Permit q CITY OF TIGARD MECHANICAL PERMIT
• - COMMUNITY DEVELOPMENT Permit #: MEC2012 00509
T t G A R D 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 10/08/2012
Parcel: 2S110DD01400
Jurisdiction: Tigard
Site address: 10395 SW CENTURY OAK DR
Project: Stone Subdivision: SUMMERFIELD Lot: 21
Project Description: (1) furnace replacement
Contractor: COLUMBIA HEATING & COOLING INC Owner: STONE, GORDON J
PO BOX 230397 10395 SW CENTURY OAK DR
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE' 503 - 971 -4441
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/08/2012 $46 75
Type of Use: SF 12% State Surcharge - Mechanical 10/08/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/08/2012 $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: 19A1. 41:91 6/4-1DAL
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.
10/05/2012 11:48AM 5035980270
COLUMBIA HEATING PAGE 02/02
Mechanical Permit ApQlicatio
Ci .,..
ty CIV1
Cit of Tigard
0 8' � Permit No ��}�
• 13125 SW Hall ,Blvd., Tigard, OR 97223 OCT _ ea 10 .� es1- o06-251 . Phone: 503.718.2439 Fax: 503.598.1960 C 1 Q P l ace Review
I c t , Inspection Line: 503.639 4175 0 8 2012 Date/By. Other
Permit
Internet; www.tigard or.gov CI Ready/By. curt El See Page 2 for
Notified/Method' - Supplementalloformation
1 " t 1 , - t i t 1 { p Yr -v ru max•.• p
I 'a 1 T�' ij J, 1 i't A . ? 's YIds S .l:I; % iR' ?•.,:, ' ---- .dS'I'
Mechanical permit fees* are based on the value of the work
❑ New construction didon /alteration/replaoement performed. Indicate the value (rounded to the nearest dollar) of,
0 CI Other; mechanical materials, c • i •ment, labor, overhead. and profit.
s J r, ? -' , ; : .,:,7:2- i 'rt t rc Value: S , --
"= t _ .,_ -. c . � `i 5 ''�I� ��:', ,1�t. r- t : s u.
^ wand 2- family dwelling El Commercial /industrial 0 Accessory building For special Informationura c#reeldlsi.
❑ Multi- family 0 Master builder 0 Other: Description
��� .�� D
.. • P I Qty , 1_ �a. Total
,
S ;:.Y Healing/cooling:
�Si :. K , ;_'_; Air conditioning
Job site address: 1 .i a' ( ,k er . QAr d ,, re• ulree site • tan showui; • laeemem 46 75
~�� " ,U City /Statt/ZIP; Furnace 100.000+ BTU (ducts/vems) 54.91
Suite/bldg./apt_ no.: Project name: Heat pump
r • wires site • tan shwrin : • laccment) 61.06
Cross street/directions to job site: Duct work 23.32
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 an, of above 23.32
Other. 23.32
Tax map /parcel no.: Other fuel appliances:
' .' i l . '''" - .....='.' ,- -: . `' , '=';;;-', - :5.:;7J. Water heater 23 32
A- ° -C� ^
Gas fireplace 3339
Flue vent for water heater or gas
fireplace 23,32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplaceinaert 23.32
? , : : . ._ _ _ . . . _ `y ', , ,:(17,E1 , Chimney/liner /flue/ven 23,32
Other; 23,32
Name: . a GA; 1 Environment_I exhaust and ventilation: —
Address: Range hood/other kitchen
equipment 33 39
City /State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: Sod) '' f _ dye( r Fax. ( ) toilet compartments, utility rooms) 23.32
. e -r t `, :.. ... J " ` . ' '' 1 . . , ' Attic/crawlspace fans 23.32
It ' Business name: Columbia Heating and Cooling, Inc. Other: 23.32
Fuel�iping:
Contact name: Marlene Meedom 514.15 for first four; 54.03 for each additional
• Address: PO Box 23039'7 Furnace, etc. _
Gas heat pump
City /State/ZIP: 97281 Wall/suspended/unit heater
Phone: (503) 624-2704 Fax; : (503) 598 -0270 Water heater
Fireplace
E -mail: columbht a@teleport,com Range
Business name: Columbia Heating and Cooling, Inc. Clothes dryer (gas)
es
Other: _
Address: PO Box 230397 i,,;� : 7 ,, ._ :.;-. i': «T 'Ti, ig �' :, • -
City /State/ZIP: Tigard, OR 97281 Subtotal
Phone: (503) 624 -2704 Fax: (503) 598 -0270 Minimum permit fee permit fee
• Plan review (25% of permit fee)
CCB tic.: 7639 State surcharge (12% of permit fee)
TOTAL PERMIT FEE IDD • Esv
Authorized signature: This permit application espir s if a permit is cot obtained within Igo
days after It has been accepted as complete.
P rint name: Marlene R Meedom Date: !� /J, • Fee methodology by Tri -Coumy Building Industry Service Board
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