Permit •
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CITY OF TIGARD MECHANICAL PERMIT
l a • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00587
' T l GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012
Parcel: 2S 112 BC07500
Jurisdiction: Tigard
Site address: 14652 SW 83RD CT
Project: Jacobson Subdivision:GETTY'S EMERALD ACRES ESTATES Lot: 8
Project Description: (1) furnace replacement
Contractor: • COLUMBIA HEATING & COOLING INC Owner: JACOBSON, LAURA S
• PO BOX,230397 14652 SW 83RD CT
TIGARD, OR 97281 TIGARD, OR 97224
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PHONE: 503- 624 -2704 PHONE: 503- 730 -6658
, FAX: 503 - 598 -0270
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FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/13/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/13/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/13/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
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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 ling 503.232.1987 or 1.800.332.2344. /�
Issued By: /1 �/ / I l5 wi / /. ,1 Permittee Signature: � ,'PPt/C47D& w
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.
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11/12/2012 09:25AM 5035980270 COLUMBIA HEATING PAGE 02/02
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Mechanical Permit AppliLf 1_ -Il Eiv ® l (il: O1 1.l 1. I .'. ,l' : rl\i.ti
City of Tigard Received
1 t (3 �� t7'
Remit No. ee (/I a. -00. 7
13125 Sw Ha11 Blvd., Tigard, OR 0260 V 1 3 2012 „
Phone: 503.718 2439 Fax: 503.593 1960 Other !ad mit
i' I l; ,\ tc I J Inspection
nt ctio Line: 503.639,4175 CITY OF 9,4175 TI/ '3 ta
Date ReadylBy: u: El See Page 2 for
tap River 1 � V �' l � S � , Notified/Method: /7 4p Supplemental 114011101071
"L� ;.�: -. :,- ^'.: .',•'. ;aa c ,•r s ?ns;;, , :wI'- :.,. .' s 7- d ' c :✓_`��s, .. 7-5R2 ? -00, . •
, n �.'t• .. - • r Paa
Mechanical permit fees* are based on the value of the wort;
❑ New construction [.} 1tdcTiiitNl /alteration/replacement perforated. Indicate the value (rounded to the nemeat dollar) of all
❑ Demolition [] Other: mechanical materials, equipmrnt, labor, overhead, and profit.
'a` -'• t x" ,': = � .': Y. ' : �jr a Value: $
d. .,•: •:•li,-.
"` ~� `d ti7r a ) F -,5∎- A l a . 5.' t.liM _ _ a= W �
U. _ .., a 7'K. ^ �'�_:� ,�i lLR". �tP �: l.`.r.Ca�;: iii Z: ]41E.1 r 'a ::
®•fra1Ilf£- family dwelling q Commercial/industrial ❑ Accessory building For 'pedal Infonmmten We
❑ Multi- family ❑ Meter builder 0 Other: Description I Qty. I Ea ( Total
rile p
i3•.'.i..' t . a' - r.PlA:"'.` t ..., i 3 7 ;:a7.57T7 •y usatinr1cWillig:
.. :,. ,::
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Job site address: (.pains hut showing oraee nernl 46.75
r^ �� � I T - Furnace 100,000 BTU(daras/venls) 46.75
City/State/ZIP: 77 �7 /7� �� � y Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt.... [ Project nam �j9 CCiece0 Ai Heal pump
(requires site plan ahowingplaaoravne) 61.06
Cross street/directions to job site: I Duct work 23.32 • A.
Hfdronio hot vratcr system 23,32
• Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type, not electric),
ih•wall. in -duct, suspended, etc. 46.75
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Subdivision; I Lot no.: Flue/vent for any of above 23.32
Other. F 23.32 I
Tax mop/parcel no.: Other fuel appliances: _
y ";;r ;<'':_ i ;. ,_ t ; ..,... .... I1;Y .v . : . �,M... :1 Water heater 2332
rte. -- ::x.i::._ �a�:. -_:tV .:�nat,;;.::�� :�.r.::.i!.^,q: '� 'Y�Y
�Z,/ MC_Cl- /26 �l
f7'-. Gas fireplace 33.39
_ � U C �� Floe vent for water heater or gag
I fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
• Wood fireplace/insert • 2332
- '''''.0441) •'"'17177-g7.:r: Cfi �,.:� ` =-G a' tea^ - i,:1'1- 2'I Chimney/liner /flue/vent 2332
a r7 f 4 t 71 c'. s ' ,, ' . ,. Y 11.• Other: 23.32
Name: ' 1,,e,„ Oe7t I Environmental exbaustand ventilation:
Address: I Range hood/other kitchen
! equipment 33.39
City /State/ZIP: I Clothes drer e, h mtst 33.39
Sin gle -duc a thaw:1(bathmnms,
Phone 3) J 0 - t�6oZ Fax: ( ) I toilet compartments, utility rooms) 23.32
•u s e , uz � .�, c ,,��
4 J .t? F ;rr.i' . •e c'.de ikA i' " ; ;: it • ;.•. , ,fie ,...
,i .r,.>sl, : z. = � 1` n _,- --,: r�C,9 e At1itlerawisptteefens 23.32
Business name: Columbia Neslf:ng nod C.nndng, loc. I Other. 23.32
Fuel piping:
Contact name: Mariam Meedom I 514.15 for first four, 54.03 for each additional
Adch cvt: PO Box 230397 I Furnace, et J I •
• Gas heat pump
Cityl$tate/ZIP: 97251
Wall/suspended/unit heater
Phone: (503) 624.2704 [Fax:: (503) S9e -0210 water heater
E -mail: columbhc@beleporl.com 1 Esc Fireplace
f,: ?r ?_'JeV1:o44Tiis ` .. :_ ? rr " • i .'riio . t'E4 Barbecue
liminess name: Columbia Heating atl0 Coating, Inc. I . Clothes dryer (gas)
nddreaa: PO nos 230397 01hu:
. .- 73,,, • .artaeii
City /Stoic/ZIP: Tigard, OR 97281 I Subtotal
Phone: (503) 624-2704 Fax: (603) 598 -0270 Minimum permit fee ($90.00)
I Plan review (25% of permit fee)
CCB 1k.: 76359 State surcharge (12% of permit fee)
TOTAL PERMIT FEE /0O. BD
Authorized signature: Atai This permit Application expires If a permit b not obtained whet, 180
days after It Iah been accepred ra complete.
Print name: Marlene R Meador Date:1 • Fee meuliodoiogy set by Tri•Comny Building Industry Service Board
, ..... ,,, .. ..e..- .........r.P....w......A..- no-,vnn 44hK777 (I IKMINIMIWF.11l