Permit CITY OF TIGARD MECHANICAL PERMIT
11. • COMMUNITY DEVELOPMENT Permit #: MEC2013 -00002
T WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/02/2013
Parcel: 2S104DD02700
• Jurisdiction: Tigard
Site address: 12859 SW RIDGEFIELD LN
Project: Salamat Subdivision: MOUNTAIN HIGHLANDS NO.2 Lot: 24
Project Description: (1) gas furnace installation
Contractor: COLUMBIA NW HEATING Owner: SALAMAT, FRANK
PO BOX 622 12859 SW RIDGEFIELD LN
SCAPPOOSE, OR 97056 TIGARD, OR 97223
PHONE: 503 - 543 -3624 PHONE: 503 - 449 -0682
FAX: (503) 543 -6285
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/02/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/02/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/02/2013 $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: /� /4.0/21/ / /i 4 TDl
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
C ' f
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.
Mechanical Permit A plication RECEW I
s lop 01..1..1(. l: (, mix
City of Tigard Received
`�1�
13125 SW Hall Blvd JAN 0 , Tigard, OR 97223 � 2 D ocdBy : / Permit Nn � { GL
_,_ � ", 3 --0000()-- SS
Phone: 503.639.4171 Fax: 503,598 -1960 Plan Review'
T 1 C;:14 t) Inspection Line: 503.639.4175 CI Dateray: Other Pe ,,�t;
�'Y OF TIGA I• Re.do3y, mi RI See 'Page 2 for
Internet: www.toprd -ougov BUILDING PI sf tt dettmd
Supplemental 7nihrmMkon
- nen OF WORK • COMMERCIAL ME SCHEDULE. - USE CrIECKLIST
O New construction VAddition /alteration/replacement Mechanical permit fees* are based on the value of the work
Detuolition Other performed Indicate the value (rounded to the nearest dollar) of all
mechan malt ta, ent
, c�uipm. labor, overhead, And profit
CATEC,ORY OF CONSTRUCTION _ value: $ _
gg 1- and 2-family dwelling El Commercial/industrial. ❑ Accessory building . REs1J L Ell , _ . . 4T I SYSTEMS FEES
LI Mltlti - fame] Other: For s pecial information checklist.
use checkl
Y p Master b uilder _ - (
Description L Qty. I Ea_ 1 Total
.IOU SITE INFORMATION .AND LOCATION tttatinglcoaling
Job site address; i S f � Air conditioning
(regmms site plan showing ptec..ams) 46.75
City/State/ZIP: :La • . llnrrac , 00013'IU(arrct, , 46. t1�75
name: Furnace 100.000+ BTU(duets/vents) 54.91
Suite / bldg. /apt. no.. Project R --- Han ptunp 61.06
Cross street/directions to job site: Duct work 23.32
Hydronlc hot water system 23.32
Residential boiler (radiator or
hydrunic) 23,32
Unit heaters (fuel -type, not electric).
in -wa11, itlyduct, ended, etc, 46.75
Subdivision: ot no.' Flue/vent for any of above 23.32
fir; 23.32
Tax map /parcel no.: Outer fuel apidlftneea _
DESCRIPTION OF WORK Water heater 23.32
:n n h Gat fireplace 33.39
It iLki C L Flue vent for water heater or gas
frrcylace 23.32
--� — , l lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insect 23.32
V PROPERTY OWNER J 0 TENANT Chimney/liner /flue/vent 23.32
Other: 23.32
Nam `/Jj � rrr}}} / / - y ' /A(/ Environmental exhaust and ventilation
/ 2 /5 L_ 5_4_, � { J 4 r lam! N
Range hood/other kitchen
Address:
!l _ equipment 33 -39
City /State/ ? - -.TP: Z � - t Clothes dryer exhaust
33.39
Single-duct exhaust (bathrooms
Phone: t e L q 6 47 Fax: utility )
Y ( ) toile compartments, util' rooms) 23.:,I2
Ia APPLICANT 0 CONTACT PERSON , AtticJCrnwispaocfane 23.32
Other Business name: Same as Contractor 23.32
Fuel paw ,
Contact name:
__ $14,I5 for first four; $4.03 the each eddltloatal
—
/lddrec9; Furnace. etc.
Gas heat pump
City/State/ZIP: Wall/suspended/ueit heater
Phone: ( ) I Fax: : ( ) Water heats
E -mail:
Fiscplacc
Range
CONTRACTOR Barbecue
Rosiness Warne: Columbia NW Hearing Clothes dryer pa
- - Other.
Address: PO Bbs 622 SAN CAL PERMIT FEES*
City/Stara/ZIP: Scappocnc, OR 97056 Subtotal 1.16.75
Phone: (503) 5433624 Fax; (503)5436255 Minimum permit tee ($90.00) go. 60.
Plan review (25% of permit fcc)
CCD lie.: Q947 State surcharge (12% of permit Tee) /(f .
l TOTAL PERMIT FEE Q
Authorized signature: ' V Taft permit applicuttue expire* Vs permit ei sot obtained ..tthtn 180
Print na C•n r� Jacobson Date: after k Fags been *erupted ax complete.
mime: / L7 7 - /3 • Fe met hodology set by T6-County Building industry service Banal
1:1 &n IdivalPerrniMMEC- Pcnm*App.doc 10,01/00 4.I0 -4617T (1 I /07/COMIWax)
P.O. Box 622
Scappoose, OR 97056 Columbia NW Heating, Inc.
503 -543 -3624 (Phone)
503 - 543 -6285 (Fax)
Fax
To City of Tigard Building Dept From: Gerri Jacobson
Fax: 503-598-1960 Pages: 3 (Including this one)
Phone 503- 639-4171 Date: 1 -2 -13
Re: Mechanical Permit CC:
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