Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 00508
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 10/08/2012
Parcel: 2S114BB16500
Jurisdiction: Tigard
Site address: 16270 SW 103RD AVE
Project: Snyder Subdivision: RIVERVIEW ESTATES Lot: 11
Project Description: (1) furnace replacement
Contractor: COLUMBIA HEATING & COOLING INC Owner: SNYDER, GREGG L & MOLLY S
PO BOX 230397 16270 SW 103RD AVE
TIGARD, OR 97281 TIGARD, OR 97224
PHONE 503 - 624 -2704 PHONE. 503 - 620 -1539
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 $100 80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to , O � OUNC by calling 503.232 1987 or 1 800 332 2344. r r
Issued By: ,SSYY/I O . 1 6 Permittee Signature: O� .;� AMOC / 1 DLL
�� Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
16/65/2612 16:22AM 5635986270 COLUMBIA HEATING PAGE 62/62
Mechanical Permit A licati
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City of Blvd Tigard ' ,F
Han „ Tigard, OR 97223
Da te (D/9' /} sr Permit No. •Go AeAD , .: • a 13125 SW Phone; 503.718.2439 Fax: 503.5 Plan iew --
98,1960 p 2012 ��.
I I r: A u I> inspection Line: 503.639.4175 8 Date /By: Other Permit.
t: www.ligard- or.gov ^` /� Date R /B
�JTMn[ 1yn a r,� Notified/Method, d/Method, J°ni S Sae Pen Information
Internet
. yr I U T149 Supplemanm} (nformytion
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❑ New construction d . - - teration/replacement Mechanical Permit few are based on the value of the work
❑ Demolition ❑ Other
perforated. Indicate the value (rounded to the nearest dollar) of:
mechanical materials, equipment, labor, overhead, and
profit
:.:§ s ...,I t i i } l + Value:$
e.
Et 2 dwelling [) COmmercialAndustrial [] Accessory building " z, �' ,;� "���" :`ire �'` V. c.A �, r
❑ Mufti - family Master builder For Spedallnform�losrusedreekl(ss
3Ta a+ , 0 Other: Description
Vim s , . I r . Qty. Total
•
ti? + i. -v. .. 1 ` . , ?-._`,7'','.:.'t..:'.. i ' P , ;a Head ' Cn011n:'
Job site address: 0 .� /0J L Air conditioning
0 v (iequ�res 9ite�l showing placement) 46,75
City/State/ZIP: �, Furnace 100,000 BTU(ducts/vent
46.75
Suitelbldgiapt. no.: '{ Furnace 100.000+ BTU (duetyvents) 54.91
Project name: lii',e _ Heat pump
Cross street/directions to job site: requires site plan shpwmgplacelnent) 61.06
Duct work 23.32 • .
Hydronic hotter system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall in -duct sus. - • ed etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above
Tax map /parcel no.: Other: 23.32
`a� {x� S ^ Other fuel appliances:
v) .a..r.r. . r 1 ' y , c ; n '''' r i " �' ; i � i ' : - -, Pl aaCeb:
P
,', Water heat
,, 23,32 _
Gas fireplace 33.39
,,,,'r Faue vent for water heater or gas
fi . lac e 23,32
Loo lighter (Igas) 23 32
wood/. liar stove 33.39
147,1 �71,', Wood a /liner/flue/vent ace/i a /v e
23.32
� ..r � r � , e, , �i s ; � i �' � "'y Chlmne fltner /�lne/Venl 23.32
Name: ` y r D Other. _ 23.32
V Environmental exhaust and ventilation:
Address: Range hood/other kitchen
•
City / State/ZIP: ui. mem 33,39
• Clothes dryer exhaust 33.39
Phone; tt'aI) 00 Ai ' Fax ( ) Single-duet exhaust (bathrooms,
• toilet tom . torments, utili rooms 23.32
��i� r r r � - , . - 7 I .,r I 1
' ' . !'r '-'I Attic/crawlspace fans 23.32 •
Business name: Columbia Heating and Cooling, Inc. 23.32
Fuel piping:
Contact name: Marlene Meedom
514.15 for first four $4.03 for each additional
Address: PO Box 230397 Furnace etc. —.
City / State/ZIP: 97281 Gas heat pump
Wall/suspended/unit heater
• Phone: (503) 624 - 2704 Fax: : (503) 598 -0270 Water heater
E -mail: eolumbhe@telepotteom Fir lace
Ranee
�4 ,. �:;.�: � . :� � - I ' Barbecue
Business name: Columbia Heating and Cooling, foe Clothes
Address: PO Box 230397 Other drYe jam) .
r. e -,n �. ,. .:Y r -u.
City /State/ZIP: Tigard, OR 97281 .... ° : :,' +` -,t, ''. a ! ;
—
Subtotal
Phone: (503) 624 - 2704 Fax: (503) 598 -0270 Minimum permit fee ($90.00)
Plan review (25eloof permit fee)
State surcharge (12% of permit fee)
I
TOTAL PERMIT FEE , / • , i
• Authorized signature: 1 1` f 1 J _, _0 This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
•
Print name: Martens R Meedom Date: / - / / • Fee methodology set by Tri -Count Building Ind
• t•VauildinalPontriutA�c•Y r y r g u Y Service Board
anaiUpp.doC 09/09/10
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