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Permit CITY OF TIGARD MECHANICAL PERMIT i • - COMMUNITY DEVELOPMENT Permit# MEC2012 -00475 Date Issued 09/18/2012 T I G AR D 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S112CB09600 Jurisdiction Tigard Site address 15270 SW KENTON DR Project Moffitt Subdivision ASHFORD OAKS NO 2 Lot 110 Project Description (1) furnace replacement Contractor COLUMBIA HEATING & COOLING INC Owner MOFFITT, JOHN PO BOX 230397 15270 SW KENTON DR TIGARD, OR 97281 TIGARD, OR 97224 PHONE 503 - 624 -2704 PHONE 541 - 517 -8100 FAX 503 - 598 -0270 FEES Specifics: Description Date Amount Furnaces < 100K BTU 09/18/2012 $46 75 Type of Use SF 12% State Surcharge - Mechanical 09/18/2012 $10 80 Class of Work ALT Type of Const Minimum Fee Adjustment - Mechanical 09/18/2012 $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 4 /, Permittee Signature D/ A Pi/Lie k.) 7101J 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 09/17/2012 11:22AM 5035980270 COLUMBIA HEATING PAGE 02/02 ,., : Mechanical Permit Application I ()11 ()1 I I( I. l .til: 11 .1 City of Tig>� Recelved Q `/ �/ .� � ill 13125 SW Hall Blvd.. Ti : _�� s;: D9Ie/9Y: 7 � g� f �'J Permit No �L�D/ a �Y 7� Phone' 503,7182439 Fax:` ' ' :. 615'"r Other Review Other i 1 1.. A t; I, Inspection Line: 503.639.4 ,5 Date/ Permit. r Internet, WWW.tigard -or gov C EP Via Date R 4/Met y, luny to See Page 2 for J Notified/Met ed/Method S ppkmaotalInformation . _ i ` -: , e. ; S,i - v `I ?' 7 v 1 r et i p a A ' t I:cKLIST r �q'. `}ate. ., .., t i . , '' t ' at , -.. ,. o.U. +rtisaq.,+ i a c: . d...:rur:'iirr Mechanical permit fees* are based on the value of the work © New construction E Addtt .iterat performed Indicate the value (rounded to the nearest dollar) of ❑ Demolition Other: mechanical materials, u eqipt, labor, men overhead, and profit f Rk tr 1 I i + r i 1:f 7 i V Value' s . Viand 2- family dwelling ❑ Commercial/industria! ❑ Accessory building For special InformatIon use checklist. _ 0 Multi - family ❑ Master builder [] Other Description },� ,raw Qty Ea Total r ,...• _ ._ ,-,. 4-1 a. a . �la l Air conditioning , Job site address: 3 o q 0 C I ei � t '� Trot' D r - 4rc site plan ?homy placemem) 46.75 City /State /Zip: % 1 , I, ne lJ Furnace 100,000 BTU tductslvents) 46 75 Furnace 100,000+ BTU (ducts/vcnls) 54 91 Suite /bldgJapt no.: Project name: m Qi 7 ---- 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 (fuel -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 /pare)! no _ Other fuel er uel appliances: ` J •� U Water heater 23 32 tQ,Gl�7 _Gas fireplace 33 39 ; ' Flue vent for water heater or gas fireplace 23 32 _ Log lighter (ga I 23 32 Wood/pellet stove 33 39 Wood fireplace/insert 23 32 � ;S: -7 .- �v ;,,, Chimney/liner/flue/vent ne • - -x ui; - - ".'1� ::r „' ,�.y s, . l.;�_. m /liner /fine/ vent 2 111111101-115974i,'.1;:''''''..--• ...,._,I �)'- r t I t � 't i _ Y 3,32 x, Other. , 23,32 Name O PF f T r - Environmental exhaust and ventilation: Address. Range hood/other kitchen equipment 33 39 _ City /State /Z1P: Clothes dryer exhaust 33.39 Phone: (5' /) = CO Fa ) Single -duct exhaust (bathrooms, l ., !• , . toilet compartments, utility rooms) 23 32 T'� J I r i 4t I ~ It ,. I � � 7 t t 7 � . %a Attic /crawlspa.ce 23.32 Business ' Business name. Columbia Heating and Cooling, Inc. 23 32 Fu i i Contact name: Marlene Meedom $14.15 for first four, $4.03 for each additional Address PO Box 230397 Furnace, etc Gas heat Bump City/State/ZIP 97281 Wall /suspended/unit heater Phone: (503) 624 -2704 Fax: : (503) 598 -0270 Water heater E-mail. columbhe@teleport.com Fireplace a i . Range v Barbecue Business name, Columbia Heating and Cooling, Inc. Clothes dryer (gas) Address PO Box 230397 - City /State/Z1P Ti 97281 :,r`,' ''• :.Y,5r'•'�) I r ?i q ' Ig m;(: ' .. i Tigard, OR Subtotal Phone. (303) 624-2704 Fax. (503) 598 -0270 Minimum permit fee (590 00) Plan review (25% of permit fee) CCB lie .76359 State surcharge (12%ofpermit fee) TOTAL PERMIT FEE ta) 8t7 Authorized signature This permit appCtcatlon elcpirn tra pe b pat obtained within 180 days after it has been attepted as complete, , Print name. Marlene R Meedom Date: — / • Fee methodology set by Tri- Comity Buildma Industry service board i 1BuildlnalrermaO tEC- PermiiApp,dx 09/09/10 4444F17711IlnY