Permit CITY OF TIGARD MECHANICAL PERMIT
.11 a CO MMUNITY DEVELOPMENT Permit #: MEC2013 00107
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/20/2013
Parcel: 2S110AB01800
Jurisdiction: Tigard
Site address: 14260 SW 114TH AVE - -•
Project: Blank Subdivision: COLE'S ACRES Lot: 5
Project Description: (1) furnace replacement
i '
• Contractor: COLUMBIA HEATING & COOLING INC Owner: BLANK FAMILY TRUST
PO BOX 230397 BY BLANK, ARDITH H TR
TIGARD, OR 97281 14260 SW 114TH AVE
TIGARD, OR 97224
PHONE: 503- 624 -2704 PHONE:
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount •
Furnaces < 100K BTU 02/20/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 02/20/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/20/2013 $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: �4 Labe/ Permittee Signature: 00, 4PPLI • dial
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.
2/1/213 12: 24PM 5035980270 COLUMBIA HEATING PAGE 02/02
Mechanical Permit Appli
EIVED
:
,,,,,(), ,.„ ,_. „,.,,,,
City of Tigard 6
974- Received -
13 ), Daraly: . _ • (3 Permit No.: 1,46 3 -0001
N, 13123 SW Hall Blvd., Tigu 213 9 d, OR Plan Review
Phone: 503.718.2439 Fax: 503.ewo ChttelBy: On= Perm&
Inspection Line: 503.639A175 In OF TIGARD Date Ready/Br tali Ffi Sas Pate 2 far .
Internet: " Avw ' ti g ard-c4.4 " BUILDING DIVISION Notifed/Method; : Supplemental InfOrmanau
Mechanical pemiit fees* are based on the value of the work
0 New construction alarliti . , teration/replacement performed. Indicate the value (rounded to the nom dollar) of all
El Demolition 0 Other: mechanical materials, equipment, labor, ovedtcad, and profit.
Value: 5
atIrod 2 dwelling 0 Commercial/industrial 0 AccesSo building For spedal WellnadOn Me caecklin
0 Multi-family 0 Master bl 0 Other. Description I Qty. I Ea I Total
':... ....‘: 4' .i .:t.?? : J 1 '3: tfft■I'''T \ - .0' .g'A ileating/coolity;
,.. .,. , i, , ',...1., : V. ,.,,.... • ' ., .. '''r...-a•12'-1,.fiL:452...likorr4.&.ilia M'afP:CI% -'.--n Air conditionittg
Job site address: PY,1 r 0 S4..) 1/ trequirmi Om aLmt showintplacerneml 46.75
,,,. Furnace 100,000 BTU (ducts/vent_.9 X 46
City/State/ZIP: -n 4 4 1641 I 0 1 1 r oli 1 Furnace 100,000+ BTU (ducts/vent) 54.91
Suite/bldg./apt. no.: [ Project mine: liati•Wg Bear pump
(requires site plan showittutacement) 61.08
Cross street/directions tojob site: Duct work 23.32 • A-
Hydronie hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type. not electric),
_______ in in suspended, etc. 46.75
Subdivision: i .t no.: Flue/vent Pot an of above 23.32
Other. 23_32
Tax map/parcel no.: Other fuel Apollo dal:
...17 . : K .6.- .. t q i M iP riktitg 4.7 1:72 L 1:2 - F i ' 7 4 5 11 7V EY05 1 7.fra l ...2;" 'CL;4c 7. , ater heater 23.32 --
,
C Pas fireplace 33.39
t CE /Zeit-Ace a 6..u7- Fiu. vent for water heater or gas '
I I fireplace 23.32
Log lighter (gas)
23.32
Wood/pellel stove . •
33.39
I Wood fireylace/insert . 23-32
:... .,, :; AISTOLgalk,.7 .%2„ EM Chimney/liner/flue/vent 2332
Nante: figts . A rLitt i vK I Environmental exhaust and ventilstiOn: • '
Address: 1 Range hood/other kitchen
. i equipment 33.39
City/Statc/ZIP: I I Ootbes dryer exhaust 33.39
Phone: TO ) ej, 0 •-• /163 I Fax ( ) I Single-duct exhaust (bathroom,
toilet compartments. utility rooms) 23.32
AtticicrawisPm fans 23.32
ra
Raciness name: Columbia Heating and Cool ng, Inc. ther: 23.32
Furl piplosp
Contact name: Marietta Meedom 514.15 for first four 5403 for each additional
Addretv PO Box 230397 Furnace,
Gas heat pump .
City/State/21P: 97291 Wallisspendedunit heater
Phone: (503) 624 J : (503) 598-0270 Water heater
Fireplace
E-mail: columbhe@telcporLeom Runge
:- :!' :T Barbecue
nusiness name; Columbia Heating and Canting, fee- Clothes dryer (gos)
Other:
Addreee: P() Box 230397 4.. P!'',:• ' IMIllig
- -
City/Stole/21P: Tigard. OR 97281 Subtotal
Phone: (503) 624 I Fax: (503) 598 minimum oermit fee ($90.00)
Plan review (25% of pelmit fee)
CCB lie.: 76359 State surcharge ( 1 2 .4 of petmit ibe)
TOTAL PERMIT PEE
Authorized signature: Ankhirlik /2 permit a pplleatiou . a • peruslt h uot .bigh.4 whine leo
days after It has been now ted a* taRPItle.
I Print name: Marlene R Meedom Date: -/ 7 _ . a 1 - FCC methodology XI by Tri•County Dulldiag Industry Service Boma
, vr (11/0,/COMIWF111
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