Permit ph a CITY OF TIGARD MECHANICAL PERMIT
.;`
IS ,;, COMMUNITY DEVELOPMENT Permit #: MEC2009 -00650
-T, [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/08/2009
Parcel: 2S114BB11600
Jurisdiction: Tigard
Site address: 10449 SW KERI CT
Subdivision: Lot: 0
Project: Sill
Project Description: Replace furnace.
Owner: FEES
SILL, DAVE Description Date Amount
3892 NW CRAIG DR
BERAVERTON, OR 97006 Furnaces < 100K BTU 12/08/2009 $46.75
12% State Surcharge - Mechanical 12/08/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 12/08/2009 $43.25
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
TIGARD, OR 97224
PHONE: 503 - 453 -4822
FAX: 503 - 968 -7224
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
r
Issued By: cg Rk a �� Permittee Signature:
V
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
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; Dec 07 2009 10:04RM CLIMATE CONTROL INC 5039687224 p. 2
Mechanical Permit Application..; a r N�
J` City of Tigard Received 4. - T J
, ." • , 13]25 SW Hall Blvd., Tigard, OR 97223 DEC ®7 200 Dax /By : Permit No.: � `� /_ Cyr gli Phone: 503.639.41 71 Fax: 503.598.1960 Plan Review .. `b �Q W
' Inspection Line: 503.639.4175 Date/By: Omer PPermit - ` 1 7 1 ,
Internet: ww 5 rd•or.gov fi CITY OF TIGAR Date Ready /By - Jruu:
s; " sue£ . ' FT- BUILDING VI edMethod. PP m 1lnfo information
DI SI S See entat i nr
�� � Su le enta r
..:. .rec - i , gy .. � . =: ..,.. M?� ' s , • "` . '1 .., ., - .... 6 i r : i e+T•iS -.F.T `,. Fit m,r. Fri a..+ w -.
.si yr .4 -- . - ,t: �Y ;ins+, `v , ;4; �. -' ,- .:! -1 t, ii ' 4 a :te
❑ New construction Additionialteretion !replacement Mechanical pesmit fees* are based on the value of the work
performed. Indicate the value (rounded to the dollar) of all
❑ Demolition ❑ Oh
;* z s»rFr � r } � I , r mechanical materials, =.ut , ent, labor overhead, and .lit
.aa�SO. x V,Wy o .- ` -f y -W , gi-1 't' >_ Value $
Erl - and?famil d wellin tit, - + !'-'. rtr, , i 'f 1'`' 9 z.'
Y g ❑ CommerciaUmdustria ❑ Accessory hullding -` -- c x^axs , x1r� 5 ,1�41;1-;
❑ Multi- famil ❑ Master builder ❑ Other: For special information use checklut
Y o f > k_ �e� ties r t r c3u Description I Qty. i Ea. I Total
7 i t s :•(%"'�` .3. ':{4Y 1.1: a `a e s!td x q° - tss is 1;.' . t_ 3 -r ' `.
//(,G ')'� � '• � �} ��., `� .
Head ' _coolie :
Job site address: /07 7 ! 5/...t) �� e Air conditioning
(requires site plan showing placemem) 46.75
City/State/ZIP: 776472, DK. ?7 zz y Furnace 100,000 BTU (ducts/vents) / 46,75
yb •7
Suite/bldg. /apt, no.: I Project name: St _ x JA L Furnace 100,000+ BTU (ducts/vents) 54,91
Heat pump 61.06
Cross street/directions to job site: Duct work
23.32
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: I Lot no.: Flue/vent for any of above 23.32
Tax map /parcel no.:� 23.32
4 j i'i t t of c,, rt ri z , .�u. e, a.l}'�' r i r r i 1 ` -� ;� Ei � :1 2 �'luG h"'�c - >'��� c 1a j`�% r'4 ua Other fuel appliances
_3
; ;r' tx a ` . g * �" r ._ .t:.�..,. IJI �r,:ta�:. -, .�...._� e, . rai:�; `_ ..r,' ,s At ytda ;. t.. Water heater 23.32
6'2,14-C6 F�,�, E Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 1 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
'r �w � l i f , o i 3 1 7 e . ` t `l t -r, Ati Fist.
, ?S a 5 y �. . - .- m.r
t .4�...a. ,rr . + •S v't _ i .n vx E a a r - t a• other
23.32
.,•x 7 tkg '•*.f.. ?.* � c ._' -f�a ��r= 7 `1..•s n, _ a .�.,.,'F.�..a, ? u':....�i "u� y ica > ±:
Name: �^ Other: 23.32
vE Ji7� Environmental exhaust and ventilation
Address: , 39 . /� Cy . /1 b f Rangehood/other kitchen
�" ✓ equipment 33.39
City/State/ZIP: /3 •vim D2 ,-zoe Clothes. ex exhaust
33.39
Phone ( ) �� y Fax ( ) Single-duct exhaust (bathrooms,
� Y i q
toilet compartments, utility rooms) 23.32
h * s v°� t �-1 a 4 a i ,, ''k 4 ugii S^` ':(-7 ' P7 alt L,V . .•:
1zirn .x�r:.: ,;.i'.s.s f;,. �';. .ig..:1:IliYi t"�.,�'xal.:a ` t'i; l � r4p � A,Ii:. `t Attic/crewlspacefans 23.32
Business name: au MA L
- d O n TToL `fly Other: 23.32
r t Fad piping
Contact name: Ro 4 f.}.1j- r l_S S14.15 for first four; $4.03 for each additional
Address: 1 (6.500 15(A) - rt0 r C
Furnace, etc.
Ci ty /Statel2Tp: - Gras heat . ur .
r eland r -f 223 WaNs . cd/unit heater
Phone:(93) 1 1s3 - gBZZ Fax: :( sp3)c (p8--72.2.9 Water heater
E mad � O 1 `CO L 7 Fireplace
III
G t t7 - T WIC C
`�,{�, � @ . M a a� C a!1i -�t, ,- r1 O r✓'1 Range
r
'W. Paces kWri bri t Rza x � r CI Barbecue
Business name: CLt yo 4-Tr o n L- f h e , Clothes dryer (gas)
Address: t S O Gruber
e Ci /$tate/ZIP: }.» .�.,,: Rse� m.zea 7 4,.- � s „��
?pc,- Or C(- 7-Z.z(./ Subtotal 4/4.7j-
/Phone: (5 ` 4 J - (i ZZ I Fax: (�S) ° I �O -1ZZe/ Minimum permit fee (S90.00) `30. p!3
V CCB lie.: b �t 0 7 Plan review (25 % ofpemrit fee)
State surcharge (12% of permit fee) /U, 42, U
- TOTAL PERMIT FEE /pa, •g4
Authorized signature: / T hus permit application expires If a permit b not obtained within 180
days after It has been accepted as complete.
Print name: 0 y • ,..-„,c Date: /2 • Fee methodology set by Tri- County Building Industry Service Board
1 : 41 mIdits \Pcrmi171MEC- PtrmiiApp.da 11Y0I/09 400.45177(11 /02/00M/WEB)
l- rd° L.- -�- PD ?5”,