Permit CITY OF TIGARD MECHANICAL PERMIT
11/1 L COMMUNITY DEVELOPMENT Permit #: MEC2012 -00543
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
Parcel: 2S 103BA00124
Jurisdiction: Tigard
Site address: 12080 SW 116TH AVE
Project: Gates Subdivision: LERON HEIGHTS NO.2 Lot: 38
Project Description: Replace furnace
Contractor: COLUMBIA HEATING & COOLING INC Owner: GATES, ADAIR
PO BOX 230397 12080 SW 116TH AVE
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 590 -3699
FAX: 503 - 598 - 0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/22/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/22/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/22/2012 $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 Notif - •• - -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direc • uestions to Ob C b - • g 503.232.1987 or 1.800.332.2344.
Issue. :y: /
Permittee Signatur _A 4 0.0.4.A._ 4
•
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.
10/19/2012 09: 54AM 5035980270 COLUMBIA HEATING PAGE 02/02
RECEIVED.
Mechanical Permit,ApplicatiZT . 2 2 2012 1 ul vit t-. t , ,I..(r.d.)
City of Tigard TY OF TIGARD Received
DM ; : o ggi Pecmit l'In rite,laa-oo 3
13125 SW Hall Blvd., Tigard, OR , 7. ANC
111
' 11! Plan Review
RIM 503.5.
: 503.718.2439 Fax 'DING DIVISION Date/By:
Other Permit
A ic I) Inspection Linc: 503.639.4175
Due Readvffly: Uric Er See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental laformstIon
Mechanical permit fees* arc based on the value of the work
0 New constrUetion alerditionfalteration/replacement performed. Indicate die value (rounded to the neatest dollar) of all
0 Demolition 0 Other: mechanical materials, abor ovcth, and prurt,
Value: $
- : < '-!; 1 1 : - : i. : . '"Wri TaM ,RWS,Tr .• ' -,: 70 . :41 1 ,44-.1 .0.- 7;,..7.,,. / r, '},., -
_.......a.. fiL . . ..1,-,... .. .. 6. • .: ..,„5 . • :,' .,,,.... !;,.',.: ''::
'al- and 2-family dwelling 0 Commercial/industrial 0 Accessory building Far special Nfonnallon use cbealin
El Multi-family 0 Master builder 0 Other . Description ( Qty. 1 Ea. I Total
.. . , . _ , • '4:i• •■-•, - .. ' j ' ' ' '''''' ' - '" 6 : .:4: " -. Air conditioning
Job site address: 40 59 ccC4) r A (/ 6 or,. site pin showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) , X 46.75
City/State/ZIP: i 6 A d 9'7- c( Furnace 100.000+13T1.1(dueuivento 5 4.91
Suite/bldg./apt. no.: Project name 6 Heat pump
(rapines sire plan 'hawing placement) 61.06
Cross street/directions to job site: Duct week 23.32 • A
Ilydronie hot water systent 7332
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type. not electric).
in-wall, in-duct, suspended, etc. 46.75
Subdivision: 1Lot n o . : Flue/vent for any of above 23.32
- Other. 2332
Tax mop/pared l no.:
Other fuel C0`.. gees:
1` -.-- ''' -'-' '•:'''',' .1 *r. t ; ..'w;PW■C'. 'L''''' - r • . . - V, -
Y.'' .,-,'. , . - , :-,,..1.:8 .,.Aang:i: :..,111,4L ',c,kg;,), War honey 2332
Gas fireplace
Al A Ck le-C1 Co4-C 33.39 6 Theta 7 Flue vent for water heater or gas
fireplace 23.32
Log 1iiVer (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
• Chi gin iiincr uaivent
.. ' , .:''''''. IFT•eri 7 ' 23.32
Name: h0A ti_ (54-r- es
- Environmental cabalist and mina Ion:
Addren: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Slagle-duet exhaust (bathrooms,
Phone: . 0 ) 570 .7C'7 9 VA 0 ) - - 5 - toilet compartments, utility rooms) 23.32
..
. . •:••••••';' 77' Nic. . , ' 7.31' 7, ... Aftie/erawispace Pans 23.32
. , . - :. " • :'•.:- - • -- '..... .., . ex.. V .. '' ,-. ' • • • ' " .:..--W —
23.32
Business name: Colombia Heating and Cooling. Inc. Other
Fuel Mollify
Cnntact name: Marlene Meedom sto.ts tur first (Our; 54.03 ilir wad, additional
-
Address! PO Box 230397 Furnace, etc.
— Gas heat pump
City/Stale/ZIP: 97281
Wall/suspenderilunit heater
— -
Phone: (503) 624-2704 I Farr : (503) 598 Water heater .,
, Fireplace
E-mail: columbhe@teleporLeom
fta_en
."::' -,14" ' ,„p,...' .. Barbecue
• 1 ' w.,:. • ' ..L".: ..--s '..4bi r!'
business name: Columbia Heating and Coaling, loc. Clothes dryer (gin)
• Other.
Address: PO lio —
x 230397 , 1■ ( 4 . 1 1 1 $ .1ti7 . -'Or0 7 41K telfrA.V
City/State/ZIP: Tigard. Oft 97201 Subtotal
Minimum permit fee ($90.00) C/19 .r
Phone: (503) 624-2704 I Fax: (503) 598-0270
Plan review (25% of permit fee) .---
CCI3 lie.: 76359 State surcharge (12% of pennit tee)
TOTAL PERMIT FEE c iao. 1(
This psralit application expires ir a trench it not obtained within 1
Authorized signature:
Jaya after it has Imo ItccePird 83 comPlete•
Print name: Marlena R Meedorn J Date: 0 /9 --og ij • Fee methodology set by Tri-Couniy Building Indusiry semi= Roam
..1.1.,...aurmiAvara-.P.M a no AA. 110411Ar IA AalLatt rrr ri ymnrowwwi