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Permit CITY OF TIGARD MECHANICAL PERMIT » COMMUNITY DEVELOPMENT Permit #: MEC2011 -00508 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/09/2011 Parcel: 1 S133DC00601 Jurisdiction: Tigard Site address: 13030 SW FALCON RISE DR Project: Chase Subdivision: ASH VALLEY TRACT Lot: 8 Project Description: Furnace replacement Contractor: COLUMBIA HEATING & COOLING INC Owner: CHASE, ALLEN L AND KAY L PO BOX 230397 13030 SW FALCON RISE DR TIGARD, OR 97281 TIGARD, OR 97223 PHONE: 503 - 624 -2704 PHONE: 503 - 984 -6778 FAX: 503 - 598 -0270 FEES Specifics: Description Date Amount Furnaces < 100K BTU 11/09/2011 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 11/09/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/09/2011 $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 Notific- •• • 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 direct • .estions to •. C by calling 503.232.1987 or 1.800.332.2344. Issued B : 0 L - i t Permittee Sign ure: ett Call 503.639.4175 by 7:00 a.m. for the next available inspection • ate. 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. Nov 09 11 08:20a Columbia Heating /Cooling 503- 598 -0270 p.2 RECEIVED NOV 09 2011 Mechanical Permit Application FOR OFFICE iCE USE' ONLY CITY OF T Received Y Nn.: City of Tigard Received i/ 9 # A t t/ge�?�fae5a I r a 1=125 SW Nall Blvd., Tigard, OR 97 JILDING DIVISION Plat, xcview o,,,M Permit' • Phone: 503.711.2439 Fax: 503_598.1960 B93.1960 Date.y: _ 'T IGAKr, inspection Line: 503 Dar Ready'3y- runt 61 see rage 2 for Internet: wow.tigard- or. gov Notitied :Met Supptctaental information .... Ct)kIMpRCI4Ii F'EE S(3B D 1.LE.- USE CITECKI IST • TYPE Of-- WORK Mechanical permit fees* are based on the value of the work New construction 2: cddition ,-'allcration/replacement performed. Indicate the value Irounded to the icaresidollaijol all Q Demolition © Other: mechanical materials, equipment, labor, overhead. and profit. Value: S CATEGORY .OF CONSTRUCTION - - -� RESIDED 'IXL_FQUIPMENT /SYSTEMS FEES* ©-1 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi-Family ❑ Master builder ❑ Other: Description Qty. 1 :a, l iotal JOB SITE INFORMATION AND LOCATION Hcatingicooling: Air conditioning { lob site :iddre 6.3' (reFnite> site plan showing t g placerrt) 1 4d.7 �� Furnace 100,000 BTU (dncniiyents) j I 46.75 ' Cii State/Zl lt: 116 ,e.o o� Furnace 1043,000+ 3'IU (du kAcat) 54.91 Suite/blde.iapt. nu.: Project name: I feat pump (requires site pies showing placeinent) 61.06 Cross street/directions to job site: Duct work . 23.32 Hydronic hot water system 1 23.32 1 Residential boiler (radiator or hydrnnic) ' 23.32 Unit heaters (fuel -type, not electric), i in -wall, induct, suspended, etc. 46.75 Subdivision: Lot no.: Flueivent for any of above 23.32 I -- Other: 23.32 Tax map /parcel too.: Other fuel appliances: 23.32 .. e .. .: DESC'RIPTION. il�','WORIC.. Water l•,eate r i Gas fireplace 33 39 Ff/I .v4f G. £ D4ACE4i..✓ Ei^ - ' Flue vent far water heater or gas .i fireplace 23.32 Log lighter (gas) 23.32 Woodtpclletstove 33.39 Wood fir placetinsert 23.32 0. OWNER . J ' . ..0.TENANT Ot h er: cyilinerlilue %tent 23.32 f , s t Other: 23,32 Name: kA y n _ Lnvirontnti l e exhaust and ventilation: -- 7 - Range hood/other kitchen Address: /.;Cpl © :Sw rA i,co; LAS F p2., eqUipm_nt 33.39 City'Sta!e/ZIP: 'Ti (J 2. O _ az �/rf�t4 v- Clothes dryer exhaust i 33.39 15 l / F �� Single - due: exhaust ,bathrooms, Phone: ) C Fax: i ) toilet compartments, utility rooms) t 23.32 - _ ❑ APPLICANT. . - 1' '..'0 _CONTACT PERSON . . Atticrerawispace fans 23 32 Other: 23.32 Business name: Fuel piping! f - p p e' Contact name: 5� � (J k- t_., J 514.15 for first four; 54.03 for each additional r 3 Address: Furnace, etc. I y Goss heat pump City /State;ZIP: Walt /suspended ;unit heater Phone: ( I Fax:: ( ) Water heater - i place E -mail: 0 , - - (b tla.ftY.:b t ■c� � 5IJ as- - iNe..' ` Range CONTRACTOR • .... .1 Barbecue__ . �_ Clothes dryer (gas) Business name: _IR i • t_ - - +� - : a- _- -- -'f' �+ .. 0CLl � ---... Other: Address: _II 6a$ 6C.r$ c2s 1o3' ilECH.ANICALfEft99ITF W._ . . Citr'State /ZIP: . r 0 -- 9 � ' f -_- -._ Subtotal . - f = 4finimum permit fee (�90.GU) Phone ; �) �rt� -^7 Fat': (S-D3 ) �-- ' 0,,z Platt review (25% of permit fee) CCR lie.: Tc1,3 I Slate surcharge (12% of permit fcc) _ TOTAL PERMIT FEE _ This permit application expires if a permit is not obtained within ISO Authorized signature: ,, �+ -d a m s complete. c. name: Jar C ^' � �, - - Vim'' C Date: 0 (1 - f 1 - ! ` FLc m Klt,340loky ter hv'rti- Cnwtl N.:M'-intz t, dustry' Se:t.i,;e board 1:.liutidirtakreeniit04EC- Pctrcil Apr•.doc 00/05110 40.4., "'t't1l:l_`L.f1M!xum;