Permit a CITY OF TIGARD MECHANICAL PERMIT
I — a - COMMUNITY DEVELOPMENT Permit #: MEC2012 -00525
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 10/11/2012
Parcel: 1 S136CB08800
Jurisdiction: Tigard
Site address: 11084 SW 81ST AVE
Project: Dees Subdivision: HERB AND PEGGIE'S PLACE Lot: 26
Project Description: (1) heat pump add on Heat pump must maintain 5 side yard setback and approved rear yard setback
Contractor: COLUMBIA HEATING & COOLING INC Owner: DEES, DANIEL L SHIRLEY M
PO BOX 230397 11084 SW 81ST
TIGARD, OR 97281 TIGARD, OR 97223
PHONE' 503 - 624 -2704 PHONE: 503 - 863 -6753
FAX 503 - 598 -0270
FEES
Specifics: Description Date Amount
Heat Pump 10/11/2012 $61 06
Type of Use: SF 12% State Surcharge - Mechanical 10/11/2012 $10 80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 10/11/2012 $28 94
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 ` 2322 1987 or 1 800.332.2344 //�,/�� �\
Issued By: C Permittee Signature: ad Pl�Lf C:f„l! [oll:
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.
10/11/2012 11:53AM 5035980270 COLUMBIA HEATING PAGE 02/03
:'' Me chanlical Permit Arwiicatio E , I
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City of Tigard 1!, • evolved
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' • 13125 SW Hall Blvd., Tigard, OR 97223 OCT j 1 Date/By: ' Penult "0 1 .0 . C ., 6/4b2 . ! Q7S•��
u Phone' 503.718.2439 Fax 5 03.598.1960 2012 P� Review
1 4 4 action Lute. 503.639,4175 Date/By: Other P ermit Ilil/ \I:.i) p ary O FTAD DateReciT
tV11� J t ""'
Q/ 11� Nottfi(n El See Page E for
Internet www.tigard-or.gov
�JV1 , Supplemental Information
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❑ New construction C ddttton /alteratton/replacCment Mechanical permit fees* are based on the value of the work
0 Demolition performed Indicate the value (rounded to the nearest dollar) of t
[I Other mechanical materials, equipment, labor, overhead, and profit
e $
' 'i G 1• and 2-family dwelling ... • ...� y., Valu : ": �.:, - ,
Y g ❑ CommerCial/industrial Q A ccessory building For :pedal Information use cheekiest.
0
Multi family [] Master builder _
Othe Description 1 Qty. I Ea I Totai
/ ruK / '�.� , .. s i : ,iii r. i + f Hting/ooingi
//0� _:t w ,,n� : >. n.r l•; Air condi l tog
Job site address. / . r
� - V � if/e (requires site plan showing placement) 46.71
City /State /21P. / Furnace 100,000 BTU (ducts/vems) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt no.: Project name: / e Heat pump
Cross street /directions to job site: (requires site plan showing placement) X 61.06
Duct work 23.32 • •
Hydronic hot water system 23.32
— -
Residential boiler (radiator or
Jiydronic) _ 23.32
Unit heaters (fuel -type, not electric).
in - wall, in - duct, suspended, etc. 46.75
Subdivision; Lot no.: Flue/vent for an_y of above 23.32
Tax map/parcel no.: Other: -
23.32
T t.,,, , Other fuel appliances:
_ .... Water heater 23 32
U �P D Oil J Gas fireplace 33,39
Flue vent for water heater or gas
_`__ fireplace 23.32
Log lighteligEITW11.1.1111111111-- 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
'ita''J , : ' ;;) Chimney/liner/flue/vent 23.32
Name: # . N , E E j-- Other' _ 23.32 _
Environmental exhaust and ventilation!
Address: C • 1
//O ; W 8 / E Range hood/other kitchen
• equipment _ 33.39 _
City /State/ZIP: • D C Clothes dryer exhaust `
• Phone: (50j) (7r Fax; ( ) Single -duct exhaust (bathrooms. 33 39
3). w 7 „ .._. A n i c compartments, utility rooms) 23.32
.,•'`L" . -4 a t ' ` ,. . I_ " . - ' ' , .. r, �.i ,'•
AtciGcrewlspace fans 23.32
Other, 23.32
Business name: Columbia Heating and Cooling, Inc.
Contact name: Marlene Meedom Fuel piping:
$14.15 for first four, 54.03 for each additional
Address: PO Box 230397 Furnace, etc.
• [
City /StnterLlP: 97281 Gas heat pump
Wall/suspended/unit heater
Phone: (503) 624 -2704 Fax: : (503) 598 -0270 Water heater
E-mail: eolumbhc@teleport.com Fireplace
Range
• LCA: r tit a .._ .a .._ ... . I .,.•_ ' v .i Barbecue
Business name: Columbia Heating and Cooling, Inc. Clothes dryer
Other:
Address: PO Box 230397
City /State/ZIP: Tigard, OR 97281 Subtotal
Phone: (503) 624-2704 Fax: (503) 598 -0270 Minimum permit fee ($90.00
Plan review (25% of permit fee)
CCB lie.: 76359 State surcharge (12% of
permit fee)
_ TOTAL PERMIT FEE �
Authorized Signature:
This permit application expire if a permit is trot obtained ,rich Igo
days after it bee been accepted as complete
Print name: Marlene R Meedom — Date: / j / / — 1 • pec methodology set by Tri- County Building In d,suy Service Board
•
I. I611ildiog \PermiteocC.PermkApp.d oeros 10 d 44O - 461 rt im dereLo vet.
10/11/2012 11:53AM 5035980270 COLUMBIA HEATING PAGE 03/03
ar
HEATING & COOLING, INC.
P.O. BOX 230397 - TIGARD, OR 97281
(503)624 -2704
SffE PLAN A) e �s
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ADDRESS: If °c i i4j 8f A UE