Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 00449
Date Issued: 10/12/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S1106A03500
Jurisdiction: Tigard
Site address: 11575 SW CLOUD CT
Project: STOHR Subdivision: SHADOW HILLS Lot: 30
Project Description: Gas furnace replacement
Contractor: COLUMBIA HEATING & COOLING INC Owner: STOHR, PENN RAYMOND TR
PO BOX 230397 11575 SW CLOUD CT
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE:
FAX 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/12/2011 $46.75
Type of Use: COM 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:
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.
Issued By: Permittee Signature:
AAl
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 01:20p Columbia Heating /Cooling 503 - 598 -0270 p.2
Mechanical Permit Application I OTZ OFf'ICE us1c,Nl;Y'
S)
21 Cih Rccen ed of Tigard Caleb∎ �`
Perna —. at if
1312 SA aid. OR (fall Blvd ,'I i f Ii --� 'No.' U
1 \ Plan Rtvi,. 1
Phone: 303.7182439 Fa x• 50159 1 41- �,� Cate u : 0:11e I
Ti Internet: vt
RD Inspection Line. 503.639.4175 C � P Q � Cate Ready.Ay. `n. ® See Page 2 for I
Internet: ww.tisard -or gay V ` `,� O � IJotii<d.fiwleth Supplemental information
1 OF WO N1tNV <7.0M EFiClALFPE'! Sea EBuLE - USE CHECKLIST
Mechanical permit fees* are based on the Wallis of the work
❑ New construction sSdditton(elterat c n /replacement performed Indicate the val (rounded to the nearest dollar) or all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead and profit
. . - .. —. -- Value. S
.. CATEGORY OF CONSTRUCTION - - t21rS l DENT! aL F.OUIPM ENT) SYSTEMS FEES*
and 2 - fam i'y dwelling ❑ C'omrnercialutdustrial ❑ Accessory building For special information usedrecl.•1ist.
❑ Multi famiiy ❑ ).-(aster builder ❑ Other: Descript:on tiny I.a 'Iota)
JOB SITE INFORMATION AND LOCAT� Ilea «n /cool LOCATION 1
Air conditioning
Job Site i:ddre s: uegu=res sue p'an >hcwrae p.awrneat) 46 75
C � Fumace 100,000 BT1.1 Iduoiskems, I .16 75 . ?S
City /Slats /ZIP: 4 1 r ,
97 - � Furnace I00,C ,.UU�- F3't'„ i,luctti\enrsl 54.91
Suite/bldg./apt. no.: Project name: �a1l IQ..., heat pump
ircqu :res site plan shew,ng p.accment) 61 06
Cress strecudirections to job site: Duel work 23 32 ____
Hydionie hot water system 23 32
Residential boiler (radiator or
hvdronic) 23 32
1 Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46 75
luetvent for any of above 23 32
Subdivision: Lo: no.: Other. } 23 32
Tax map /parcel no.: Other fuel appliances:
. . . DES CRIVION OF- WORK, . - - , L ". Water heater 23 32
�� c /� (� / S -7^; (�/(_ ^ Gas fireplace 33 39
�/t� `�� Flue veal 11,7 water neuter or gas
fireplace 23 -32
Log lighter (gas) 23 32 ,
Woo d'pellet stove 33.39
Wood fireplace/insert 23 32
ROPERTV OWNER / . _ ❑ TENANT Chimneyilincr;flue 2332
,
Omer: : 23 32
I t ,
Name. _� EmKrnnmetrtal exhaust and ventilation: i
Address Ranee hood/other kitchen
4 -01.e -e _equipment 31.39
City/Slate/ZIP Clothes dryer exhaust 33.39
/a3) 4-5, -S 4 -T ) comp
Single-duct compartments, (bathrooms.
Phrnt� Fax: i toilet comportmenments, uthty rooms) ! 23.32
❑ APPLICANT 0 CONTACT PERSON ' Aa €cicrawlspace fans 23 32
_i O :her. 23.32
Business name:
_ f Fuel pining:
C'ootact name: ��,ty,�f� A j 1 S14.15 for first four; S4.03 for each additional ff Fumace, etc. l
Address: ,
Gas heist pump_ 1
City /State /ZIP: \Sal I'Suspenaled;unrt heater
Phone t ) Fax: : ( ) Water heater
('� Fireplace
E-mail: C7"7r+�C L.. C 4Ai1LIN% Y1. 0i) CL .-- - Ak-k Range
CONTRACTOR . - : Barbe
Business name: r 4, Clothes dryer (gas)
Address: 1IEC3AA7C'.di FERMI r. ErS
City;State;F(P : F � 0 7 Subtotal — 24‘4 i
f Minimum permit ft ($90.00) qQ aC�
Phone: (5 ,.. ,A.:70 9- 3) �.� " 'ra f .?T) S - Q A ?� Plan review (25% of permit fee)
C('R lit.: ' ?/ + ! r � Cj State surcharge (12% of permit fee) 0 -
� TOTAL PERMIT FEE; Rio
This permit application espit-es if a permit is n tit obtain. d within 1511
A uthorized signature: it! • - a ,ltr days after it has been accepted as complete.
Print name: joI, . s r /. Date: /0.... -7— J ' Foe me hu.ln'ogy ev by 'IA-County 13t Industry Sc ice 3oard
v r it
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