Permit CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00161
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2012
Parcel: 1 S 125DB01500
Jurisdiction: Tigard
Site address: 7100 SW TAYLORS FERRY RD
Project: Jensen Subdivision: SHADY DELL Lot: 15
Project Description: Replace gas furnace
Contractor: COLUMBIA HEATING & COOLING INC Owner: JENSEN, RYAN
PO BOX 230397 7100 SW TAYLORS FERRY RD
TIGARD, OR 97281 PORTLAND, OR 97223
PHONE: 503 - 624 -2704 PHONE: 971 - 219 -9666
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/29/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/29/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/29/2012 $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 Notificati.. -nter. 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 q tions to O C b • ling 503.232.1987 or 1.800.332.2344.
Issued :y: ' 4/1 Permittee Signatu pC'/�- 1(
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 28 12 04:48p Columbia Heating /Cooling 503 - 598 -0270 p.2
>: • Mechanical Permit Applicatio \(+)
:1::;:::',.;!:: City of Tigard ; 'l Received
Q Permit No.: N d /
;.:.-: : IN I • 13125 SW Hall Blvd., Tigard, 0•( • 7 " ` rL % Ou g ' `���� � I
Play Review
Phone: 503.718.2439 Fax: ''�` : 1 % Date/By: Outer Permit:
T I G n R l) Inspection Line: 503.629 � � '
Internet: wtv'w.ti d-or. v `� '� R
o Really/By: ' I P mental Information
� \� �� ' `� � �� �( � " Notified/Method: � i f y
Supk pent 2 for
_ r�•: err: f :.. : ,•' ah ,.: ���ty^ t � b -
•• ; ;d: :`'07 _ - ..i ^`.:) sits; ?,5:{t. : r ;! 1'. ._'..-cO. .,,Nhi'..R,c, _ ,A,' ,r :,.. I a4r3:� ^ = - USEL' L�LISr
Mechanical permit fees are based on the value of the work
Nev; construction Additionialterat ��re laeement
m t P performed. Indicate the value (rounded to the nearest dollar) of a
❑ Demo':tion ❑ Other: mechanical materials, equipment, labor, overhead, and profit
�: f`�r-i� ' ' 1ha��' �l�Ys�'+i,' : :� Value: S
.. :di .��IT > ,a: :..
- y: •, ! $FSAI$NT EQUIPMENT / S'YST'EMS FEES*
`siel- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
• • ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. r Total
�7y��� 1..., Heating/cooling: •
,'.10 &'$1�`Ea=.�b ; �I(Qbi?,A; ria3p�j " ��+ :._i - - :� ; i �7 . ,.
f /�r� t Air �nditioning !
.lobsite address: �// Ir , ap 1 i /437/R" - (requires site plan showing placement) 46.75
• • City :Sate /ZIP: t , •[ ' l /7►�y� / ` ` ) Furnace 100,000 BTU (ducts/venis) j 46.75
� [ a f l t-�I l -7 . Furnace 100,000+ BTU {duasivenrs) 54.91 •
Suite/bldg.lapt.no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Ductwork 23.32 • A.
Hydronic hot water system 23.32
Residential boiler (radiator or ;
hvdronic) 23.32 f _
Unit heaters (fuel -type, not electric),
• in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: i Flue /vent for any of above 23.32
Other: 23.32
Tax map/parcel ro. • Other fuel appliances:
%. :03 t nnt'�, , l_� : :; � . v; i Water heater 3.32 •
��.�� ��'"�'"`��' + - •,,, .34�" 5� 7t;-q4;7:4734
-Y i! �� 3��I��� :fir {�;; :. W 2
4(+•• /L ^ � _ /`' --8` 1 m R t=iti rwix.y.:� ;. :1�_. ;-al :hah =..'s; �''.!
Gas fireplace 33.39
Flue vent for water heater or gas
fireplace • 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39 _
• • Wood fireplace /inset[ 23.32
•
•. PBO ilk! +� ; "is' x t la :.a te..ic :,q ?T� t; ;, Chimney /liner/flue /vent 23.32
r•t+r.•�.. c.Rs '^:t-. r. 23.32 Other:
Name: (� J -
• �� •i11C�f ] Environmental exhaust and ventilation:
•
Address: 7l i O - t . Range hood/other kitchen
...
• !! - t equipment 33.39
City/State/ZIP: pOrk � � 1 '� :{ Clothes dryer exhaust 33.39
97( - Single -duct exhaust (bathrooms,
.:
Phone: "l � Fax: ( ) toilet compartments, utility rooms) 23.32
:•!;:..., : ® - s; :: ;�{ "' , 1 p r•i r - . w'=' Attic.crawls ace fans Z
r • : - -? 4 ' p 3.32
L ` -. Business name: Columbia Fleeting and Cooling, Inc. Other: 23.32
Fuel piping:
Contact name: Ma rlena Meedom $14.15 for first four: 54.03 for each additional
Address: PO Box 230397 • Furnace, etc. I I
Gas heat pump
CitylS[a[e :ZIP: 97281 Wall/suspended/unit heater
• Phone: (503) 624 -2704 Fax: : (503) 598 -0270 Water heater
i Fireplace
E -mail: columbhe®teleport.com Range ;
: _
',s -�� � ..T� �;�.•� � : ,,�,��.�' Barbecue
Business name: Colombia Heating and Cooling, Inc. Clothes dryer (gas)
Other:
Address: PO Box 230397 ':., y` ,,_ , i i .. ;
a......:,,- -_.. AiE0:044d.P)9T.FBFS
City /State/ZIP: Tigard, OR 97281 Subtotal
Minimum permit fee ;390.00) 90•
Phone: (503) 624 -2704 Fax: (503) 598 - 0270 I Plan review (25% of permit fee) .-
C CB tic.: 76359 I State surcharge (12% of permit tee) /Q, ko
TOTAL PEEWIT FEE '9f). 5 )
Authorized signature: jAajduuck This permit application expires if a permit is not obtained within tae
days after it has been accepted as complete.
Print name: Marlena R Meedom Date: 3 -aA- f� / , • Fee methodology ser by Tri- County Building Industry Service Bo rd
I :iasilding',Pemrirs\MzC- Perm. , pp do[ 0949/10 0 440.4617T (I ,'o'C (°.$41