Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 00452
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 2S 112BB08800
Jurisdiction: Tigard
Site address: 14255 SW FANNO CREEK LP
Project: Winterstein Subdivision: COLONY CREEK ESTATES NO.3 Lot: 70
Project Description: (1) gas furnace replacement
Contractor: COLUMBIA HEATING & COOLING INC Owner: WINTERSTEIN, SHERRI R
PO BOX 230397 14255 SW FANNO CREEK LOOP
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 577 -9066
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/04/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 09/04/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/04/2012 $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: DM J ppoe4 / l)JJ
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.
08/31/2012 12:01PM 5035980270 COLUMBIA HEATING PAGE 02/02
Mechanical Permit • •
FOIL Or1•It. l: ► tit: 0\1.1
City of Tigard Received
• 13125 SW Hall Blvd., Tiger _ DareeY 9 u II 14 Permit No.: 201 ,1-o0sts -,
Phone: 503.718.2439 Fax: 503.598.1960 Plan R040.
t; . I: l 1 Inspection Line: 503.639,4175 S E P 0 4 2012 OUT Parade
[!Hemet: www.tigard- o'.gov Date ReedyBY: Mir 55 See Page 2 for
Notified/Method: -
Supplemental
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Mechanical
❑ WelvCOnslrualOn . - .� -..r. ._ j . ,r . .. .a :n'fc: '?•O"• .L t r .n f t fc w_..,.��:n the alue oft _ t l�l :
Addiuon/alteratioo/r,epl permit fees• aare ba = vlre lAlr
❑ Demolition ❑ Other: pe formed. In ditate the value (rounded to the nearest dol of all
,. �� &: mechanical materials, e • i • emu, labor Overhead, and . rofh.
... .'AO. 1 } 4. }.5.'..'.• i .y�lt?,' 11; r, .51 -.\?t 3���VJ re
Y�ta: .D
■ 1 -and 2.femily dwelling ❑ Commercial/industrial � "' 4 1'' l ick . f-7 ,8 .'ems :: ,:,.
industrial 0 Accessory building
CI Other: For t;vac►urlq(ormet/oa rae
0 Multi - family ❑ Master builder . z _ , Description
. ' a ',Y; , `u -s{.� rl � is -"'R'F.; ,•�,?�.--^...,, .,�,.^�+:t•�-.fir, :,- �... ;� r-. Qty. Ea Total ,
r ' "' ° u a - v- T.h, Z <cb Z2.. r - �'2 1 y�; ; +' r '� 1. �f 5>. i Heatla7,/tm" - :
Sob site address: / �r J_ 5 Ace conditioning ''�� - A' Lams tote Ian .win . d<ceneetN 46.75 -4
City/State/ZIP: r - Furnace 100,000137U ducts/vents Milli 46.75
Suite/bldglapt no.; Furnace 100,000+ y U deatovenvi I
PfojetH name: Heat pump
Cross street/directions to job sits: ��
(=wired Site vhn ahowinS Plaoemau) 6I A6
- -
Duet work 2332 M®
H ., .pie hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in•wll M-
adu
Subdivision: etc 46.75
Lot no_: 23.32 MI
Tax ma p /parcel oo,: Other
„ may 13.32
: i:,. r4 ! %, lxv� :c =-.. ..:t":7= ' _r'` , -4,.V7:, Other fuel a lances:
-
.� :'34_ s y f i• - . . x .4- 7, y ^ -',,,,,'_,L, cj ) ;.7,, ` w . 1. gA",.. 1•
.. F? :1 ill .. W heater 2332
Gas fireplace 33.39
Flue vent for water heater or gas
fire .11300 I. 23.32
Log lighter (gas) 2332
Wood/pelletstove 33.39
'.� + T . I ; '� tia ' 'a C . +.r''i'7 C!� - 3 ;%V, Wood fireptaee/maett . 23.32
'~ '^ 3 �i[Y. Y, nil e. 5 r } . t r 77" m4/IUNv
s . _:.4 ::� Le , _'s: �+ ' =. 1 ; ; ' Ch i A' ont 23,32
Name: r
.N r Other MI 23.3z
Add M� / Environmental eabaeat and ventilation:
Range hood/other kitchen
City /StateflIP: e 'u " 33.39
Phone: ( r / - a 44 Fax: ( )
Single -duct exhaust (6alhrcrotus, ~ 33.39
Sin
;'-:1.:•i'''': a �`, ?,= l �?'; _ti ; p - r��q.�;ry.. - - �.,�., toilet corn * • s, utility rooms) :e.,: �N w „cW��r, � X30.: �: ^'y; a- i',�x .z:_r...ac ��!•• en tili ) 23.32
.
Business name Columbia Heating `�'.° Ndspaae fans 2332
ling gad Conn lnC utter. 2332
Contact name: Martens Meedoro Purl plpWg:
514,15 for first four. 54.03 for each additional
Address: PO late 23(1397
Furnace, etc. .111111111MMI
City/State/ZIP: 972$1 Gas kat pump
1 � ■
Phone: (503) 624 - 2704 Wall/ - unit heater
Fax:: (503) 5913 -0270 b_
E-mail: colatnbbt a®telepott.cOttt
`. ' ':' f ; 'r ' : "�` ;L .fin. ; - K Rene ' �
Bu8inms - .. f ` ? [ `:u "`D 4r es 1 Barheeue �-
name: Columbia Heating a CooU and n;, Inc. Clothes d er ;..3
Address: PO 1)01 734397 Other: N1111
City/State/ZIP: Tigard, OR 97281 �_ a=te � � ' P '
Subtotal
Phone: (503) 6242704 Fax: (503) 598 - 0170 Minimum permit fee ($90.00)
z eCB lie.: 76359 Plan review (25% of permit fee)
State starharge (12% of permit fee)
Authorized signature; 1 TOTAL PERMIT FEE D O. :' 5..c J �.` t t . _� A.
r�, Thin permit epphtavoe expires to permit is not obtained within ISO
Print name: Marlene R Madam days after It Iran been angered u complete_
Date: Ale • Fe , na llodology ter by 7ti.Gounty Building
n..:u�np.....:•..•.��.e,x e.,.. nn. man
r , industry Service Leant