Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00281
Date Issued: 06/17/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S 13 /2011 00
Jurisdiction: Tigard
Site address: 11645 SW TIGARD DR
Project: TORRES Subdivision: BURLWOOD NO.4 Lot: 26
Project Description: gas piping for range.
Contractor: COLUMBIA HEATING & COOLING INC Owner: TORRES, NANCY
PO BOX 230397 11645 SW TIGARD DR
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Fuel Piping 06/17/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 06/17/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/17/2011 $75.85
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 O NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: �
-
03.639.4175 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.
Jun 16 11 05:09p Columbia Heating /Cooling 503 -598 -0270 p.2 •
Mechanical Permit App1ica#i rn, NS FOR OFFICE USE ONLY
City of Tigard ' A P,Ctcd M � \ Gata'lry; ite / illiarl■Ami Mi i L .
• w ` 131?5 l ' 1 Ia11 13Ivd., 'E inard, tJR. 972 ri:
' Plan Review
503.718.2439 Fax: 503.5%, 196i1 �` `� O t c:r Permit-
V CateB�:
TIGARD inspection Line. �U3.639.31 ?j �ri�� 5 d a Re;tdv,`Bv: Jurii. ® See Page 2 for
Internet: Nti�>tiv�.ti ctr.gov C ` ��1 Notifiedrlriethod: Supplemental Information j
• ... • ... ,. • , t. ..]:1::,;:i „t-
,'. .. , . ]4lii 'FIiclALi 'EZ, SCL•W !L£ • I: :,'• CJS£ -• CF4ECKL4ST
Mechanical permit fees* are based on the value of the work
❑ hew construction 4ddition /alterationlreplaccment performed. Indicate the value (rounded to the nearest dollar) of ail
❑ Demolition thca': mechanical materials, equipment, labor. overhead, and
Value: S
'- ; . :...CATEGORY . OF : CONSTR> CTION • _
13.$11WNTIAE, E Uli�';4111;NT:1SYS Y,141 S FEES"'
. '- and 2-family dwelling ❑ Commercial /industrial ❑ .Accessory building For special inforrairnn use cheekllst.
❑ Multi- famit ❑ Master builder ❑ Other: J Description Qty. Fa total
: }ieatiB
JOB SITE INFORMATION AND LOCATION '"
Air conditioning
Job site txlriress: f / e �� 6 t t ' n {requires sate plan ;homing placement) 40.75
! `� V' _ Furnace I (fG,f30(I $'l - [! (cuctsh�cnt;l 46.75 C :it } ;State/ZIl': p jti *-t-� I Fu rnace
J b' 100,000+ E3'I'U (dllctt;cents) 54.91
Suite/bld no,: P tt�J 1 name: Heat pump
(utq ulrca cite plan showing placon:tin) 61.06
i Cross street /directions to job site: Duct work 23.32 i ____i
----- Hydrenic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel - type, not electric),
in -wall, in -duct, suspended. etc. 41).75
Subdivision: Lot nn.: Flueivent for any of above 23.32
- ' Other: 1 3.32
Tax mapiparcel no.: Other fuel appliances: •
: :: . . : ... : : ;.D OiF.: W :pti'1: :: ° - ....i' ` ..: ::.... :. :- . : :.,. ,,.;:
`attr heater 23.32
^ Gies fireplace 33.39
(� + Flue vent for water heater cr gas
fireplace 23.32
Log lighter (gas) 1 23.32
Wood /pelle. stove { 33.39
Wood fireplace/insert _ 23.32
Chimney/liner/flue/vent 23.32
iROPEll 7 ' .OWNER . ❑ TENANT : . . - . -
Other 23.32
Na - Environmental exhaust and wLntitation:
Address: : ! / f/ .S Y4 Range hoodioiher kitchen
10 5 J K„/ o �i oquirment 33.39
City; StatelZIP: 1, .1" f / , 07?- 9 7z2- Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) t*_ t Fa.x: ( ) toilet compartments, utility rooms) 23.32
CI _Ant: -
Attic/craw Is aye tans 23.32
- co�� :�cr ��a� r
Other: 23.32
Business name:
• Fuel piping:
Contact name: 50-ANN-9- iti } S14.15 for first four; 54.03 for each additional
Furnace.. etc.
i
Address:
Gas heat pump
City/State/ZIP: Wull/su pencled/unit heater f I
Phone: ( ) Fax: : ( ) Water heater 1
-
'- Fireplace -
E 0 c jt .b�''&KJ ..... ° "" Range 1
.. :. garhecue •
Business :tame:
Clothes dryer (gas) l l
_ii 1 h. r # 4 - `-- f- - . -.._.. Other: i
.Address: 1›.43 )c 35' :..T:' IEOix.''q F RMIT3?LI S .: -
Cit. StateiZIP_ f ` i . . . j , . 9 C f UUE1�tx1 " 1
• :._...._ _ l - 7
9 J 88
Minimum permit fee ($90.00} , c if ) . c )
Phone: V1/ ) r , r 1 P Fax: ; � .� - 0 Plan review (25% of permit fee)
CC`R liu.: 7 � r "° S surcharge ((2% of permit fee) /0 -10
TOTAL PERMIT FEE IN _ 1.0
This permit application expires if a permit It not caiain%.,1 -within 180
Authorized signature :.!r► Imo. i r lt .fro days after it has been accepted as complete.
Print name: „„ , , ..-- mite_ # " foe methodology set by Builditcg Indus ;ry Stir ice Board
i
1 '1suil .ii:le:Pcre,its'.MCC -permi ?Ann tine !14 ;p9ile - 1411 -le17t (FF=f.. :1.V 1'.t.' VER) .