Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00227
I'IGAILp 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
Parcel: 2S 111 DB07200
Jurisdiction: Tigard
Site address: 15480 SW ALDERBROOK DR
Project: Prosser Subdivision: SUMMERFIELD NO.7 Lot: 389
Project Description: Replace furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: PROSSER, MILLE
PO BOX 230397 15480 SW ALDERBROOK DR
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 684 -7811
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/25/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/25/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/25/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 OUNC by calling 503.232.1987 or 1.800.332.2344. 4 � 97
Issued By: ��lf��_ Permittee Signature: 6r,/ /�/ 0fr /
Call 503.639.4175 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.
May 23 11 10:55a Columbia Heating /Cooling 503 -598 -0270 p.2 -,‘„Fo .-. .
Mechanical Permit Applicati , t
City of Tigard MAY 2 3 2011 Da R 3 Zs • - Pert �ColOf/� /00142
1 11114
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
$ Phone: 503.639.4171 Fax: 503.598.196t'i n DateBv Other Permit:
Inspection Line: 503.639.4175 VI ®t � L�1 e �0 Date Ready/By; lu Qf Sec rage 2 for
f1t;nitD Internet: www.tigard- or.gov BUILDING DIVISION Nctifiedimethod: /rj6 Supplements' Information
i
TYPE OF WORK . . C01111N11£RCIAI:FEE� SCHEDULE - USE CHECKLIST
•
❑ New construction odition /alteration/replacement Mechanical permit fees* arc based the value of the work
performed. Indicate the value (rounded d to the nearest dollar) o: all
Q Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: S
CATEGORY :OF :CONSTRUCTION • .. ::'.•......... •.:
,,��!' . RESIDENTIALEQUIPMIENT / SYSTEMS FEES*
Ili- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special ilrjorrnatron ue checklrsr,
❑ Multi family ❑ Master builder ❑ Other: Description Qty ' Ea. 1 Total ,
JOB SITE .INFORMATION AND ,LOCATION • • . Heating/cooling
l J Air conditioning
Job site address: / I 3 ---/./8.0 LJ > r l � �� (requires site plan showing placement) 46.75
City /State /ZIP: G 3 Y 1 �� � l ' w/ 9 � - L t t Furnace 100,000 BTU (ducts:vents) j 46.75
Furnace I00,000+ BTU (ductsrvcnts) 54 91
Suite/bldg./apt. no.: Project name: Heat pump 61 06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system : 23.32
Residential boiler (radiator or
hydronic) • 23.32
Unit heaters (fuel -type, riot electric),
in -wall, in -duct, suspended, etc. 46.7 5
Flue /vent for any of above 23.32
Subdivis ion: Lot no.: .
Other: 2332 ,
Tax map /parcel no.: Other fuel appliances
•
.
DESCIUYriON OF WORK. Water heater 23.32
Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32 ;
Wood/pellet stove _ 33.39
Wood fireplace/insert 23.32 '
Chimney/liner /fl ue/vent 23.32
ROPERTY OWNER ❑ NAT . Other- 23.32
Name: 6CC66 ry - ! , +4 . ? - Se Environmental exhaust and ventilation
1 Range hood/other kitchen
Address: 5 A-o1€ equipment 33.39
City /State. /Z; P: . r i c a - .e Clothes dryer exhaust _ 33.39
Single -duct exhaust (bathrooms,
Phone: (iO3 ) (n-8'4-s -7.g'1,1 Fax: ( ) toilet compartments, utility rooms)
APPLICANT - . ' 0 CONTACT PERSON . - . Atticicrawlspace fans 23.32 •
Other: 23.32
Business name: Fuel piping
g
Contact name: 717(-) Y / ii(/ 7 ee $14.15 for first four; S4.03 for each additional
L- / l Furnace, etc.
Address: ' Gas heatj)urnp
City /State /ZIP: i Wall/suspended/unitheater .
Phone: 5 3) (-( -a70Li Fax: :GO-3 55/E3, _ba.7O Water heater
Fireplace
E -mail: Range _
. CONTRACTOR; ' ' , , • Barbecue i
• Clothes dryer (gas)
Business name: 6 - . la it r...ri� ?1 , . _ Ili_ . _ Other: 1
Address- xl36� .39 7, MECHANICAL PERMIT FEES*
7
City /State/ZIP: Q 7 '/ Subtotal
Minimum permit fee (590.00) ' I'Q err,
P one: ( ) i p `� + Fax: 0 ,a70 ( 2 5 %
B lie.: xi) 35:9 surcharge ( permit t7
r i State surchar e 12% of ermit fee) /D t io0 . � � ii
C C
r TOTAL PERMIT FEE P
This permit application expires if a permit is not obtained within ISO
Authorized signatur ✓✓ SS .f d • days after it has been accepted as complete.
: - {
Print name s , /C - (17j. Date :. 3 - f 1 • Fee methodology set by Tri•Counly Bufding Industry Servi,;e Board
. n... u:..,. doe :0/rtsle 440- 16ITr(l] /02 /CD14.9/E13)