Permit :ii 7,0 CITY OF TIGARD MECHANICAL PERMIT
` li COMMUNITY DEVELOPMENT Permit #: MEC2010 -00333
I d Ak D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2010
Parcel: 2S111 CA04500
Jurisdiction: Tigard
Site address: 9680 SW LAKESIDE DR
Subdivision: Lot: 0
Project: Sheldon
Project Description: Change -out gas furnace.
Owner: FEES
SHELDON, DOUG Description Date Amount
9680 SW LAKESIDE DR
TIGARD, OR 97224 Furnaces < 100K BTU 07/14/2010 $46.75
12% State Surcharge - Mechanical 07/14/2010 $10.80
PHONE: 503 - 620 -6054 Minimum Fee Adjustment - Mechanical 07/14/2010 $43.25
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97281
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: Natural Gas
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 • cation a ter, Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di ct questions to OUNC • • 'ng 03.246.6699 or 1.800.332.2344.
Iss d By: j / I7 Permittee Signat .
Call 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.
Jul 13 10 04:58p Columbia Heating /Cooling 503- 598 -0270 p.2
'
Mechanical Permit Applicatioli4ECEIVED ..t►it U •I I(l: 1 sr. ()NIA
City f Tigard ROB Pe [m itNo.
t3 JUL n Date/By: 7 � 3 to WE e ,g0 -co 5
13125 S W Hall Blvd., Tigard, OR 97223 J U t- 1 3 (� t U pl Roview
Phone; 503,639.4171 Fax 503.596.1960 Date/By: Other Permit:
I lki A tu.
Inspection Line: 503.639.4175 CITY OF TIGARD l �y/Br r S ee Page 1 fu
Internet: www.tigard- °t.gov NptiticdJMethod: J. Suppkmeotal tnfurm
BUILDING DIVI / r I
• ti , ti °.4}', .•TYPE, OF ;WQII , . ;. i. r %.,01 ; .,.�•' r, vLE - USE CHECKLIST
E New construction Ad Mechanical permit fees are based on the value of the work
performed, Indicate the value (rounded to the nearest doll ul• all 1
Demolition ❑ Other: mechanical materials, equipment, Tabor, overhead and prota.
CATI?GPRY O _ value: S
'i - and 2- (nuttily dwelling ` RESWEN IALEQUW MENr YSTEMS FEES*
g ❑ Commercial /industrial ❑ Accessory building
For special infcrmaaon use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty I Ea. I "i'ctal
JOB • SITE INFORMATION ;. AND' LOCATION ' .i ` ', '' ' :t Heating/cooling
• I ' Air conditioning j _ „...
Job sae address: I W 1 r `_ & AP ' . (requires site plan showing pia I , , 45.75
tL Furnace 100,000 BTU (ductsivenus) I 46. i5 1
`� 1 I
Furnace 100,000+ BTU (dutxs/vents) • 54.91
Suite/bldg. /apt. no.: t Project name: Heat pump 61 06
Cross street/directions to job site: Ductwork i f 23.3= ,
Hydronic hot water system ' 23.32
r 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
St:bdivision: 1 Lot no.:
Other: 23 -32
Tax map /parcel no : . Other fuel appliances
DESCRIPTION'O ,. `' , :x2';+ Water heater 23 32
Gas fireplace 33 39
j .111 ,r ,,_, • A _.„ , _ Flue vent for water heater or gas ,
fireplace 23.32
Log lighter (gas) 1 . 23.32 '
Wood/pellet stove 33.39
Wood fireplace/Moen 23.32
ri)s( i Chimney/liner/flue/vent 23 32
PROPERTY w. : , r; . 1'. :'n:, �7..TE1!IANT• ..... .
Other f 23 32
f 44,1 Nrme: ' � / Environmental exhaust and ventilation t � l ” Y+ Range hoodfothcr kitchen
.4ddress •
- -••� t +.1�,�yi / � (Tj i c ui rtcnt : 33.39
City /State/ZIP: l • A . . alma
Clothes dryer exhaust 33.39
�, 1 Single -duct exhaust (bathrooms, •
?hone « i Fax: ( ) toilet compartments, utility rooms) 23.32
APPLI ':f.::i ;':„ to l41 m 1! N r :i:X.1 , 1 Attic/crawlspace fans 23.32
Other. 23.32
Business name:
Fuel piping
Contact name: /)' - f27 e p T J 6 rn $14.15 for first four; 54.03 for each additional
Addre : ' , ` Furnace, ate. _ _
Gas heat ptunp
City /State/ZIP: WalUsuspended/unit heater
' Phone: 6-23) l 111.,, 7QL. Fax: : 6D 3 5 r S .Oa.70 Water heater
T , Fireplace
E-mail: Range I
. CONrRAc7`Q$ ' : «_ Barbecue I I
Clothes dryer (gas) j
Business name' ( ,. � (1 m l7-i-1 - :) t
TTr Other: 1 f
Addressi 3 J '� '' ,; `' . �;:, ,: ,.�:.•I +r : MEC'�iAMCAI, P PRMIT PEES # .
City /Stat&Z1P Subtotal
1(T �� � ^ Minimum permit Pee (590.00) Q �°
?hone: )
• ► --1/ i Fax: jig 5 _ !� J Plan review (25% of pcnnit fee)
C I C CB lie.: '/(p , ‘3.,.(3 State surcharge (12% of permit fee) /0:36" $O
+ TOTAL PERMIT FEE /Oh .SO
Authorized signal i
,
� / �� This permit application expires if a permit is not obtaioed withi a'
l /(U I (E�1� , days after it has been accepted as complete.
Print name: I ( _I --__'_11•717111111 Date: 1 1 ' Fee methodology sel by Tri- County Building Industry Some, l9uard
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