Permit �� CITY OF TIGARD MECHANICAL PERMIT
'" COMMUNITY DEVELOPMENT Permit #: MEC2011 -00448
Date Issued: 10/12/2011
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 1S134BD03600
Jurisdiction: Tigard
Site address: 11970 SW SPRINGWOOD DR
Project: Steinke Subdivision: ENGLEWOOD NO.2 Lot: 124
Project Description: Replace gas furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: STEINKE, JOSEPH
PO BOX 230397 11970 SW SPRINGWOOD DR
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 590 -3340
FAX 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/12/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/12/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/12/2011 $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 N [cation enter Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or dire questions to • NC b calling 503.232 1987 or 1.800.332 2344
Issue By: / / , Permittee Signat 411111W I `/ = e
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.
Oct 11 11 01:12p Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Applicatiollt 2\ vox ()Fp•I E, tl5 u;1tl.
ill City of Tigard � i d / // # , i Permit 0�� .' 4
r ° 13t25 Sy, 11a)I Blvd., l'i5art, OR 97 `\ GV 1 ptan Rev.e
PI-one' 503 7 i a 2439 t• ax: 303 593. O C � ��J Otter Permu' •
T1 : Inspection Ltne ?03.639,4 V r O Date Readtii ky dug.: 0 See Page 2 for
Internet: wwa Hoard or. fi4' P , 6\ Notified/Method - Supplemental lnromaonon
V�
TYPE OF WORK .. `commrF1RC(Au ev St`-13i�:DIJY.E'— (3 ECHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction NcAdditio7%alteration /replacement perforated Indicate the value trnunded to the nearest dollar)) of a :l
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
- -- - Valua: S
CATEGORY OF CONSTRUCTION -
� - - 'ELESIITEkVTiAI. EQUIPMENT /SYSTEMS FEES*
/".- and 2-family dtieIlling ❑ Commercial/industrial ❑ Accessory building For special information rise ehedlist.
Q multi - famil ❑ Master }guilder ❑ Other: 1 Desixiption — 1 Qiv ' i-a. Total
JOB SITE INFORMATION N AND LOCATiOT Heatittp/eouling:
Air cond,liening
/! �,�� Hires si re lan silo«m: lacementI 46 7 Toh site dddl e,s: �� Ca17G 'S(i4J �J�t (Le g P p YY Iperinq Pu!na+`x• IO(l,Il(iUBTl1[ciucts'varts: i I 46.7
5
Lit}' %StateJZlP - 1r) 97 1l
(/r rc - Furnace I OO,UOU+ [3 1'U CJu tvvcat - 54 41
Suite/bldg,iapt. no.: , Project name: l� n f 4) Heat pump
(Icquwres site plan showing plscerncnt) 61 06
Cross street/directions to job site: Duct work 23 32
Hvdronic hot water system 23 32
Residential boiler (radiator or ,
hvdronic t 23.32
Unit healers (fuel -type, nor electric).
in- wall, in -duct_ suspended, etc. 46,75
[ Subdivision: Lot no -: l i Tine/vent for any of above 23 332
I Other: i 23.32 _
7 mapiparcel no.: 1 Other fuel appliances:
- " DESCRIPTION OF Wtpftk.,_ ' ' , - , ' ' - . - Water heater 23.32
` _ f .Q 7 Gas fireplace vent 33 39
JY{ ( stir. Gas vent fur water hclner or km
fireplace - 23.32
i Log lighter ;gas) 23.32
i .'<°oodipellet stove 33.39
wood lit:lace °insert I 23.32
Chitnnevllinerff ue/vent 23,32
PERK 4' £IVYV [Q TENANT Other: 1 23.32 i e.
Name: Environmental extra ustand ventilation:
Address: Range hood /other kitchen
� t9 - r'! -e equipment 3339
CttyiStale /ZIP: Clothes dryer exhaust 33.39 I
Single - duct exhaust (bathrooms,
Phor 3 ) 14 6 Fax: ( ) toilet tempurtments, utility roams) 23.32
Q APPLICANT , 0 CONTACT PERSON Atnc /crawlspace fiats 23,32
_
Business name: Other. 23.32 -
Foci piping:
S t it ., a rr�. {
Contact name' ti14.15 for Gat four: S4.03 for each additional
Address:
Fun, ace, etc. I
Gas heat pump I
City/State /ZIP: Wali /smpendcdlu!ut healer
Phone: ( I Fax: : ( ) Water heater
f- t+ t`) Fireplace
F -mail: O �k
�-s c9�tta f1Y.•S�t - f\e _i"" Range ,
C01vTRAtQ11. 1 Barbecue
Business name: r .,t
Clothes dryer (gas)
(Aber: L
Address: PO 112x (2.30,V-) IVIEGIANICALPERMII TEES"
Cit}iState;Z1P: 7-,• 4� 9 7 / -_ . Subtotal (tJ•CU
Minimum permit fee (S90.00) 7
Phone: ( �) , ?Q ;'ac ( 571,0 ?tJ I Plan to feu; 125 % of penult t'cc) ° -----
CCR lie -, 7/ State surcharge I12 °0ofpermtl fee) /b. To
TOTAL PERMIT FEE .42%)
l?•1L .." j - L'} Y . r r- Z
This penupermit application expires if a c is not m tn.d within I1811 /'�
Authorized signature: `r1.'!T days
�
days aftter r it t has been accepted as complete.
Print name: Jar rJ /40r Date: 1C)-di 1 / . Fee meihodology set hyTri- Countv Building lndt .slrySc : vice Board
I Ruddrne -l.erT Anp dnc 09;09 0 •.4i -:5 17T (I i' i,2 C.:0 N:1 \EH)