Permit
"p CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit fl: MEC2009-00546
g 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/16/2009
Parcel: 1 S135DD03613
Jurisdiction: Tigard
Site address: 11528 SW LOMITA AVE
Subdivision: Lot: 0
Project: Nebert
Project Description: Replace furnace.
Owner: FEES
NEBERT, SUSAN Description Date Amount
11530 SW LOMITA Furnaces < 100K BTU 10115/2009 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 10/15/2009 $10.80
PHONE: 503-620-1290 Minimum Fee Adjustment - Mechanical 10/15/2009 $43.25
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
TIGARD, OR 97224
PHONE: 503-453-4822
FAX: 503-966-7224
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.
Issued By: Perm ittee Signature:`
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.
'Oct 14 2009 7:33AM CLIMATE CONTROL INC 50396872.2.4 p.2
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, r - Mechanical
of Tigard i Application �- , rig : , , .' 1K aOl At_1E'Ccir t; N. ` '
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e ED n N .. i M1t! ®.
Perm' ,
13125 SW Hall,Blvd Tigard 2 3 ,
Han an Review
® 4 Phone: '503'.639.4171 Faz. 503.598.7, i 1 2 9 Uate!Byi_ Other Permit:
„t1';1,(1 , D: Inspection Li 503.639.4175 Date Ready /BY id See Pa6e 2 for
Internet: vv _ ww.t or.g TIGARD Notified/Method; rill � Suppleme i nform a ti on
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I: New construction IgAddition/ alteration /replacement Mechanical perm fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑Other: mechanical materials, equipment, labor, overhead, and profit.
�t tt ? r ( e , gatai t a rtat ' tatty t " . 41. r Valuc $
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rtit;t'it 1- and 2-family _ii .c-Y k . ..v...: _..t< ° lz, a tr,+rs3tH,9GL(ta.. d. ... $a ;„ � ., , ,..- . „„ ,Asz q, -art:,, s .y .,„_..e..,,,,,, C'7�„ F a r p a •
dwelling ma_ ' -. :ar � r.mo re �,.sa ' a.t p .:, .'thug xrr»sr
' _ti„- lw, >,a�§itit
y g ❑ Cotnmerclal / industrial 0 building
El Multi - family ❑ Master builder ❑ Other: Des
For special information use checklist
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Description
L)" 1 ffi i ritiV x c a .Ar .:.a x ..:� w„ "r s 2 M :3' n , �F .,1'Pv� 1 I . �N TURF p ..... ' Qty Ea. O
�t I I T to
,.c s... ° :tn, rtes isiitts-t: .. ,,..tl�,ig „, • Heating/cooling
.
// e ' 2 8 6 1 Loth, ri conditioning uiTes sit•ln
J /�(J� r e.e ,len
Job site address: allow' : rlaceme+it) 46.7
City / State/ZIP: 77 ,4 Ot t f? - 3 Flunace 160,000 BTU(ductsrvents) / 46.75 (/4.)
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: I Project name: N/ ;b0z7-- Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydroriic hot water system 23.32
Residential boiler (radiator or
bydronic) 23.32
- Unit heaters (fuel -type, not electric),
in-wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no Other fuel appliances
Its! 4 r•n ae ce�xaart �,d'#`' �£ �1r , r r tl g� '
t +s > .n� f t e l G vk i s -a ' ` 4t�a4 k Water,heater 23.32
_.til,.r_,..tg,t,2 -,1. xr .. n,„.01,„ .t:..w.e"- 4+.t,_. . } ? 3#i..3xext _.._ .- . r ... P. .:t.. . I,.s+
Gas fireplace 33.39
Flue vent for water heater or gas
�'� fireplace 23.32
�� Lo• li_. ter (gas) 23.32
Wood/.ellet stove 33.39
Wood: fir . lace/insert ■ 23.32
. Chirnne /liner /flue /vent
tsL� .; �,.. .� 9"i' - -t. F t 5-r,:r� i .r '`.e� " d a l- tl t a: 23.32
uw sg:4., � trak Al4:1 1aI,. .tti:;i .. .,._..rr11..J 0 439..4." Other: 23.32
Name: 5e1" ,UFber- -
Environmental exhaust and ventilation
/
Range hobd/other kitchen
Address: //VC .lc) :f OP7// equipment 33.39
City /State /ZIP: 774,4,,,E ®' 97 t2-3 Clothes dryer exhaust 33.39
Phone ($�3) 21�. _ Fax; ( ) Single -duct exhaust (bathrooms,
gg� fit, l toilet compartments, utility rooms) 23.32
n N 1- `3 iEf- 'E�a.� flu °s$F t Nfi +. r• H[ r Vi l ast 1e• -
tt � ` �F� _ t + ,, �.I Attic /cra fans 23.32
. L .ti.tS; ,, wr1,ritltt - „, 4.w i . �+ f?, , l .ri :1. 141:31.. . 1 1 -t , . -? R
I ' A Other 23.32
Business name:
6L.I Iv` A T i o n Inc._ Fuel piping
Contact name: Ro L (+ , f r IS _S14.15 for first four $4.03 for each additional
Address: 1 Jw --- fi0 Ali Furnace, etc. S
I "- Gas heat .ump
City/State/ZIP: p r a C r 9- Z3 Wall/sus .ended/unit heater __
Phone, (503) 1 153 - 98 Fax: : ( SD3) C o `7 2. V Water heater
Fireplace
F,-mail: CEO ed c. I t fv -, 0.,#e. c o:n rp � I t1C c d � Ran' e
� 5. a , � � � ���sF �p +C.iN: �(�FI � qa a Barbecue 4. b r L_s... :,:.1.,,, a.�.wx frfi- .;ttr£. nl:E xstea: k[x;x�3at� � iaP5&�� „-"': fa�8'EdJB�a�"_kv4.k45'A�.wn'; d II
Business name: C Lt rii 6,....-r&--- Co, i- vL , re Clothes dryer (gas)
/I�__ - 7 Other.
Address: I W Sao l ' I t � .:n
.. .;YY�2 P2 i �` •. 4
City/State /ZIP: or "- -` 0. it G ';''( zq Subtotal
� / t� p G�•Z y4
Phone: (D3) "1 L' 8 ZZ Fax: (g),S) c l Io - 7ZZ/
Minimum permit fee ($90.00) •
Plan review (25% of permit fee)
CCH lie.: C 7.....A01 � State surcharge (12% of permit fee) /0. 0L3
. TOTAL PERMIT FEE /Do. eo
Authorized signature: of p�� w _ This permit application expires if a permit not obtained within 1511
iVl/liib days after It has hen accepted as complete.
Print name: 0 y /1,4 ./ Date: /p // 4//0 f,' * Fee methodology set by Tri Building Industry Service Board
1: lBu.tdiag\Pemits\MEC PcrmitApp, dee 10/01/09 440-4617T ///��� 666 (1l /02/COM'WEB) /)T/ 9c1f4 7-
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