Permit CITY OF TIGARD MECHANICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: MEC2011 -00393
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/02/2011
Parcel: 2S111DB05200
Jurisdiction: Tigard
Site address: 15271 SW ALDERBROOK PL
Project: Keenan Subdivision: SUMMERFIELD NO.7 Lot: 408
Project Description: Gas conversion for furnace and water heater. Install gas furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: KEENAN, LYLE T
PO BOX 230397 15271 SW ALDERBROOK PL
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 620 -0336
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/02/2011 $46.75
Type of Use: SF Fuel Piping 09/02/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 09/02/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 09/02/2011 $29.10
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 N. . ion -nter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir- questions to OUN • • 03.232.1987 or 1.800.332.2344. ^ `
Iss ed By: / � Permittee Sig :ture: / / ,ii C 0'
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.
Sep 02 11 01:40p Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Application ° I , I'OR (WF'iCE USE ONLY
City of Tigard x i , °�1 i Received 9 // p Pei No.: tite.gev y� 00 3 715
.erw ' - i Date,By'
`` ``
s
IN
g 1 3125 Stir )tall Blvd., Tigard. oR `9,"223, 61, Plan 2cvint,
Phone: 5 {;3.715.2439 Fax: 503.59S°391�a v O:berPennil:
1,V
Date:By:
TIGARD Inspection Line: 503.539.4175 A. S <Q -.s . & \O - Reaay.33 - ?urs 0 See Page 2 for
Internet: aww.tigard At AY (3<( . M Notiftedhletlted: ! Supplemental information
..TYPI OF WORIf Y.'' » x ` s } COMMFRcIAL F EEF- SCHED JLE - USE c`ItECKL1ST
'y%) Mechanical permit fees* are based on the value of the work
❑ New construction 2 Additionialteration /replacement : performed. Indicate the value (rounded to the nearest dollar) of oh
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
L'aine: S
CA7 GO Y .0E- CO S7 RUCTION RESIDE:10 AI. E QIAPMENTJ SY :5TIMMS FEES*
and 2- family dwelling ❑ Co nlnerciaiiindu, trial ❑ Accessory building i For specialritfnrmalioa use checklist
0 Multi - family ❑ Master builder ❑ Other: Description I Qty. La. Total
JOB: SITE INFORMATION AND LO Heating /cooling:
Ail conditioning
J oh site address/ L 5'9:1 ( Sw P ( (eauires siie elan aho.t•ing placement) j 46 75
Furnace f 1.0,000 BTU hitietsnt
vesl , } 46.73
Cf[yv�ts[e'City/State/ZIP:
TrckA v•-01,, Ore co acvf Furnace 11 )0,000+ BTU ,daet„vcn :s) ' 54 91
Suite /bldg.iapt, no.: 1/43 1 Prgjectname: i Heat pump
' (requires site elan shownig placement) I b I .06
Cross strectidireetions to job site: Duct work 23.32 I
Hydronic hot water system j 23.32
Residential boiler (radiator or
ltvdronic) 23.32
Unit heaters (suet -type, not electric),
in -wall, in -duct, suspended_ etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
' I Other: 23.32
Tax map /parcel no.: Other fuel appliances:
: DF,S RUiTIOl? OF WOR - ' ..: Water heater ( 23.32
Gas fireplace 33.39
m- �( 2e,' 4 • 0 P(,L�11� e CLD clue vent for water heater or gas
ill ��.� A , fireplace 23.32
*+.
L . I:. MI ''' ' ' Log lighter (gas) 23.32
Wend/pellet stove ' 33.39
Wood fireplace/insert 23.32
Chimney,3iner /fl ueivent 23.32
PROPERTY OWNER ' 1 " 0 TEN NT
Other: 23,32
Name: Environmental exhaust and ventilation: I
Address: Asa -- i act) r,J ,r r �� p Range haodiother kitchen
t
_uirrment 33.39
City/State/ZIP: it—ii 17
Fax: ( Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
^ Phone: (533) 6 033L. I I- ) toilet compartments, utility rooms) , 23.32
- ❑. APPLICANT 0 cot'r tcT p)FBSoN ' Atticlerawispace fans 23 32
i Other. 23.32 '
Business name: E
Fuel piping:
Contact name: 5 j &A &-.O -aLJ 514,15 for first four; 5,4.03 for each additional
}Address: Furnace, etc. 1 _ k s
- Gas heat pump
City/State/ZIP: Wall /suspended /unit beater
I Water heater
Phone: ( ) i Fax: : ( )
Fireplace ...
E-tnai l : O -*,.i c o ttsoly\irt. s 0 as.... - A " Range
•
- , . CONTRACTOR - Barbecue
i - .."1". J`��, j her: Clothes dryer (gas) name:
It� �' 1 � - _ •
_. .- 4 -- -_.. - _ c _ OO1 , - ... - -.. -. - other:
Address: �,} ., ' - .. ,
� ±�±t! � t� l� � " ,4IEC.tfA1?f3�,41� PER:vIt'I' k'CCS ".
J`
City/State/ZIP: Tzt t( a te.. 'g' Suninfut
1 Minimum permit ee 590.00) Phone: ; s) � -�0 f1'r Fay; ( ) . Q Plan review (25 %orpermit feel ....---
CCB tic.: -4 ] State surcharge (12 %o: permit fee] J. r
TOTAL PERMIT FEE / pp. 8q
Authorized sip tature: t A � ..y. �� y This permit application expires it a permit is not oh within ISO
zJ Ji'...ASI ~� ' i) ti"r'_'• --__
days after it I1a3 been accepted as complete.
Print name: ja lcrp 44 I Date: *Ill � iii F ntethntetcay set fly Tr,- C,noiy Building .ado airy Service Board
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