Permit � CITY OF TIGARD MECHANICAL PERMIT
`F '� 2 :,fi COMMUNITY DEVELOPMENT Permit #: MEC2010 -00032
13125 SW Hall Blvd., Tigard OR 97223 503 :639.4171 Date Issued: 01/21/2010
T 1 'r. 2 Parcel: 1S135DB10600
Jurisdiction: Tigard
Site address: 11076 SW 95TH AVE
Subdivision: ASHBROOK FARM Lot: 22
Project: Michaelis
Project Description: Inspect furnace previously installed under expired permit MEC2004- 00495.
Owner: FEES
MICHAELIS, CLAYTON Description Date Amount
11076 SW 95TH
TIGARD, OR 97223 Furnaces < 100K BTU 01/21/2010 $46.75
12% State Surcharge - Mechanical 01/21/2010 $10.80
PHONE: 503 -620 -3494 Minimum Fee Adjustment - Mechanical 01/21/2010 $43.25
Contractor:
CLACKAMAS HEATING & COOLING LLC
15115 SE PENNY LEE CT.
CLACKAMAS, OR 97015
PHONE: 503 -658 -4808
FAX: 888 - 500 -2912
•
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: y /,/3 1 C t \(1 /� (� Permittee Signature: J
�/ �� 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.
Jan_ 20 'ii0 01:49p Clackamas Heating &Cooling 18885002912 p.1
-.
Mechanical Permit Apnlicatio q `r t o
1 tY►l, t1r.l ►t F 1 Nl c��1 ''Y'''1,-'r 9 0
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a �l f atn 4y "
dt rtl'. fly, '' City of Tigard `� 1 V . `'� Ramie �; Permit No. $ , � 1a R?" r ...,
ill 13125 SW'Hall B1vd:,:Tigard, OR 97223 Plan Review
f Phone 303.43 Fax: '503.598.1960 JAN 2 0 Y•
I other Permit
F IG 1' 1,0 i inspection Eine: 503.639:4175 �� 10 Date Ready/By: El See Page z for
r icy ^IN t,' Internet www.tigard-or.gov c N r {a Supplemental lotornatien
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OF TIGARD
RUILI IPfC DIVIIUN.
TYPE OF. "WORK , ..: C0114MERCIAL FEE 'sC1liE11ULE USE CfitEcKLIST
[=I New construction ® Addition/alteration/replacement Mechanical hermit fees* are based on the value of the work
performed. indicate the value (rounded to the nearest dollar) of all
C] Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
• 1- an d 2-family dwelling 01? CONSTRUCTION
Value
R ESIDENEIALEQ 0VENT /SYSTEMS FEES"
® y lling 0 Cammercial/industrial D Accessory building
For special information use checklist.
❑ Multi - family 0 Master builder ❑ Other: Description 1 Qty. Ea 1 Total
110 111 SITE _1NFORMA'IYON • • : AND LOCATIO Heating/cooling
Air andit
Jab site address: 11076 SW 95TnAVE eplan
(requires site plan showing placement) 4b.75
City./State/ZIP: TIGARD, OR 97223 Furnace 100,000 BTU (ductslwents) 1 46.75 46.75
• Furnace 100,000+ BTU (ducts/Nerds) 54.91
Suite/bldgJapt. no.: Project name_ _Heat pump 61.06
Cross street/directions to job site: Duct work 2132
Hydnonic hot water system 2132
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
i Flue/vent for any of above 23.32
Subdivision: Lot no.: Other 23.32
Tax mapfpareel no.: Other fuel appliances
DESCRTPTION OF• iiV4RK,.
Waterheab.7
23.32
Gas fireplace 33.39
FURNACE NEEDS TOBE RAISED 18" OFF OF GROUND Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) . 23.32
Wood/pellet stove 33.39
Wood freplacelinsert 23.32
mer /fluefvent
Chirnnty/l� 23.32
® P)(R0P RTY OWNER .' • . • : : 0 IVANTN
�: �a TE Other: 23.32
Name: CLAYTON MICHAELS Environmental exhaust and ventilation
Range hood/other kitchen .
Address: 11076 SW 95PtAVE equipment 33.39 .
CitylState/ZIP: TIGARD, OR 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)6203494 Fax: ( ) toilet compartments, utility rooms) 23.32
o • APPLICANT r ' ... C CoNvTACr. , fRSON crawlspace r .
At tic) 23 32 .
Other. 23.32
Business name: CLACKAMAS HEATING & COOLING LLC Fuel piping
Contact name: VLADIMIR MIKHATS $14.15 for first four; $4.03 for each additional_
Fauce etc.
Address: 15115 SE PENNY LEE CT
Gas heat pump
City/ State/' LIP: CLACKAMAS, OR 97015 Wall/suspended/unit heater
Phone: (503) 6584808 Fax: : (888) 5002912 Water beater -
Fireplace
E -mail: CHCLLCQCOMCAST.NET Range
C N ' r R A CTOR
.. Barbecue
Business name: CLACKAMAS.IHEATIING & COOLING LLC Clothes dryer (gas)
Other
Address: 15115 SE PENNY LEE Cr A4ECH1lT(1CAlc1!! tM FEES•
City/State/ZIP: CLACKAMAS, OR 97015 Subtotal 46.75
Minimum permit fee ($90.00) 90.00
Phone: (503) 6584808 Fax: (888) 5002912 Plan review (25% of permit fee)
CCB lie.: 165630 State surcharge (12% of permit flee) 10.80
s TOTAL PERMIT FEE 100.80
i This permit application expires if a permit is not obtained within 180
Authorized signature: )ems G4 -1 daps alter it has beets accepted as complete.
Print name: VLADIMIR MIKIIATS /// Date: 01.20.2010 ` * Fee methodology set by Tri County Bedding Industry 5entce Board
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