Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00135
T i G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
Parcel: 2S114BB15800
Jurisdiction: Tigard
Site address: 16096 SW 103RD AVE
Project: VANKLEEK Subdivision: RIVERVIEW ESTATES Lot: 4
Project Description: furnace replacement.
Contractor: COLUMBIA HEATING & COOLING INC Owner. VANKLEEK, CRAIG
PO BOX 230397 16096 SW 103RD AVE
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -2704 PHONE: 503 - 307 -8451
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces <100K BTU 03/14/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/14/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/14/2012 $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:
J �-
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.
Mar 1412 08:07a Columbia Heating /Cooling 503 - 598 -0270 p.2
'RECEIVED
Mechanical Permit Application FOR OFFICE List: °NIL
City of Tigard AR 14 2012 Received
13125 SW Hall Blvd., Tigard OR 972 oaeB Mme i= • i S
V g ' Phone: 503.7182439 Fax: 503.598.1M OF TIGR�D Plan Re`W'r Met Permit:
DarcBy:
f I c.; A I: D Inspection Line: 503.639.4175 BUILDING DIVISION Dare Readyihy: El See Page 2 for
Internet: www.tigard Nolified/Meohod: , Supplementallnformndon
- ,..,.. .. .... L USE CHECKLIST
Mechanical permit fees' ant: based on the value of the work
❑ New construction E Addition/eltetationireplac emenl performed. Indicate the value (rounder' to the nearest dollar) of all
❑ Demolition 0 Other mechanitml materials, equipment, labor, overhead, and profit.
F
- 'a:, . r q .•AIh OSY' .; F ; f'D3 - 1C�ION - , : "r: .r. • • FEES'''.
r. RESIDENT/AL �QU1PMEhr[' r 5Y3TEMS.
[2.1 and 2 d yelling ❑ Commercial/ industrial El Accessory building F peclo.! info ion disc/riot
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. I Total
- -:.., .. r _ . Heating/cooling: toolin
. . JOB :$Ii'$, Il!�FOItMA'1fJ(ilSt :iA.trlD LB�AI'ION: ; ° :' conditioning 7
Job site address: / y o 5 ( 3-w /Q 7 / . t /t A e � lrcq;tin: site Wan Bliovri q PLutnctgl �[ 1 46.75
Y Furnace 100.00(1 BTU tdra tsr.ent9 :. r"•• 46.75 I/4. •1 "IF
City /State /ZIP: 774 47 0,e. 9P,2-0.21/ Furnace 100,000 - 13TU 0,w:1 :ems) 54.91 1
Suiterbldglapt no.: [ Project rla ie: osra j<t e Item pump
(requires aka plan showiasplacartem) 61.06
Cross streetltiirections to job site: 1 Duct work 23.32 • q...
.11ydronie hot water system _ 23.32
Residential boiler (radiator or
hyd.mnic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, induct, suspended, eta 46.75 _
Subdivision: Lot uo.: Flue /vast for any of above 23.32
Other 23.32
Tax map/parcel no.: Other fuel appliances:
2332
' D-C6r- C (+ AN4E- a Gas fireplace 33.39
Fluu rent for water heater or gas
fireplace 2332
Log lighter (gas) 25.32
Wood/pellet stove 33.39
Wood fireplansert 1 23.32
0.P.ERT* :- ..O1315NEg'.. : ;,7•:: :: ,.'` . :. :. -. : ChimrleyJliner /Rue/vent 23.32 •
�r +s1 /t
Other. 1 l 23 .32 _
Name:
C VAN E-E K Environmental exhaust and ventilation:
Address: / co I ( S ' /0 J ,d`cf R ange hood/olher - - - - -
equipment 3339
City /State/ZIP: 'OK AR;, 02 9i?aA_ Y Clothes dlr erexhaust 33.39
Single-duct exhaust. (bathrooms.
Phone: 603 To _Bli f Fax: t ) toilet compartments. utility rooms) 23.32 ,
: .. .= ' :. A.PPL1C NT :,: : :.' : - - aj. .CONTAC{'.'-,PERSON. • Aniekrawlspat;efans 2332
Business name: Columbia Heating and Cooling. Inc. Utter 23.32
...
` Contact name: Marlene Meedom S1t.15 for first four; 54.03 for each additional
Address: PO Nos 230397 Furnace. etc.
Can heat pump
Cie SteterZTP: 97281 Walt/suspended/unit heater
Phone: (503) 624 - 2704 , Fax: : (503) 598 - 0270 Water heater
Fireplace '
E -mail: columbbe;o3teleport.com Range
lusiness name: Columbia Beating and Cooling, Inc. Clothes dryer (ens)
Odic';
Addre. : PO Box 230397
. :. `' • • rMECkANPCAL PERSLtT FT.ES
City /Stale/21P: Tigard, OR 97281 - -- Subtotal iz, . 7
Phone: (503) 624 Fax: (503) 598 - 0270 - Minimum permit fee (590.00) ' ' .tj
Plan review (25% of permit fee) -----
CCB tic.: 76359 State surcharge (I2a/ of permit fee) >a Jr)
TOTAL PERMIT FE
Authorized signature; j( LA - Thiv permit application espirsa ifs permit is not obta fled within 180
daps after k has peen aaepted as complete.
Print name: Marietta R Meedom Dale: T.. f y -/•1 ' fu: ncthuduhtgy act by Tri•Cuwtty Building Industry Service Berard
6 •,u..u.,..o..�., As. .w nu :nWtn 340.4fiiTr el 1.a!"r(W w•FR