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Permit CITY OF TIGARD MECHANICAL PERMIT 'F! COMMUNITY DEVELOPMENT Permit #: MEC2011 -00562 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2011 Parcel: 2S110BB04800 Jurisdiction: Tigard Site address: 12297 SW CHANDLER DR Project: KREMIDAS Subdivision: ARLINGTON RIDGE Lot: 25 Project Description: Duct work. Contractor: COLUMBIA HEATING & COOLING INC Owner: KREMIDAS, THOMAS G TRUST & PO BOX 230397 KREMIDAS, LETITIA J TRUST TIGARD, OR 97281 12297 SW CHANDLER DR TIGARD, OR 97224 PHONE: 503 - 624 -2704 PHONE: FAX: 503 - 598 -0270 FEES Specifics: Description Date Amount Duct Work 12/06/2011 $23.32 Type of Use: SF 12% State Surcharge - Mechanical 12/06/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/06/2011 $66.68 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: (_,./ - . - •ermittee Signature: / / / ^ Call 503.639. , 5 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. Dec 02 11 05 :OOp Columbia Heating /Cooling 503- 598 -0270 p.2 Mechanical Permit Application .0�� FOR OFFICE USE ONLY City of Tigard - 44 V D a'iv y : r� /y Penn" No.: �`1 rt e Rec /� // J� / - / ©��� 5 n 13125 SW Hall Blvd., Tigard, OR \` Plan Review Data /By: 111 Il l Phone: 603.639.4171 Fax: 503.0 60 � Other Permit: Inspection Line: 503.639.4175 yC P Dale Rea6y;'By Jars See Page 2. for TIGARD Internet: www.tigard- or TYPE YPE. OF W01,0 W O� K Norified:'Mediod: ‘776' ` Supplemental Information • - 1� EE* SCHEDULE - USE CHECKLIST �G � CQhtl15ERCL44. F ` Mechanical permit fees* are based on the value of the work ❑ Now construction VI Addition,%alteralt /replacement performed. Indicate the value (rounded to the nearest dollar) of all ['Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ • CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* j I - and 2-family dwelling ❑ Commercialtindustrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Hearing/cooling ' ^, Air conditioning Job site address: / ei- Air site plan.showingplacement) 46.75 City/State/ZIP: qa1-61 o - Furnace 100,000 BTU (ducts's.ents) 46.75 /� ��� Furnace 100,000+ BTU (duets/vents) 54.91 Suite/bldg. /apt. no.: Project name: ( bC N _Heat pump 61.06 Cross street/directions to job site: _ Duct work 23.32 Hvdronic hot vv•ater system _ 23.3 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall. in -duct, suspended, etc. , 46.75 Flue /vent for any of above _ 23.32 _ • Subdivision: Lot no.: Other: 23.32 Tax mapiparcel no.: Other fuel appliances DESCRIPTION OF. WOSIK Water heater 23.32 Gas fireplace 33.39 > 4 J f � 3 LL�� � 1 i S }'� f - } • /2 j t, � aLL Flue vent for water heater or gas `it z + / �x (/JtY fireplace 23.32 d Log lighter (gas) 23.32 1 /?6,0 a 0) - 1 ` 1�--r J 1 /+ 1 - t oa Wood /pellet stove 33.39 • Wood fireplace /insert _ 23.32 Chimney: /I loan /flue /vent 23.32 • ( PRO ! TYY OWNER. + . ❑ TENANT '' Other: 23.32 - Name: 7 Kvem do ' Environmental exhaust and ventilation l� Range hood /other kitchen Address: equipment 33.39 City/State/ZIP: Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms. Phone: ( ) Fax: ( } toilet compartments, utility rooms) . 23.32 ❑ APPLICANT ❑CONTACT ,PERSON Attic /crawlspace fans 23 . Other: 23.32 _, _ Business name: _ Fuel piping . Contact name: 514.15 for first four; $4.03 for each additional Furnace. etc. Address: Gas heat pump City /State/ZIP: _Wall /suspended/unit heater Water heater Phone: ( ) Fax : :( ) Fireplace E -mail: Range CONTRACTOR _ Barbecue Clothes dryer (gas) Business name: _. 1911 �� _� a 0- At a. • �C J as 1 II Other .Address: 021_ rD x ,_... I 7 I • MECHANICAL PERMIT FEES* %'ZiP: Eft !� � / Subtotal t C ) L -_ Minim permit the ($90.011) 1 City /Slate 0 . 00 Phone: l C Fax:) �)� ��, Pl an review (25% of permit ice) ( CCH lie.: - 7(P5,9 1 State surdiargc (12% of permit fee) (t) v t TOTAL PERMIT FEE L()d. S This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. k to / / y i Date: I - I See methodology set by Tri -County Building Industry Service Board Print name: fr / / /��' 111���-- -CCC"' � , . . --. M 470.4617T411 'I18)