/2012 $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. , / l l I//�
Issued By: 1i Q Permittee Signature: DM rl PP(�I C 14
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.
07/16/2012 11:41AM 5035980270 COLUMBIA HEATING PAGE 02/03
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Mechanical Permit ADP licaREcpivED i.,,„.,„,..,..,,,.}.i„,s,...,,.
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City of Tigard 0.1 1 111/MIE P.,,,,it , . ail?- OD3 A
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Phone: SW Hall Blvd., Tigard, OR 97223
%At 1 6 2012 Flan Review
e: 503.718.2439 Fax 503.598.1 Date/By: Other Permit
Inspection Line: 503.639.4115
Date nearly/5y: lie 9 till see rage 2ror
Internet wwl,v.tigard-orgov CITY OF TIGARD Notified/Method: S upplementa l infaraution
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mechanical penn it fees' arc based on the value of tbc work
0 New eOnstruction dition/alteration/replacemont perfortned. indicate the value (rounded to the nearest dollar) of
El Demolition 0 Other mechanical materials, equipment, labor, overhead, and profit
Valu: $
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-ad 2-family dwelling 0 COMMerciaindustrial 0 Accessory building For speclal hvbrmallon use cheddist
0 Multi 0 Master builder 0 Other: Description 1 Qin Ea 1 Total
77 H :
Job site address: ,t77 r' j—td PC,A16 X (sequins splan showing placement) I 46.75
Fun' 10_( 000 131R1 ducts/yenta 46.75
City/State/ZIP; rigAgio og 7 ii Furnace 100,000+ BTU (ducts/vents) 54.91
SuiteibldgApt, no.: I Project name: .57±N ct- Heat pump
(rcquhr lite plan shcrwing liancinent) 61.06
Cross areet/direndente so job site; Duct work 2332 • 4,..
• Hydronic hot water system • 23.32
. — - Residential boiler (radiator or
hydronic) 23.32
•
Unit heaters (fuel-type. not electric).
in•well, 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; _
,•--; •.',.:YiT-i.7 , "A"/".‘" '.., ....€".. ' :" I; • '1 ::4:
1 ;;i ! .1-..::. Water heater 23.32
.A...:..., - , T44. ". . ,1; ', "..-.4:. . " :, ; . ... - -g- 4,, ." 1 .'. 7 :•- 0- .'i'l:• . "-;
Gas fireplace 31.39
A c &fidiccostelvr Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) 23,32
Wood/pellet stove 33.39 • Wood fireplacclinsert 23.32
!-,..,,.„ . : Cbinineyniner/fluevent 2332
Other 2332
Name: COCX/C Environmental exbaust and ventilation:
Range hoodlother kitchen
Address: qt7,75 3co Pe.mageoic equipment 3339
City/Stele/ZIP: n ae 97.1xti Clothes dryer exhaust 33.39
• Single-duct exhaust (bathrooms.
Phone: (5t1 ) MCI - eao 11 Fax: ( ) toilet compartments, utility rooms) 23.32 _
" .'" - ,.." - e-,..• • .-. ,....=_____r■ ." i ' SA:‘,..",:ri_..i ,. rT : a .;._ _.. . _, -:,,,,^ •"'", -i=r' • - — ,.-77- A 2332
:.-..z 1 .. :-41 .k.A . WWW.tfilk, - ;P: - AZ-ii . : . -44c.:,■Wg.gR.P 1 1:•i•; : '" -.'::;.!:: tticieraw l'arts
Other: 23.32
Business name: Columbia Heating and Coang. loc.
Fuel piping.
Contact name: Marlene meegom
SWF for first four; S4.03 for each a dditional
Address: PO Box 230397 Furnace, etc.
Gas heat pump
City/State/Z.IP: 97201
., Wallisounit heater ,..
Phone: (503) 624.2704
Lam : (503) 598-0270 Water heater
Fireplace
E colnnibbe@teleport.com
Range
'4:4-Wria,:.:Y.L-e'..i.';:1::4XL.'•74AULI.1?..:".... ; Barbecue •
business name: colunotit Meeting Ana Cooling, Inc. Clothes dryer (gas) • -
Other:
Address: PO Box 230397
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City/State/ZIP: Tigard, OR 9728i Subtotal
,
Minunum permit fee ($90.00)
Phone: (503) 624-2704 I Pax; (503) 598
Plan review (25% of permit fee)
/ CCB lie.: 76359
State surcharge (12% of permit fee)
—
'emu .., PER' FEE lift)
Authorized signature: JAntlejlAil nit Permit ePPItatiOn eepirat If a permit is eat obtaiDed with!; ISO
AIMS niter It IMIS been accepted as ampere.
. I Print name: Marlene R Madam Date Date: . '''' tr. ( • Fee merbodelumf tar by Tri-Conety Building Industry service Board
ct...........n........cr..P.,....4,....tr 1117041,11 40645t1'r It ItCOMMAWIll
07/16/2012 11:41AM 5035980270 COLUMBIA HEATING PAGE 03/03
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HEATING & COOLING, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503)624 -2704
SITE PLA.NV WM C (C
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r6 1111111
PEP'
97.3 eflo°
ADDRESS:
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