Permit CITY OF TIGARD MECHANICAL PERMIT
ill
m : COMMUNITY DEVELOPMENT Permit #: MEC2012 -00267
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 1 S 136ACO3801 •
Jurisdiction: Tigard
Site address: 10820 SW 74TH AVE
Project: Kemmerer Subdivision: METZGER ACRE TRACTS Lot:
Project Description: Oil to gas furnace
Contractor: COLUMBIA HEATING & COOLING INC Owner: KEMMERER, SARA
PO BOX 230397 10820 SW 74TH AVE
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 780 -5747
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/23/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/23/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/23/2012 $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. ���11 A�nnn
Issued By: Permittee Signature: D/ll� ttml
___Ajiy2deti_tik 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.
May 22 12 03:23p Columbia Heating /Cooling 503 - 598 -0270 p.2 91
Mechanical Permit Applicat
$� CEIVED Recei•.ed Penntt aoia_po,, - �
City of Tigard Uate:Ap siaN/
1114
13125 SW Hall Blvd., Tigard, OR 9 7223 Plan Kevin.:
Phone: 503 718.2439 Fax: 503.598.19` i ll AY 2 2 2012 DMelB pm Permit:
- r i G A RD Inspection Line: 503.039.4175 Uric Ready; By: [urie: fa See Page 2 for
Internet: . www..tigard•oegov Naiii eevlert.od: "( Suptdemcntal Information
CITY OF TIGARD "(
.. ..::. ........ E:. . NG MINIS Col1SMERCIAL FEE" SCQIEDULE
....._ :- -;TYP : .., . � . � ,.� . USE cd>acicLtsr.
Mechanical permit fees* are based on the value of the work 1
0 New construction f 9CddilicnYt teration'i r placement performed. indicate the value (rounded tL the nearest dollar) oral) 1
0 Demolition D Other: ' mechanical materials, equipment, labor, cvcnccad, and profit.
Value: - ., . -
.::. fir �F,lr(I!FRI1flGTIN ` • .
_ -. IZESlDiiT"l7AL EQUIPMENT'S YS'CEMS FEES"
• D d 2- family dwelling ❑ Commercial/industrial ❑ Act ssor'y building For special Information use dreefilst
❑ Multi- family ❑ Master builder ❑ Other. • Description 1 Qty. I Ea. 1 Total
• . 11 eatitgrcooling•
dfl . - _ . •IIVFOBR9AFIOY AND Ii QCATION
^ Air conditioning
Job site address: I C)4601.0 �2-.j �/ yr& /� r ( (require sttc plan shtn mu placv�nent) `' 4(i.75 1
Cit :Stalc,ZlP: �-A / 1 /'7V g � ? fultlace 104 37U (dw[s•'vemal ]G. 46.'.5 I
r �� f) �i d/t ote� J Ptcnace I00 R'fll (chat:venni 54.91 1
Suite!bldg./apl. no.: Project name: bloat pump
(requires site plan showing placement) 61.06
Cross strcet+dircctions to job site: Duet work 23.32 • A .
llydronic hot water system 23.32
Residential boiler {radiator or
hronicl 23.32
- Unit heaters (fuel -type, not electric),
iu- mrall. in -duct. suspended. etc. 46.75
Subdivision: Lot no.:
Fluelvent for am• of above 23.32
•Other. 2132
Tax map/parcel no.: a Other fuel appliances:
. ' , •. - . DBSCR1PTHOAI ;OF . Wp Irk ..: :, .•._.. water healer 23.32
01 L Tp As Fot,v Gas fireplace
33.39
Flue vent for water halm or gas
fireplace I 23.32
Log lighter (gas) I 23.32
Word /pellet stove I 33.39
Wood fireplaec/insen 23.32
. .. Chimneyiliner /luefveat 23.32
El- PItOPEai'fY OVi9YER •� ,, r ; ._ .: ; , r •, � •�= i B"AiV'i
o Other. 23.32
Name: S n1.4- /c6 si EA6t- Environmental exhaust and venlilatiu
Address: i 0 S4.4 r? y rff Ali& . Ran hood+'other kitchen - T
equipment ,3.39
CityiState /ZIP: / Ir ( az ,h41. Clothes dryer exhaust t 33.39
Single -duct exhaust i had)mnnis. •
Phone: (I y ) r7 _ 579.17 Fax: l ) I toilet compartments, utility moms) 23.32
® •APPIdCAXE.. : .. :.0 c0N TAcr PERSON... AttiJcrawlspaee Pans 23.32
:u.. _ - ,.... ether. 23.33
Nosiness name: Columbia Heating and Cooling, Inc.
Fuel piping:
Contact name: Martens Meednan ___ SI4.15 for first four: 5-L03 for each additional
Address: PO Box 230397 I Ftvnace. a :e
Gas heat pump
City /State /21P: 9 7291 ,walli suspendcdiunit heater
Phone: (503) 624-2704 ( Fax.: (503) 598 -0270 water heater
Fireplace
E -mail: cotumbhr @teleport.com '
Range
COA77tACIOR-,., .
.. ,. - Barbecue
liusine' name: Columbia Heating and Cooling, Inc. i Clothes drier (i(ns)
Address: PO Box 230397 Other __ - _ __-. . tHlsci#a �nCn[, .. .. r Fees
- -
City /State2IP:Tigard, OR 99281 Subtotal 'Al./S.
Phone :1503) 624-2704 Fax (503) 598 -0270
Minimum permit fee 590.(h)) Li 9.2 5
Plan review (25% of permit fee)
CCB lie.: 763,59 State surcharge (i2 %ofpc mit fee) I
_ TOTAL PERM T FEE /Ob. SI)
71sit permit application expires if a permit it nut ebtaiacd within tan
Authorized signature: days after It has been accepted is complete.
Print name: Martens R Meednm Dale: 5 - -AG • tea uK liodolopv su by 71i- County Buik/inl hiduriry Semi= Bunt:
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