Permit CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: MEC2014-00090
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/27/2014
Parcel: 1 S 136AD01300
Jurisdiction: Tigard
Site address: 10470 SW 69TH AVE
Project: MONROE Subdivision: VILLA RIDGE Lot: 1
Project Description: Hood vent installation.
Contractor: COLUMBIA HEATING&COOLING INC Owner: MONROE, ROSS&
PO BOX 230397 MONTERRUBIO, ROSA
TIGARD, OR 97281 10470 SW 69TH AVE
TIGARD,OR 97223
PHONE: 503-624-2704 PHONE:
FAX: 503-598-0270
_ FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 02/27/2014 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 02/27/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 02/27/2014 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-00 0090. You ma •. .in a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
..kAAIssued By: � •ermi ee Signature: f
L i
Call 503.639.4175 by 7:00 a.m.for the next available in •_. ion date.
This permit card shall be kept in a conspicuous place on the job site until completion o the project.
Approved plans are required on the job site at the time of each inspection.
r
Mechanical Permit Application FOR OFFICE USE ONLY
eceived
71 City of Tigard r�/a�/� Permit No.:
telly: !� �y 7 p
— • 13125 SW Hall Blvd.,Tigard,OR 97223 t `3T f' )��"°`t-'1 Li c j 0
Phone: 503.718.2439 Fax: 503.598.1960 °' eyv. Other Permit: AeC-
Ins
Inspection Line: 503.639.4175 JTr�B ����
1 1 A R l) p Date Ready/By: Juris: RI See Page 2 for
Internet: www.ti and-or. ov 14
g g ce,t,
�� Notified/Method: Supplemental Information
GcP, tit e. _
TYPE OF WORK "� ',` r �,.` COMMERCIAL FEE* SCHEDULE — USE CHECKLIST t' c. Mechanical permit fees*are based on the value of the work
❑New construction X Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
el-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION:AND LOCATION Heating/cooling:� � 1 Air conditioning 46.75
Job site address: I 0,4 ! S W lJt l AA&
Fumace 100,000 BTU(ducts vents) 46.75
City/State/ZIP: I k relf4 Furnace 100,000+BTU(ducts/vents) 54.91
t Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
1 p ilk V i l t `.,n O 7 _ VPV Flue vent for water heater or gas
l/N l+D-rtl/wv/ll5/A//�I17 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ItOther: 23.32
PROPERTY OWNER I ❑ TENANT
p Environmental exhaust and ventilation:
Name: < Vj�� j ) -b, J Range hood/other kitchen 2
Address: t O 10 5 ` & J ,.p _ equipment 33.39 �j '/�
5 VC �{l/�/ Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
( ���� toilet compartments,utility rooms) 23.32
Phone: -+ Fax:( ) Attic/crawlspace fans 23.32
112 APPLICANT CONTACT PERSON Other: 23.32
Business name: 1/e f ] )f- �, 0� 1 t
Fuel piping:
1 �yJ $14.15 for first four;$4.03 for each additional
Contact name: r■ Q u Furnace,etc.
Address: • 4
Sven / Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: ' � 7 Water heater
Phone:( ) .l�� ,. 5�Z&�]i, ax: :( ) Fireplace
444"'
° Range
E-mail: IA). 1 vt, � (7 Z V C Y l/ t 7 0 i . C( Barbecue
ue
CONTRACTOR
Clothes dryer(gas)
glum h Other:
Business name: f - ,e , _ �_ J � MECHANICAL PERMIT FEES*
Address: FO B�� Z -3' -7 Subtotal 13.31
City/State/ZIP: -fl r r Q 9-7 2_6/ Minimum permit fee($90.00) `7hU'�
/^ Plan review(25%of permit fee) cl
Phone:( �Y D L Fax:( ) State surcharge(12%of permit fee) �, d v
CCB lie.: TOTAL,PERMIT FEE /06 A-6
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: / + * Fee methodology set by Tri-County Building Industry Service Board
Print name: f 1/4.4� tAlt rw Date: Z� I if
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