Permit •
' CITY OF TIGARD MECHANICAL PERMIT
ASS 44_ " ti
y
COMMU,NITY DEVELOPMENT Permit #: MEC2009 -00588
'� ' RWr 13125 SW Hall Blvd., Tigard OR 97223 503.639.41.71 Date Issued: 11/03/2009
4 0,1 irAR.D 9 Parcel: 2S101DB00710
Jurisdiction: Tigard
Site address: 13235 SW 72ND AVE
Subdivision: ROLLING HILLS Lot: 30
Project: Amundson
Project Description; Change out gas furnace
Owner: FEES
AMUNDSON, KRISTOPHER S Description Date. Amount
13235 SW 72ND AVE Furnaces < 100K BTU 11/03/2009 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 11/03/2009 $10.80
PHONE: 503- 970 -5985 Minimum Fee Adjustment- Mechanical 11/03/2009 $43.25
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97223
PHONE: 503 -624 -2704
FAX: 503- 598 -0270
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes all other
applicable law. All workwill be.done.in accordance with approved plans. This permit will expire if work is not started within 180,days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon' law requires you to follow the rules adopted by' the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. ;-
Issued By: , / iib> a ¢ Permittee Signature: 5),(___ /gy G _ a ea Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. Nov 02 Q,9 03:49p Columbia Heating /Cooling 503- 598 -0270 p.2
Inif: i 1'acation 'Ra�' r�� " ;S:;s w; �ri�rt r1(rrr'i' l:ii\i m .m,Y xi3 } ; i L
. echanical Per pp � �. , p 14
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Datet4:
'. 13125 SW Hall Blvd., Tigard, OR 97223 --
NOV 0 2 I Ian Review
w . , Phone: 503 .639:4171 Fm; 503 IV V Z009 D$te•'BV; Other Permit:
0", -. inspection 1 me' 5 03.639.4175
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� Notinod/1+1ethod „ Sdp p lemental Inform : atio n
TYPE OF '4'1 O M iI , i"DING DIVISION _ _ i
j COMMERCL FEE ED
SCHEDULE - USE C HECKLI ST ,
Mechanical permit fees" arc based nn the value of the work
[] New construction [ J Cdditionlaltcration /replacement pertorm«i. Indicate the value (rounded to the nearest dollar") of nll
0 Demolition [] Other: mechanical materials- equlen>ent. labor. overhead, and profit.
T CATEGORY OF CONSTRUCTION Value: S
9 - — RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building h'nrrpecta/infrrrmatirrr, use checklist
❑ Multi - fancily ❑ Master builder ❑ Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Al conditionin
oh site address: , 32....35 ) Z (re site plan showing placement) 16:75;
City' /State/ZIP: — �Tj 9 `. o,2_ Z� 2-Z 3 Furnace 100,000 !3TU tducrslvcros) 4fi 75.
Furnace 100,000+ [3'1 U tducts/vcnts) 54.91
Suite /bldg. /apt. no.: , Project name: Heat pump 61.06
Cross street/ directions to job site: Duct work 23.32
H!,dronic hot water system 23.32
Residential boiler (radiator of
hyironic) 23.32
Unit healers (fuel -type, not electric),
in -wall, in -duct, suspended, etc, 46.75
Flue /vent for any of above 23.32
Subdivision' Lot no.:
Other: 23.3 I
• Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
' (as fircp[ace 33.39 , ,
L.,/ AG .. ; Flue vent for water heater or eas
- i fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.30
Wood Fireplace/insert 23.32
Chimney /liner /flueivent 23.32
1] PROPERTY OWNER ❑ TENANT Other: 23.32
Vance: Ki"' S 1 /IA did N Environmental exhaust and ventilation
Range hnod/othcr kitchen
Address: I 3 2 _ 1 s - - . 5 --7Z /7 d - - equipment 33.39 j
City' /Slate.JZI F: r 4_/ o'— 5722_,) Clothes duct exhaust 3±39
S in g le -duct exhaust (bathrooms,
Phone Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans ; 23.32
Other: i 23.32
Rusi :ress name: Fuel n r r
PP�fi
Comae l an e: _ Ai A I®' - COI 514.15 for first four: F4.03 for cach :add Worm I
Furnace, etc. _
address:
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
r 1 / a - bn�.7C� Water heater
Phone:
4.�?3 7'7`F Fax:: �/
�7 Fireplace
E-mail Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Rosiness name: f A. I A. it t t r t r! ► i ma *I� � Other:
Address: ,. k � .9 7 M PERMIT' FEES'
Cliy /StatcrZIP• I' J 0 !c D 1
Subtotal
I ' J� r � .( �� } M inimum peirrtit fee (590.00)
P net ) I p a 9 Q - 7 ( J I F a x : 5 B ` O Plan review (25°ra of permit fe )
COB lie.: 76) 9 �- a/ State surcharge (12% of permit fee)
1 . TOTAL PERMIT FEE (a-
/ r lig t' 8 ,-).1 b
This permit application expires if a permit is not obtained within 90
Authorized Sl�tatur JAL- ,fl.,lf days after it has been accepted as complete. nrinLnai`1C / �(�, � � D ale: - /� V 5 R Pee medics:Wo v set by 'in-County Ruddily, I ndustry Service Board
• I;061c ins'.Pennm its..MEC -parm t App.doc 10 440.46[ ?T ( 11l02:CCM,A'EB)