Permit I CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Pe COMMUNITY MEC2010 -00674
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/23/2010
Parcel: 2S103BD01300
Jurisdiction: Tigard
Site address: 12660 SW 121ST AVE
Project: BERGQUIST Subdivision: Lot: 0
Project Description: Gas furnace replacement.
Contractor: COLUMBIA HEATING & COOLING INC Owner: BERGQUIST LIVING TRUST
PO BOX 230397 12660 SW 121ST AVE
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 590 -3001
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/23/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/23/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/23/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 OU C by calling 503.232.1987 or 1.800 ■
Issued By: P ermittee Signature: / — i /
f
Call 50 . 9.4175 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.
Dec 21 1002:26p Columbia Heating/Cooling 503-598-0270 p.2
I mita-lino •
Mechanical Permit Applicati!uAIU i roit (wil . F. ust: ()Nix
C , 911d0 1LLID
City of 'figard Received ill
Date/By: , .0/N U 6 ,
II • 13125 SW Hal! Blvd.. Tigard. 011 9722 9P)Z 1 g - J .7 ■ I , Plan Review '0 1 a Phone. 503.C39. I' ax: 503.5.l q&0 Date/By: Iliber Permit:
1-1(1A111) 1 , nspeetion Line 503.6:19.4175 Date iteadytliy: Juris. la Sin 'age 2 fo
i r .
merr Y.: www.tigard UgA1303111 : so,ifiut,mcaiod•
-7---6 Supplemental Information
• • TYPE OF WORK • COMMERCIAL .FEE SCIIEDuLE - USE CHECKLIST
•
i • Mechanical permit fees* are based on the v;due of the "cit.
I E 'New construction XAdditionialterationircplaccunent
performed. Indicate the value (rounded to the mimes" I ll
c.0„.ariii: .1
' 0 37:1110111i011 0 Other: mezhanica: materials, .4 ui . men.. labor, overhead, end_Eulit
$
1 CATEGORY OF CONSTRUCTION .; :•.: . •,' '.. :,,_... ;.... ' Value: ------:
• RESIDENTIAL. EQUIPMENT SYSTEMS FEES*
V I - and 2-fami'y dwelling 0 Commercial/industrial 0 Accessory building
' For special iri we cheek:;st.
,
. E Multi - 14'11 . 1:y 0 Master builder 0 Other: Deseripticin L_Qty.
JOB SITE INFORMATION AND LOCATION :-.• ..:• ,-:-•,-.: • -::--- •; - Heating/cooling
- Air conditionir,g .
al S4 Y3....k.... (recuires site plan snowinu pluementi 46.75 .
Cil0:ZileiZiP: (1
I
I"
. St.liteibltlE..ipt. nu.: Project name: „6 _.,..., Furnace 100,000 BTU (ducts/vents) 1 46.75
Furnace 130,000+ DTU icuets;vents) ::4
Pleat pump
(....ru s. itrQeAlireL:liAlis to job siLe: 41 • Duct work
i Hydronic hot wazer system ..1:. a _
I - . Residential boiler (radiater or
1 _
hydronic) . ;
. _ Unit hcale.rs (fuel-type, not electric),
in-wall, in-duct, suspended, etc.
' Flue/vent for any of above 23.3:
r S•Abdi•,•isiLiii: 1 Lot no
OCier: : 2
- FL.x. inanipwtel no.: Otber fuel appliances ______.... .
DESCRIPTION OF WO' • -
.
: ;... water hcaLer 23.32
Gas fireplace 33
di _. 0 i a . ., , A,.
- .1(e - It _ Aga I.._ • Flue vent for water heater or
l • — fireplace
-7-- 717
1
- -------- -• Log lighP•r (gas) 13 -I-. ,
--
Wood/peliet s'..cve
Wood fireplaceinsert 3332
Chimney/liner/flue/vent 23.32
1-------- XPROPERTY OWNER - 0 'TENANT .
Other: i 2 .32
Name: A / / ,/ '.41 'A 40 AI, ..... Environmental exhaust and ventilation
-1-- ,
-- flange hood/other kitchen
:%dt.ires: . 1 %... _ i 4,4 N.. I ta FA gt, A ,
w equipment -! ; 3 •
. _ ,.
Cit) (Stu 1..- /I P. az 14 ..........„ Clothes dryer exhaUS1 2.3 30 •
-- Single-duct exhaust (bathrooms, .
Phone•9 1 -a / , Fax: ( ) .
toilet compartments, util: hy rooms) — .,
......, _1.:
H
0 APPLICANT - I • 0 CONTACT PERSON . ••• Anieferawlspau fans 1 _ - 1 3.3 1
Other: i 23.32 _
' :3•.isiness name:
1 - . Fuel piping •
,
I ..
514.15 for first four; S4.03 for each additional
rContact name /6/ p - /7•2 e
---- - --
' Furnace, ctc. !
! Address:
______ Gas heat p_amp — -- • - - --- - -
I Yity/S:ittelZIP: WalL'suspended/unit heater ;
r —
Phone: 3.: /,94.,;70 4- Fax: 663 5:7E ..OD.7c) Water heater
4 ' F:replace ,
-
li-mall: Range
— .,. . _ ..._ .
CONTRACTOR.. • • . . . •
•: • Barbecue
. Clothes dryer (gas)
Business name: ("mt i m gil-.)__c A . 6 .4 ,.. i. _ ( 1 iii _ ) 6_,.. -AL
1 --- 1
Other
r Acidressi kidx Q 2 . S . 9 . 7
L ,
- • ••• MECHANICAL PERMIT FEES*
_
, L'ityiStatell.11): 7164i-Ar) 0 -.N-7C-;F / Subtotal
- Minimum perrnit fcc (S90.0
t PitOtie:&3 ) / n F,x: ( 5_-_, ) „ _ 0 0,
Plan reviev, (25% of ;acrin it fy 00 ..; L .
i 0213 liC.: 1 7(1) i_.. ) State surcharge (12% a permit fee" fa
TOTAL PERMIT, FEE j f OV_
This permit application expires if II permit is not ubru. es] it ithirs I.Si.
Am.:tort stvnaturtL_A _
i l iif ;1 0 . I days after it bas been accepted as complete.
I Print 2'011CI7 t.• - "If ea ■ Date" %, ' ,,,, — 11111 • f niethodolog,y set by Ti-Couiniy IluddLriy Inth..;in Soro,:, :,,,I.:
::,LiL:blii,e'.Perms..,..1E(.:4er•r..tAva dui: 1G/01 449 i;t1/0.11COWWEib)