Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00688
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/31/2012
Parcel: 1S133DB02400
Jurisdiction: Tigard
Site address: 11589 SW SHEFFIELD CIR
Project: Wong Subdivision: BRITTANY SQUARE NO.2 Lot: 48
Project Description: (1) gas furnace installation
Contractor: COLUMBIA NW HEATING Owner: WONG, HERMAN S H REVOCABLE LIVIN
PO BOX 622 WONG, EMMY S REVOCABLE LIVING
SCAPPOOSE, OR 97056 TRUST
15800 SW KITTIWAKE CT
BEAVERTON, OR 97007
PHONE: 503 - 543 -3624 PHONE: 503 - 734 -9831
FAX: (503) 543 -6285
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/31/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/31/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/31/2012 $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. n /�
Issued By: Permittee Signature: Ou �}-P G( ) --17Q�
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.
RECEIVED
Mechanical Permit Application IIIIIIIIIIMEIMMEMININIII
P C 31 2012 Received City of Tigard bray: i �)1 I , >; mit No/ ( -Gv(b/
1, , 13125 SW Hall Blvd. Tigard. OR 97223'' OFTIGARD - Plan Phone: 503.639.4171 Fax: 503.598.1 Dar
9* Review other wit:
Ins ction U na 503.639.4175 B UILDING DIVISION 1�
T I t ; , D Pe , Rcad y /By: /' ''J 1 See Page 2 n,r
Internet: www.tigard ar.ROv NenfiedIMethod 1 ( / SuppkmentvlInfnrmution
—
TYPE OF WORK COMMERCIAL PEE* SCHEDULE - USE CHECKLIST
❑ New CdnslnUCtiOn Addition //lterition/replacement Mechanical permit foes; are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other. mochnnicai materials. equipment. labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
J'1- and 2- family dwelling ❑ Ccraunereial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT !SYSTEMS EMS FEES'
Ej Multi- family For s coal information use cheoEltst
❑ Master builder ❑ O ther Description Qty. I Es, I Total
JOB SITE. INFORMATION AND TAXATION Heatinecod _
Job site address: b i r Sal 5,eff I LE Aix conditioning
(requires etc plan ahow ng pismned) 46.75 I � 9 y
City/StntrlZiP: '7-Ir� 7�.? 3 Furnace 100,000 BTU (ducts/vents) / 46.75 Y� 75
Suitc/bldg. /apt. no.: `�'+ Project name: 9 Fu race 100.000+ BTU (duetwe ts) 54.91
Heat pump 61.06
Cross street /directions to job site: Duct work 23.32
Hy*ronic hot water system 23.32 ,
_ . Residential boiler (radiator or
hydronic) 2132
Unit heaters (fuel - type, not electric),
in -wall in -deal. suspended, eta- 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
O@r07 2332
-
Tax map/parcel no.: Other fuel appliances
DLtSCRI!TK)N OF wow Water healer 23.32 -
(� Lit fireplace 33.39
1
1 , L L 1 � floc yard for water healer or gac
fireplace 23.32
— Log lighter (gas) 23.32
Wood/pellet stove _ 33.39
Wood f epincerxest ert 23.32
Si PROPERTY OWNER J ❑ TENANT . Ch°nmey /lincd8trelvent 23.32
/�
Other 23.32 _
Name: //WOW i 1 jj r /U �' y� /� CC,JLC4€ yn f' [ Ra*rtor..- exhaust and ventilation ventilation Address: / � �`� �v `] r � C fZCw Range hood/other kitchen
equipmrnt 33.39
City /State/ZIP: T26i3 q7)3 Clothes dryer exhaust 33.39
� Single-duct exhaust (bathrooms,
Pho ne: ( _y_ ']1 q6. Fax: ( ) toilet comparimertte _ 23.32
� ® APPLICANT ❑ Ct,r! i ACf PERSON . Actic/crawlspace fans 2332
,---'
Other 23.32
Business name: Same as Contractor - ' -
F elpip
Contact name: 514.35 for first foe; 54.03 for obeli additional
Addtees: , Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit honer
Phone: ( ) Fax ' ( ) , Water heater
- Fireplace
E -mail: _ Rang
c
CONTRACTOR Barbecue
Biminmc name: Colombia NW Heating
Clothes dryer (gas)
_Other:
Address: PO Bo's 622 M)ECHANiCAL PERMIT FEES' _
City/State/ZIP: Scappoose, OR 97056 Subtotal ' �- -?
Phone: (503) 543-3624 Fax: (503) 543-6255 rrirxamr permit fee ($90.00 QQ
Plan review (25% of permit the)
CCB lie: 61947 1 06011 `I State surcharge (12% of permit fcc) ja.go
TOTAL PERMIT FEE /00
l Thu permit upptkwtion expires if s permit is eel obtained within 180
Authorized signature: ' � / i� chwys Etter it Ins been neecpeed necninrikee.
Print name Gerri Jacobson Date_ I2 / • x a met act b y r i Building Industry Service 13nmd
P\eu Idinertimtite\MEGPennirnpp.Aoo 1001 /St 440-4617T (11/02/COM/WErt)
P.O. Box 622
Scappoose, OR 97056 Columbia NW Heating,
503- 543 -3624 (Phone) g�
503- 543 -6285 (Fax)
Fax
Tb: City of Tigard Building Dept From: Gem Jacobson
Fax: 503- 598-1960 Pages: 3 (Including this one)
Phone: 503 - 639 -4171 Date :. 12 -31 -12
Re: Mechanical Permit CC:
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