Permit CITY OF TIGARD MECHANICAL PERMIT
'' ` , COMMUNITY DEVELOPMENT Permit #: MEC2012 -00075
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/08/2012
Parcel: 1 S133DD00300
Jurisdiction: Tigard
Site address: 11601 SW 129TH PL
Project: BURROWS Subdivision:'ILLAGE AT SUMMER LAKE PARK NO Lot: 42
Project Description: Gas furnace replacement.
Contractor: COLUMBIA HEATING & COOLING INC Owner: BURROWS, THOMAS P
PO BOX 230397 11601 SW 129TH PL
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 579 -7638
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 02/08/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 02/08/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/08/2012 $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 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:
iG: — / - — .0 4411
Call 503.639.4 75 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.
Feb 07 12 12:41 p Columbia Heating /Cooling 503 -598 -0270 p.2
Mechanical Permit Aulicatiol EC EI F
:r OReceEJ- d
.
City Tigard Date.: A Penn:t No. : Mh i C ��' [ 5
131SW W t tall Blvd.. Tigard. Ott 9722.1 FEB I ►q 2 0 1 2 ! Plan , • I I
Phone: S03.713 2439 Pax: 503.598.1960 Pamir l r ato By: Other Pa
i t TI G A I.l7 Inspection Line: 503.639.4175 l�STt� /� T f� fi P � L.ate Ready od luny ill See Passe 2 for
interne:: wwtv.titzard- or.eov CITY t t LJF 4 Ii„'gr"1�•il„I 1 Notified•'Me $ l
• uppeme information
normaton
BUILDING DIVISION i 1 .
TYPE: OF': WORK COMivfERCIAL FEE' SCGIEDL'LE - USE CHECKLIST
•
Mechanical pennit feess arc based on the value of the work
❑ New construction k Addition /alterationireplacement performed indicate the value (rounded to the nearest dollar) of ell •
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and arofit. •
Value: $ , • _.. CATFC,O lr OF' : CONSTRU ': __ON • . RESIDE _\CIAL•EQUIPMENT1SYSTEMS.FEES
V I- and 2- family= dwelling 0 Commercial/industrial ❑ Accessory building F o r speciaiinformation use check/iv.
❑ Multi-family ❑ Master builder ❑ Other: Description 1 City I Ea. 1 'Final '
JOB 'SITE IP1 ORh1.4TIO3r AND LOCi3T[ON rlttatin'cooting:
1 Air conditioning
Sob site address: - i • ( j I - h - I L ` , i rapines site plan sheering ptace,nent) 46.75
C ity /State ZIP: `�>i /�' , 1 �L `] "'� � Furnace 100.000 BTll;ductshunst �� 46 75 46,
+t ° Furnace 100,000+ B'f U 011(achevs) 54.91
Suite bldg. /apt. no.: Project name: /e/L01111 -0 1 Heat V
J WV
site plan showiegpincmnertl 6(.06 I
Cross street/directions to job site: Duct work 23.32 • A.
11 •dt'orie hot water syste:n
23.32
Residential boiler !radiator or
hydronicI 23.32
. Unit heaters (fuel- type, not electric). \
iu- viall. in -duct, suspended. etc. 4625
Subdivision: lot no : Fluelvent for any of above 23.32
` , Other 23.32
Tax map: /parexl nu.: I Other fuel appliances:
1)ESCCRIP3'ION. woo* ., Water healer 23.32
Gas fireplace 33.39
Flue vent for walcr heater or gas l
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
' Wood freplace :insert 23.32
PROPERTY OWNER .. ' ' ❑ TENANT' Chimney /liner /lluc"vent I 23.32 •
. .. Other: r __3.32
Name: i.ja, t . _'L•. . 1 Environmental exhaust and ventilation:
! ��1 • ----
Address: a . • , Range ood,`other kitchen
n
� equipment. 33.39
City /Statc'ZIP: ..,„ 111 1111 PEDINg i Clothes dryer exhaust 33.39
50 5-1 a ` ` � . sin exlr utsl. (
Phone F a x ( ) - 1 1.32
� toilet compartments, utility rooms)
El APPLICANT 0 CONTACT PERSON,. Attie /crawlspacefans 23.32
Business name: Columbia Heating and Cooling, Int. Other. 23.32
... Fuel piping: 1
Contact name: Marlena Meedom 514.15 for first four; 64.03 for each additian>:il
Address: PO Box 230397 Furnace, etc.
Gas heat pump
City/State/ZIP: 97281 Witt Ususpendcd/ heater
Phone: (503) 624 - 2704 Fax:: (503) 598.0270 Water healer
Fireplace I
F -mail: columbhe(a�telcport.com Rang
• . - . CONT RACTOR ' - Barbecue
business name: Columbia Heating and Cooling, Inc, Clothes dryer (gm)
Other.
C ddr e tate,71P: Tigard, E
N
Address: PC) Box03 �._._..— _.- ......_.. __ -_ - -- _
OR 97281 _ -- CALPERMITFEES*
` Subtotal 1 16•4 , 7‹;
Mininutm permit fee ($90 .00) eiv. c1-)
Phone: (503) 624 -2704 Fax: 1303) 598-0270 Plan review (25% of permit fee)
CCB lac.: 76359 State surcharge (12% of permit fee) `(_L
TC}TA PERMIT FEE ica
f .e Tbo pe rma a ptdieation expires ilia permit i�. nut obrained within - _
AF7titot7 - Led signature: • �,. days after it has been accepted as complett.
Print name: Martens R Meedom I Dale: s Fee med'odolegy so by Tri- Cuacty IIuitding !ndusrry Sen ice Hoard
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