Permit . ,� CITY OF TIGARD MECHANICAL PERMIT
' = COMMUNITY DEVELOPMENT Permit #: MEC2012 -00388
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2012
IIGARD g Parcel: 1S134AD02900
Jurisdiction: Tigard
Site address: 10820 SW BLACK DIAMOND WAY
Project: Luthor Subdivision: BLACK BULL PARK Lot: 17
Project Description: Replace A/C. Unit must meet 5' minimum side yard and applicable rear yard setbacks.
Contractor: COLUMBIA HEATING & COOLING INC Owner: LUTHER, LINDA L
PO BOX 230397 10820 SW BLACK DIAMOND WAY
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 639 -0690
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Air Conditioning 07/25/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/25/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 07/25/2012 $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: OA/ , - fir :7 ✓e i9 - 77c,
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.
07/24/2012 09:54AM 5035980270 COLUMBIA HEATING PAGE 02/03
RECEIVED
Mechanical Permit ApplicationlUL 2 4 2012 ror, o rlc t i. sr( 1.1
City of Tigard 7 _ rto
13125 SW HMI Blvd., Tigard, OR 972 d� T.�GAgD Qom �lECaaia — Do3,�;
Phone: 503.718.2439 Fare; 503.59Iat LDNG DIVISION pateigy � v
Other Paadr
r i ,., ,, , , Inspection Line: 503.639.4175 Date Ready!By: at See Merge Z for
Internet: www.tigard.or.gov Notifed/Method; Supplemental Information
tom.. .._. .77 F ,,,.•. :=.7: -
Mechanical penult fees' are based on the value of the work
❑ New construction Addition /alteradoWr placement performed. indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
®"band 2- family dwelling ❑ Commercial/industrial Q Accessory building For :peeled thromtatIon usec*edefis.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
_ _ _,y• `^— , %- �:- ---- t i.-. :
T � ` 't i,...:7-a,:,, 9 � ' "q�' T. li
'.:: '::,..:- ::_,,:. t
- � ,:. x4_ .:e.7-1-:,,--1.:;
L•�� 0
4 �= �.:.30�- ' � _ _ . , :�__. • �:. Air conditioning
Job site address: )O13 t 5 c . i (- ' /1 • /VNo ohi • (:e4aites see plan shoerina placement) •' 46.75
City/State/ZIP: fa • , / ft , i- Furnace 100,000 BTU (dects/vems) 46.75
. � � �� J Furnace 100,000+ BTU (ducts/vents) _ 54.91
Suite/bidgJapt_ no.: Project name: L, mem i U frog- H pump G thin alumina placement) 61.06
Cross strec ldirecuons to Job site: Duct work 23.32 • A_
Hydronie hot water system 2332
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in•wedl, in sus ded. etc. 46.75
Subdivision: ( Lot no.; Flue/vent for any of above 23.32
Other. 2332
Tax map/paroel no.:
Other fuel appliances
_. �,gt'f-.--1 p 1)s �� :±? ' ' - —; Water healer 23.32
J Ai c- /fir' cta-cem Esv r- • Cas fireplace 33.39
Flue vent for water heater or gas
ihrllaoe 23.32
Log lighter (Ras) 23.32
Wood/pellet stove 33.39
• Wood fireplace/rased 23.32
=
=,a - a.r.�_ - Cbimnlline
: eyNflnehent 23.32
.,_,::. •
. . �r rt' '�ihCt�c•� °_ -' ti •- • .v..n. ' @'_ \ , . yrn•r- ° =: -
# Other. 2332
Name; 1 / Nd . (/rt+CO /Z. Environmental exhaust and ventilation:
Address: / Q5. p s ridtcic r , / � � ONQ f,,r�y oodrother kitchen 33.39
City /State/ZIP: r` g J) Ci/� tc q'7 .2.11.f Clothes dryer exhaust , 33.39 • Single -duct exhaust (bathroom,
Phone: To / " O6' 1 O Fax: ( ) toilet eompartntsits, utility rooms) 23.32
_: - J. � , e ;' ,..i;-&-::7,-. -.7. J '? ' t '. e :�x�.� Attidcrawl pace fans 23.32
Business name: Colombia Heating and Cooling, Inc- 23.32
End piping:
Contact name: Mariam Meedom Si416 for first four, 5.03 for each additional
Address: PO Box 230397 Furnace, eta
City /State/ZIP: 97281 Gas heat pump
Wall/suspatded/anit heater
Phone: (503) 624-2704 I Fax: : (503) 598 -0270 Water heater
Fireplace
E -mail: colambhc®teleportcotn
a.F? s:Y. f� Range
v.. .A-�,i _ �,. _.::: S tis°::. t
,.r - ` _,rxs '� rl .eg (-. '....:� Barbecue
1 name: Columbia Heating and Cooling, Inc. Clothes drlier (eras)
Other:
Address: PO Box 230397 ; . .-r, a Y n y
City /State/ZIP: Tigard, OR 97281 Subtotal
Phone: (503) 624 - 2704 Fax (503) 598 -0270 Minimum permit fee (S90.00)
Plan review (25% of permit fee)
CCB tic.: 76359 — State surcharge (12% of permit fee)
TOTAL PERMIT FEE coo , , c t
Authorized signature' This permit application expires ita permit is not obtained within 180
days after it has peen emoted as complete
( Print name: Marlene R Leedom Date: 7' - i " Fix mcrhodology set by Tit-County Building Industry Service Board
n....v...so, 4.u.irr.o - w•,.•. M. numvin 6i0.srrr II 1A ll'OM)WGAI
07/24/2012 09:54AM 5035960270 COLUMBIA HEATING PAGE 03/03
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HEATING & COOLING, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503)6624 -2704
SITE PLAN AUTti
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ADDRESS: l Q8P O , 61 cic ,p/A i w y
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