Permit 4 .
CITY OF TIGARD MECHANICAL PERMIT
Ph
ss. CO DEVELOPMENT
Permit #: MEC2009 -00590
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2009
TIGARD. „r g Parcel: 2S114BA15500
• Jurisdiction: Tigard
Site address: 16095 SW COPPER CREEK DR .
Subdivision: Lot: 0
Project: Davis ,
Project Description: Replace furnace.
Owner: FEES
DAVIS, DOREEN Description Date Amount
16095 SW COOPER CREEK DR Furnaces < 100K BTU 11/04/2009 $46.75
TIGARD, OR 97224
12% State Surcharge - Mechanical 11/04/2009 $10.80
PHONE: 503 - 869 -8119 Minimum Fee Adjustment - Mechanical 11/04/2009 $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 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 952-001-0100. .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: PermitteeSignature: ei i°f G / J 770
CalI,503.639.4175 by 7:00 a.m. for an inspection that'business day.
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.
IVlechan cal Permit Appli�catioan ' ` , t�i Q �, � ∎ /�
Received /// D Pe- 4,40 /-1E 00 -V OS�O
I4 + nl T . City of Tigard • � }, �, I �Qp Received
4, "a 13125 SW l °tall E31yd. l'igard OR 91223 fYl. V 200 . Plan Review (hey Permit.
<1n r ° Phone 503,639.4111 !-ax: 503.596.1960 Gateltiy:
v EA R. ?nspectior i.tiic: S(13- 634.4175 ate y/By: Read tuns: Seepage 2 for. • 1
,TIGARD: �" otif ethod: , S pplemental 1 "f6rmatfon CITY �� TIGAR
�,.t�t ,.�� l,ternet' '.vww hard � r.o � UILDIN bIVISI
r TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST,
lvicchaineul permit fees* are based co the value of the wort:
❑ Nevi construction alt dditi on/al teration /replacement performed. Indicate the value (rounded to the nearest dollar) of ail
❑ O ther: mechanical materials. equipment, labor, overhead. and profit. J
E, Demolition S f
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* I
❑-t and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For specsl injcrtnation use ch ckli. +r. —
Mufti-family Master builder ❑ Other: D - escription 1 Qty. 1 fa. I total '
❑ f
JOB SITE INFORMATION AND LOCATION I
lnh'site address: j��'� /� Heating/cooling
Air conditioning 46.75
r ^ .�t^ - � �frE> =-- c 4 < (requires site plan.showin* p
a G �S
Furnace ;1Q0,40C�RTtJ f
C`tyiState ;71P: /( � Furnaee.l00,(3Q41 BTU (ducts/vents) ` -
Project name: of U•1 S Heat pump 61.06
Suite bldg. %apt. no.: _
23.32'
CrOSS SC ^eeL'direclivnS to job site: Duct work _ Hydronie hot water systems . 32
Residential boiler (radiator or 23 23 23.32 hydronic) .. --
Unit heaters- (fact- type, not electric), 4fi 7,
in- wall, in -duct. suspended, etc.
Flue/vent for any of above 23.32 —
Lot no.: Other: j 23.32
Subdivision:
Other fuel appliances
Tax map /parcel no.: Water heater 23.32
DESCRIPTION. OF WORK Gas fireplace 33 39
Flile vent for water heater or eas
(' /Z!� C Cff�`'n ` F - 0 v%.. fireplace 23.32
- Log lighter (gas) 23.32
Woodlpelletstove 33.39
Wood fireplacelinsert
1 7372
Chimney/liner/flue/vent
23.32.
TENANT' 1 23.32
ErfCLOPERTX OWNER Other:
Environmental exhaust and ventilation
Name: 00 Rr , , E tm n 6 Range hood/other lc . c .ui meat 33.39 ood!othcr kitchen.
I .'ldd i col,� ,5,5-,--,, �'C /PEE /Z C � LE { 31,39
Clothes,dr}•er exhaust. I
CityiSlatcl'lll?z 'Y / cj�1 - Single -duct exhaust (bathrooms, 13 �
V toilet.cor npar tments,utility rooms
I -r_ (co)) 51e ; - . >�s� 2 3.3
Phone.- t',5 ,)- er9, " 1 f 'A } Ytticiciawls.ace_ fans
f [] APPLICANT ❑CONTACT PERSON Other: 23.32
Business name:— - Fuer piping
P_ '(i6J) S14.15 for first four; $4,03 f or each addition I
Coni@et name: t' /� ) m CI! ! 1 - Furnace. etc. -
�cdress; Gas heat pump —___
Wall/suspended/unit heater City/State/ZIP: 7 a // ,r., W'aterheater
Fhnne :43) 7 "o{�1t Fax : : �� � - LJ7� Fireplace
Range
Fl Barbecue
CONTRACTOR
Clothes d et i as)
11.'L. slices name° 0 - . Li ,e . 1 In 1 I � a. Y Other
� p MECHANICAL FERMTT FEES*
Address: �� ! 7 Subtotal
` �-7 t
- City /State /Z.1 j � 0 :1 /s Min imum p c me (5 90,40 ) / r �' �-
r ax: 8 •-'0 � —_ Pl r ____ (25 %Of Full fee)
1 ?hone: 63) i � 8 � F
-
permit fee) } �Q
surcharge (1 p�r fJ�tJ..i
r� _.—. -- TO'f,AL I'FR FEE _SSE i 1.---
CCB tic.: -- State surc
I t._
Thia permit application etptres if permit is not "obtained w ithin iP
days after it has beer accepted us complete.
n
,Authorized signature: ` � .../ 2 1 , 40110A I Seiler R' /L1C�
• Fee :ntztltodclogy set by Tri County B uildinc Industry
• 9 ' ° t g ris Datc: '
Print name: '
- - 440-.7617T (11 /O CO4I,WEB)
u,., i.,in Parmits'. ?TLC- Pcrnit ,lp p.det 1o
Z OLZ0-865`£05 6 ullopo / eNt.unloo d9Z 20 60 ZO ^oN •