Permit CITY OF TIGARD MECHANICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: MEC2012 -00665
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2012
Parcel: 25111 DB08500
Jurisdiction: Tigard
Site address: 15390 SW OAKTREE LN
Project: Davis Subdivision: SUMMERFIELD NO.10 Lot: 546
Project Description: Replace furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: DAVIS FAMILY TRUST
PO BOX 230397 BY DAVIS, BEVERLY J TR
TIGARD, OR 97281 15390 SW OAKTREE LN
TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 689 - 1272
FAX: 503 - 598 - 0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/17/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/17/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/17/2012 $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: D n / - /97 e-- O rV
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.
12/14/2012 08:50AM 5035980270 I COLUMBIA HEATING PAGE 02/02
RBC 1VED �]��
DEC 17 20i? •
Mechanical Permit Application Gm0F GAR roi, (nisi. l Si: O.l.t
City of Tigard BUH.DING IVISIQ1 "" 4 / /-z-, 1► ' PmnitNofEC 0/ /106
e " 13125 SW Nall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DatelBy: Olhatitilmic
f I i; A td l q Inspection Line: 503.639.4175 Date ReadyIByi Mr / R/ See Patel f.
Internet: www.tigard- or,gov Naified/Metbp(1: Tiv SuopkmentalI ormatIon
h . „•..,:; t' '"'1 $, t,. -.: ` ? ''M t,:'Tv ci . .'. l T r �s
f"_rj .i;,,, . , .A,x•i...'i tY.A. t 1 I ',�..taw'..�, �:'r 4-a :..,�•, o a.'v .c f�., �. '.. '
❑New construction ditionlalteration latxmcnE Mechanical permit fees' are based on the value of t, wort;
� { P performed. indicate the value (rounded to the n ».. ' dollar) of all
Q Demolition ❑ Other: : •'r1»k II mechanical materials. equipment, labor, overhead, • profit
y1746 i`f 11k ..4ds l i u edi? .'.'�S uta ` f.t 11wrra , A. � ''��"`�
and 2 dwelling I ^ Ark :fie ` Y. .
Y g ❑ Commercial /industri:I 0 Accm5Oty building For special G(fwwrtallon use diavtlist
0 Multi - family ❑ Master builder 1� 0 Otter_ Description � Qty. I Ea. } Total
:t, ' .:Vgi.- , 'L' ri �5.+FU3a11 itll i+"'o: 4,�'- ^.,.^m a +iw «:: Iica cooling:
e' s =��'�� �`�.: �'•••. Air conditioning
.lob site addreast /v v 3 J OA Kr * (requires site plats ahowt placement) 46 75
City/state 2IP: i Age) 0 i 9 rt t:W
Furnace 100,000 BTU (duvental 46 75
Furnace 100,000+ BTU (ducts/vents) 54 91
Sukedbidg./apt no Project name: 'Au is Heat pump
(requires site plan showing placement) 61 06
Cross welt/directions to job site: Duct work 23 32 • A _
1 14ydronic hot water system 23 32
1 Residential boiler (radiator or
hydtonic) 2332 _
1 Unit heaters (fuel -type, not electric).
in -wall, in -duct_ suspended etc. _ 46 75
Subdivision: _ I I Lot no.: Flue/vent fir any of above 23 32
. Other 23 32
Tax atop /parcel no.' Other fuel appliances:
en. ,e + r TZ ?.:,1,. '.'.' r. •.YSt. Water h 2332
FU RCS Gas fireplace 33 39
fireplace e vent (a water Mater a gas
firepp lace 23 32
Log lighter (gas)
23
Wood/pellet stove 33,39
I 1 Wood fireplace/inaert 2332
?? 1 i ,.. >atpn ) 11 - ti 1-:v, t . Chimney/liner /flue/vent 23 32
Name: IQ tS 5'(' L 7
, ' Cif O the r : 2332
C! Environmental exhaust and veaeilation:
Address: Range hood /other kitchen
equipment 3339
City /State/21P: Clothes dryer exhaust 3339
Phone; 1f.. 112 ,r Single -duct exhaust (bathrooms.
F ax: ( ) toilet compartmcnts utility rooms) 2332
tip . aF =,."�. tc 1p�
:..' ."..' . "..' , ..A . �r a f t r, �, - • '+"�'°'k9 a J ' t i ++S r •`e `` . Attic/craw Y fans 23.32
Ruainese name: Colombia Heating and Cooling. Inc. ()thy 2332
Fact piping: I _
Contact name: Marlene Meedom 1 S14.15 for Rrst tOu7 sa.a3 for earn additional
Address: PO Box 230397 Furnace. etc. 1 l I ..
Gas heat pump
City /State /ZJP: 97281 WaJI/suspended /unit heater
Phone: (563) 6242704 Fax : (503) 598 -0270 Water heater
E-mail: columbhc ®teleport.com
Fireplace
Range
Husincss name; Columbia Heating and Cooling. Inc. Clothes dryer(kes)
Address: P(1 ilex 230397 fir' yyM 117
City /Stnie/2lP• Tigard, Olaf 072si Sabretal
'hone: (503) 624 -2704 Fax: (503, 598 - 0270 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lie.: 76359 State s (12% of permit fee)
1 '
TOTAL PERMIT FEE /4/9 .4) v
Authorized signature: 1 ` / , a _ . .4 a „ ii This permit applteetiok expires Ir• permit is not obta..wd within l
-� days atter It has been accepted as campfire .
Print name: Marietta R Meedom Date. Aini2M11 j • Fee rctllsdalue ad by Tri•Counry Building Industry Service l3oafd
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