Permit ' q CITY OF TIGARD MECHANICAL PERMIT
: a COMMUNITY DEVELOPMENT Permit #: MEC2012 -00484
T [ G ARD. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/24/2012
Parcel: 2S104BD04400
Jurisdiction: Tigard
Site address: 12774 SW 138TH AVE
Project: Kaplan Subdivision: ROSE MEADOWS • Lot: 3
Project Description: (1) A/C replacement Must maintain 5' side yard setback and approved rear yard setback
Contractor: COLUMBIA HEATING & COOLING INC Owner: KAPLAN, DANIEL
PO BOX 230397 MANN, ALLA
TIGARD, OR 97281 12774 SW 138TH
TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 631 - 523 -3379
FAX: 503 - 598 -0270
FEES . '
Specifics: = Description Date Amount
Air Conditioning 09/24/2012 . $46.75
Type of Use: SF 12% State Surcharge - Mechanical 09/24/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 09/24/2012 $43.25
Occupancy Grp: -
Stories: -
Fuel
Fuel Types:
Gas Pressure:
' . Total $100.80
Required Items and Reports (Conditions) '
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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: DAL tl pine J1�n of
_
- Call 503.639.4175 by 7:00 a.m. for the next available inspection date.' �"� ( t
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.
09/20/2012 05:22PM 5035980270 COLUMBIA HEATING PAGE 02/03
'-; Mechanical Permit ApplicatioR
tV)It Otl l( 'F t ,1: O11.\
City of s
• Tigard �i Y' a fvedd /
!3125 SW Hall Blvd. Tigard, O R � ntr s 4 � 04'1 a• � Permit Nc•:
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■ Phone: 503.718.2439 Fax 593.598.1960 S E P 2 4 2012 gar , 97223 �'�f f�,,f •
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Plan Review
I r i ; A r; r, Inspection Line: 503.639.4175 Date/By: other Permit:
Internet: w ww.tigard- or.gov Date Ready/ luris 6d S« Page 2 for
CITY /Zt' r(�� - - NotifiedMiethod: '� Co S upplemental inror
' 'n.Fr:��1 >t� ,r�.rte '•r: � l.Jt i f OF i t f"�
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; '� ' -: a? , i4x •tkn � t ,..., f 1 j ;. *;t 1 1 °C� 'a) � 4j 1 �� (" � 9� 3 a e s Y �c
�� w,: h... + A ��`�'���• i"E CC1C1.13T
[] New construction l ddition /alteration/replsuement
0 Other: Mechanical permit fees* we bayed on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of t
❑ Demolition
mechanical materials a ui ment, labor, overhead, and rofit.
•� AY M 'i t , t i tl d , 1) + , . t -e 1 .1 . ' i �� ,, 4qqf Va
r 1- 2-family dwtltin {`;` - La%;i: age. ig'2,2,?i ,:a>� l ti e.;,.. ' •
;:i Y g ❑ Commercial/industrial ❑ A ccessory building For special inform:/0a use checklist.
❑ Multi family t] Master builder
,* ,_ � ❑ Other Description .. �'Ta „� � '� � , _ 1 Qty. f Ea. Total
fME e '
co . 1 r f a t 4, 7 A i ti4 coolie_:
s...r'i: . .... , r i
„ ;_ sh f ;•: .�.�N4?c AirHeaconditionin
Job site address: g r
(re- site plan showing placement) { 1 46.75
City /State/ZIP: 04_ -/ CW Furnace 100,000 811) (ducts/vents) 46.75
• I Furnace 100,000+ BTU (ducts/vests) 54.41
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Suite /bldg. /apt. no.: Project name: . in! . Heat pump
• Cross street/directions to job site:
to uiressite plan shown placement) 61.06
Duct work 23.32 -- A
Hydronic hot water system _ 23,32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75 -
Subdivision: Lot no.: Flue/vent for an of above 23.32
Other: 23.32
Tax map /parcel no.:
„ t z� Other fuel appliances: _
+4; �,, , ... ; :a t :1 r . ,..., ! r , `+ , } , 7 k 7 �... , t. 1 ..',::,_` � . 1 �i�,., Water heater 23.32
y , fG g4� f Cr -
Gas fir 18ce 33.39
Flue vent for water heater or gas
fireplace 23.32 _
Log lighter (gas) 23.32
Wood pellet stove 33,39
Wood fire laceJin 23.32
0 7; r 4 } 34, ; t { 4 � i i �?' r , S 7 n j t ^ ,, ,>+J, K i
+x a � „!. �t a lJ, ;,l ! , i { ' ChimneyAiner /fuC/vent 23.32
Name: lei /v/ L G .6/% 23.32
Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33,39
City/Stale/ZIP: Clothes dryer
ryer exhaust 33.39
Phone: ix ) _� 9 Fax: ( ) Single -duct exhaust (bathrooms. -
�, a i toilet compartments, utility rooms) 23.32
��: i r : t ', . - , ' w l i t:' l y :i ' !, ° i '+ $ ., �F c r ' i 15 Attic/crawlspace fans 23.32 -
Business name: Columbia Heating and Cooling, Inc. Other: 23.32
Fuel piping:
Contact name: Marlene Meedom _
514.15 for first four; $4.03 for each additional
Address: PO Box 230397 Furnace, etc.
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City /State/Z1P: 97281 Gas heat pump
Wall/suspended/unit heater
Phone; (503) 624-2704 Fax: : (503) 598 -0270 Water heater
E -mail: cotu,_/mbbhc@teleport.e0m Fireplace
Range
z a, Barbecue
Business name: Columbia Heating and Cooling, Inc. Clothes dryer (gas)
Address: PO Box 230397 Other.
4, 7 �': i ll J p "r, •i] : . 4 • t_.: ' -
City /State/ZIP: Tigard, OR 97281 �j r Subtotal
Phone: (503) 624 Fax: (503) 598 Minimum permit fee (590.00) -
CCB lie.: 76359 Plan review (25% of permit fee)
State surcharge (12% of permit fee)
TOTAL PERMIT FEE dD.
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Authorized signature: AL i J 1 r Thts permit applicati expire! if a perm is not obtained withi rgo f/
days after It bas been accepted as complete.
Print name: Marlena R Meedom q Date: ! - 20” /. • Fee metbodoiegy set by Tri.Coin,ty Building Industry Sec% - c Beard
oBuiiding PamitApp.dee 09/09/10
440 - 4617T txnrrn44nve11,
09/20/2012 05:22PM 5035980270 COLUMBIA HEATING PAGE 03/03
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HEATING & COOLING, INC.
P.O. BOX 230397 • TIGARD, OR 97281
(503)624-2704
SITE PLAN KOMAI
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ADDRESS -
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