Permit 17- CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00437
Date Issued: 08/20/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 115AD07500
Jurisdiction: Tigard
Site address: 10521 SW RIVER DR
Subdivision: Lot: 0
Project: Hyde
Project Description: Replace existing furnace and A/C. A/C unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
HYDE, LORRAINE Description Date Amount
10521 SW RIVER DR Air Conditioning or Heat Pump 08/20/2009 $14.00
TIGARD, OR 97224
Furnaces < 100K BTU 08/20/2009 $14.00
PHONE: 503 - 624 -0872 12% State Surcharge - Mechanical 08/20/2009 $8.70
Minimum Fee Adjustment - Mechanical 08/20/2009 $44.50
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97223
PHONE: 503 - 624 -2704
FAX: 503 - 598 -0270
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
•
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: emil
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Atsg 19 09 12:31p Columbia Heating /Cooling 503 -598 -0270 p.2
Mechanical Permit Application FOR OPI:fl 1 -t'SE ONLY
City of Tigard R FF! V' . 600 0 6y' -, i %• Penni, Tkry E r a00 r J ' -o 4 737
1312 SW Hall Bled„ Tigard, OR 9722.3 ' 'Pla Review
>s pther Phone: 503.b3 .4171 Fax: 503,598 1440 AUG 1 � 2 0 C Date/Br
Inspection Line: 503.639.4175 0 „ Date Ready/gy: tolls: 0 See Page 2 for I
T[GItR'D Intcmct: www.tignrd- or.gov Notified/Method: /&*". Supplemental Information
_ CITY OF TIGAR
TYPE co' 4VORICJA - i + (,DIV ti, ti t0IVRVIERCIAL;, 'EE` . .SCHEpUGE - ; FUSE -CU CKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value" $ •
. CATEGORY OF corlSTRU :TTQN _- . -.. ; . : `. _ - : r ;,, - .., ....... " E U $ NT 1, SY S T EMS : I?EFS*
RE.SXI?El.!l'S�;EQ.. - .
PI- and 2- family dwelling 1 Commercial/industrial E] Accessory building
For special information use checklist.
❑ multi- famil ❑ Master builder ❑ Other: Description 1 Qty. I Ea. 1 Total
JOB SITE LNFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address: i 05 - 2_ ( S 7t2.,1„r,-„ p_..0 (requires site plan showing placement) 1 14.00
City/State/ZIP: ----1—` Furnace 100,000 BTU (ductstvents) t 14.00
j ✓ — Q b 7 2 "z Y Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14
Crass street/directions work 14.00 ons to job site: 14 00 ]
Hydronic hot water system
Residential boiler (radiator or
hydronic} 14.00 j
Unit heaters (fuel -type, not electric), .
in -wall, in -duct, suspended, etc. . 10.00
' Flue /vent for any of above j 10.00
Subdivision: Lot no " Other'. 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00 l
Gas fireplace 10.00 I
11 s- ���� L a4 G s— Flue vent for water heater or gas
J fireplace 10.00 I f
• Log lighter (gas)
10.00
' Wood/pellet stove , 10.00
Wood fireplace/insert 1 0.00
❑ PROPERTY OWNER I
Chimney/liner/flue/vent __ 10.00 TENANT Other. 10.00
Name: Environmental exhaust and ventilation
/ r/4�� -f- i // ``� Range hoadlothcr kitchen
Address it o5 z _ ( S C,..) t''\ c ` ,..._ c• ,� c.. equipment 10.00 _
p Clothes dryer exhaust i Q00 -• Cig' /State/ZLP: *`� ^ e vr/� t2 c 1 - 2 2 t
44 a � Single-duct exhaust (bathrooms,
Phone: { Fax: ( ) toilet compartments, utility room) 6.80
3 ) ., a y_ og7
Attic/crawlspace fans 10 -00
❑ APPLICA\T 0 CONTACT PERSON Other: k 10.00
Business name: 1 Fuel piping
• Contact nam e — I y $5.40 for first four; 51.00 for each additional
Furnace, etc.
Address: Gas heat pump
City /State/ZIP: Wall/suspended/unit heater .
Phone:
Jk Water heater
�3 )& - ;1 - 70L 7 ` Fax:: ( )..S"--- d U Fireplace
E -mail: Range
• ' CONTRACTOR , • Barbecue
•
•
6 / 14 r / Clothes dryer (gas)
Business name: ( / Wr t //L �j ! Other: I
Address: q0 IS e X ,. 3 a 3 1 I /vJ l • :.: M PERMIT FEES*
City/StatelZIP: � ll 6 flo / /2 r;? 2kl Subtotal
Minimum permit fee ($72.50) '7 -5
Phone: (S ) b } `/ -.2- - 7) Fax: ( 93 ) ,c - . ? d. 7 --'•7d plan review (25% of permit fee)
CCB lie.: 71 3 s ' f I State surcharge (12(1'0 of permit fee) t ', 70
0 ----
TOTAL PERMIT FEE R7. AO
• This permit application expires if permit is not obtained within 180
Authorized signature: / days after it has been accepted as complete.
Print name: '\pniA k A7 .,C, , (Date: �1 f / , ` Fee methodology set by Tri Building industry Service Board
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.:,,.xr,k .$n •L;,.hZ•+uSic4�f,�,y*,s{ . • •
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HEATING & COOLING, INC.
F.O. BOX 230397 TIGARD, OR 97261
(503)624-274
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