Permit •
CITY OF TIGARD MECHANICAL PERMIT
II
s ` COMMUNITY DEVELOPMENT Permit #: MEC2009-00100
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/12/2009
T E [a.t� R L7 g Parcel: 25111 CB01308
Jurisdiction: Tigard
Site address: 14905 SW 104TH AVE
Subdivision: DEL MONTE SUBDIVISION NO.2 Lot: 15
Project: Lapidus
Project Description: Replace gas furnace.
Owner: FEES
LAPIDUS, DAVID J /KAY W Description Date Amount
14905 SW 104TH Furnaces < 100K BTU 03/11/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 03/11/2009 $8.70
PHONE. Minimum Fee Adjustment - Mechanical 03/11/2009 $58.50
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: Natural Gas
Gas Pressue:
Total $81 20
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: Permittee Signature: , Q
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.
Mechanical Permit Application roll or r10E USE °NI.I
City of Tigard E NED 3, 141 Other Perms.
a 9 � 1 1 Pcnnit No.: I(�l e e2 t� 0 4 - opl o0 • 13125 SW' Hal: Blvd., Tigard, OR 9 p Rc . Plan Review ,
Phone: 503.539.4171 Fax: 503.59At
Date/By:
1 o 2 009
II GA R 1)
Inspection Line: 506.639.4175 Date Ready/By. kris: ' 0 See Page I toe
Internet: www.tigard- or.gov MAR Notified/Method: T 1 9 Suypkmeatal Information
r :1
TYPE OF `7► 4 ' OD I vtS I O .. . .: lF EE* SCHEDULE — USE CHECKLIST Mechanical permit fees' are based on the value of the wore:
❑ New construction ❑ performed. Indicate the value (rounded to the nearest dollar,: of u:i
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
";'',RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
❑ I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For pQC information use checklist.
. ❑ Multi - family ❑ Master builder ❑ Other: Description Q:y. [ Ea. 7otal ;
JOB SITE INFORMATION AND LOCATION Heating/cooling
Ai con diti o nin g or heat p ump
lob site address f q9 _
or (requires site plan showin placement) 14,UG
City/State/ZIP: Fumtice 100,000 1311.) (duets'vents) ) ' 14,00
• Furnace 100,000+ BTU (duets/veins) 17.90 _ ^_
Suite/bldg./apt. no.: Project name: beat pump 14.00
Cross street/directions to job site: Duct work 14 .00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00 i T,
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended. etc. j 10 00 l _
Su'pdivision: Lot no.: Flue/vent for any of above I l 10.00
Other 1 10.00
Tax map/parcel no.: Other fuel appliances
•
DESCRIPTION OF WORK Water beater 10.00
' Gas fireplace 10.00
—�--'' Flue vent for water heater or gas
X11. --P./ �s�
' ��''� l! fireplace 10.00 I _1
- Log lighter (gas) 10.00
Wood/pellet stove I 10.00
Wood fireplacefinsert 1 l 10.00
Cb'unney/linertflue/vent 10.00
PROPERTY OWNER ❑ TENANT Otter. 10.00 I T _
Name: ���"` Gum i ' f ! `' / - Environmental exhaust and ventilat
"'7 Range hood/other kitchen
Address: equipment 10.00 '
City /State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms.
Phone: ( ) '?,,,, 4 J�,,� Fax: ( ) toilet compartments, utility rooms) 6.10
❑ APPL1CAyr / ❑ CONTACT PERSON • Attic/crawlspaee fans 10.00
Other: . 10.00 —
Business name: Fuel piping —.
Contact name:/-4j.).„\., '"D R 1 b V 55.40 for first four. SI.00 far each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phonc: c 6 3 ) 3. q - ;,-- o t/ , : ( 3 ) s ' - ef- o : -2(0 Water heater I
Fireplace
E mail: Range .
CONTRACTOR - Barbecue
7 b i L / Clothes dryer (gas) f
Business name: (,t3 (,tom) G f^ el/I / (� (7/ / e,91/1C i I
Address: qt, I a x .,23 o 3 g 1 MECHANICAL PERMIT FEES*
City /State/ZIP: --77 I , 9 2,3 0 , 9 j/' Subtotal
Minimum permit fee (T72.SOj
Phone: } Cot ?' "' • — 21) il Fax: ( )�y d y70 Plan review (25%ofpermit fee)
CCB lie.: 74, 3 5 9 r State surcharge (12% of permit fee) •
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not ebtainad within Ult., g el�fil days after it has been accepted as couplete.
Print name: /7 1) -1 I Date: b/44>J1 • Fee methodology set by Tri- County Building Industry Se: Bode
Z'd OLZ0 869 ONI1d3H VI l fl1oo d6Z76 60 01. -Ien