Permit CITY OF TIGARD MECHANICAL PERMIT
11111
• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00414
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/07/2012
Parcel: 2S111DB12801
Jurisdiction: Tigard
Site address: 9400 SW LAKESIDE DR
Project: Allen Subdivision: SUMMERFIELD NO.12 Lot: PT 679,
Project Description: (1) A/C replacement Must be placed within 5' of side yard setback and approved rear yard setback
Contractor: COLUMBIA HEATING & COOLING INC Owner: ALLEN, MARGE
PO BOX 230397 9400 SW LAKESIDE DR
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Air Conditioning 08/07/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 08/07/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 08/07/2012 $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.
Issued By: Permittee Signature: o0 AWL/M
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.
08/06/2012 09:18AM 5035980270 COLUMBIA HEATING PAGE 02/02
Mechanical Permit Application 1(m O r l l (' l: I i ti l 0\I \
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13125 SW Hall BlvdTigard, OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Oate/Oy: Other Permit:
l 14; A u I/ Inspection Line: 503.639.4175 AUG 0 6 2012 pate Ready/By: ice' ®See Page 2 for
Internet; www.tigard- or.gov Notified/Method (p Supptementnl Information
CITYOFTIGARD 1 ��+
•'s �' Y� �'' '� y , y . 119 '-1 �274 r :se:t.J1t-a rt� ,�i w' itl � ',� CKI.IST
• :'> tda Y • ^ _ _� w_�._'_t.: is ` -_ " -1.? o::?�#, 53 Mechanical permit fees' are based on the value of the work
p`; ❑ New construction dclition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of a
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
,I i i „- , 3 r , -r, Value: $
,., .:x..... ..1, .,,_ , _l _ _� _:.� 1:. � ..__,. }id _. __ grigigitOtis. ..I .'7�fX]Z"';n t�
.-F ind 2- family dwelling ❑ Commercial/industrial ❑ Accessory building Foe spedal information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. Total
., `I'. • ; s .i ` , r , L -!{, Heating/cooling:
:w., _.a _.: � . �1. s a°xx �:r :_,-l; Air conditioning
Job site address: WO A 4 eyfd PA. (requires site plan showint placement) ti< 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
CCity/State/ZIP: a� / d �� Furnace 100,000* BTU (ducts/vent) 54.91
• Suite/bldg. /apt. no.: Project name: • `(,EA) Att4 - F Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32 - A
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (ftlel -type, not electric),
in -wall, in-duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other 23.32
Tax map /parcel no.: Other fuel a . . lances: •
4 I 1 ,. s Y y water heater 23.32
.�% _ L � . 4 t.SLx :i 1 3339
Gas fireplace •
�� ' i., Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
,Wood/pellet stove 33.39
Wood fireplace /insert 23.32
1`" ._--; r . , _„sue — 1 , 17 , Chimney/liner/flue/vent 23.32
Chim
- ' ... .,: L ° •• -- _ :`. .. . _ . Other _
� ' 1�. "' ����s _ _,,. Y _ z<.,,_...... . ' s - 23.32
Name: ! ' Environmental exhaust and vendiadon:
Address: • // //�� Range hood/other kitchen
l,..a7� - (� equipment 33.39
City /State/ZIP: ( / OA- n _ ' Clothes dryer exhaust 33.39
Single-duct
toilet ( ) Fax: ( ) et co mp ( il
artmentss,uti
o utility rooms) 23.32
cw.s.c.:: A N . .. R ,• 1 .. / 1 -i 0 • Y
r .!Znm_ . : ry . . ° t ; , r . L., ..L_....' —_— ,, .' .--.:..r',- ::.::"•:._'.'.....i.'''..-.;..:.,.! I J 1 AtticicraWlSpale fans 2332
» Business name: Columbia Heating and Cooling, Inc. Other: 23.32
Fuel piping:
Contact name: Marlene Meedom $14.15 for first four, $4.03 for each additIonat
Address: PO Box 230397 Furnace, etc.
Gas heat pump
City /State/ZIP: 97281 Wall/suspended/unit heater
Phone: (503) 6242704 Fax:: (503) 598 - 0270 Water heater
Fireplace
E -mail: columbhc(gtteleport.com R
F' •'.,• i Y! . .... "oi Barbecue
Business name: Columbia Heating and Cooling, Inc. Clothes dryer (gas)
Other:
Address: PO Box 230397
City/State/ZIP: Tigard, OR 97281 Subtotal
Minimum permit fee ($90.00)
P hone: (503) 624-2704 Fax: (503) 598 -0270 plan review (25% of permit fee)
= State surcharge (12% of permit fee)
Authorized signature: .A This perm TOTAL PERMIT FEE l . SO
!` Thii application expires if o permit is not obtained within is days after it boa been accepted as complete.
Print name: Marlene R Meedom Date: 6« 6 `. /a I • Fee methodology set by Tri- County Building Industry Service Bow
1:iBultdIe5WernII \ C- PermliAppAa 09/09/10 140-4617T(1 tro7JCOM/WEB)