Permit ,r CITY OF TIGARD MECHANICAL PERMIT
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... :, COMMUNITY DEVELOPMENT Permit#: MEC2010 -00378
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 08/03/2010
..<�.- ,;,,x Parcel: 2S111CA00100
Jurisdiction: Tigard
Site address: 9457 SW LAKESIDE DR
Subdivision: Lot: 0
Project: Glass .
Project Description: A/C installation. Unit must meet minimum 3' rear and side yard setbacks.
Owner: FEES
GLASS, MEL Description Date Amount
9457 SW LAKESIDE DR
TIGARD, OR 97224 Air Conditioning 08/03/2010 $46.75
12% State Surcharge - Mechanical 08/03/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 08/03/2010 $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.
Issued By. • if ` Permittee 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.
Jul 29 2010 7:14AM CLIMATE CONTROL INC 5039687224 p.2
Mechanical Permit Application 1 uli di- [Act. t. I !S1 ONL,
City of Tigard I RECEIVED Received 7 ® 1 0 Permit No.: M `e
N
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r lei 1
Phone: 503.639.4171 ax: 503.598.19�jq Date /By: Other Permit:
Tic; r , n Inspection Line: 5D3.63 .4175 J U L 2 9 l Q U Date Ready/By: kris: ® See Page 2 for
Internet: t: www,tigard-or ,! .v NotifiedRrtethod: f-Lt✓ Supplemental Information
CITY OF TIGARD
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❑ New construction X • ddition /alteration/replace:ment Mexhanical per fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ • .. : mechanical materials, equipment, labor, overhead, and profit.
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Erl- and 2- family dwelling 0 ommercial /industrial ❑ Accessory building =r .: ? ' , ._: `,. ?:x ," ' Y. , r . _ u:..
❑ Multi ❑ saes builder ❑ Other For special information use checklist.
Description 1 Qty. 1 Pa. 1 Total
�ati kr.->" - - ' a w e 3 e, s r c , pI , .x t !s/
::v. - i��a,�'d�'X SK_�� x '�+3�.'E . .u..c_:a....'. t >s^..:_'�.:� �!� ._l; � �o Y. �.�z�.7,ti Heating/cooling
\45 Air conditioning pin s
Job site address:
7 t�� _ � (requires site plan howiaR placement) ( 46.75 q ( ,76
Cit --n 4 447-4 ar c11 2;z-54 Furnace 100,000 BTU (ducts/vents) 46.75
�aSS Furnace 100,000+ BTU (ducts/vents) 54.91
6
Suite/bldg. /apt. no.: rProject name: Ham Elmo 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 2332
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
i in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 2332
Tax map/parcel no.: Other fuel appliances
` a < y ty" y xttl a z l- . ? . u.- Water heater 2332
.37, ti a .. ,. _: , 1 2.-; ...; . - ,. E..._a cr.. . S_�, a._.r., :; Y. x;.�
A / � � ^ /► Gas fireplace 3339
- 00 A /e..- Floe vent for water heater or gas
fireplace 2332
Log lighter (gas) 2332
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
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J , "' ., r L,.., i - i . s , er r Ch�ey/liner /thlt�veni 23.32
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._ _.:..,.Y.__,.., ... ...�.r ._._: :.. ._.,, ;at other 23.32
Name: In /) �(_ G 1_ .. QS' Environmental exhaust and ventilation Range hood /other kitchen '
Address: r v 4 S 7 -w LA/tees/ OE by-
'
equipment 33.39
City/State/ZIP: m 60,4-0 ( 9- vv, Clothes dryer exhaust 33.39
r- Single-duct ethaust (bathivoms,
Phone: (03 ) / • 4 - l� ' ee Fax: ( ) toilet compartments, utility rooms) 23.32
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/.4„ te::a. Y Othe/CSSWIapaCe fans 23,32
Other: 23.32
Business name: LJ MA T E I e o n rrc L- l rL el piping
Contact name: R y 1474-r $14.15 for first four, 54.03 for each additional
Address: 1 (0ta� J ..7 t�O C Furnace, exc.
( / Gas heat pump
City /StateJZ1P:
� e T1 erne e? ( 9 Zz3 Wall/suspatdexl/tmit heater
Phone: (563) 453 - 9BZ' l Fax: : ( SD3)q(08 - -2v1 Water heater
Fireplace
E-mail: Co @ CA. vi, M -re Co r'# - roL 1 nc , C0 11/1 Range
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Business name: e_L,l Yvl a : (0 to 4 L MC C , Clothes dryer (gas)
_ Other:
Address: 1 (c Soo S 77_ A t/ _ ��,, � r A.. - � ,� s f,,� s , M g t ,,
City /State/ZIP: ?or — l 0. d or crl.ZZL{ Subtotal L{ L e .is-
Phone: ( Madman permit fee ($90.00) CIO • 0
��) y s 'J 2 Fax: (�3i �D — z Z y Plan review (25% of permit fee)
CCB tic.: c , 7 . 4 q t.O S t a t e surcharge (12% of permit f e e ) 1 O - ' ( )
TOTAL PERMIT FEE fib(), 9
Authorized signature:
e7r 7r )4114.4A' This permit application expires if a•permit b not obtained within 180
days after!! has been accepted as complete.
Print name: AID if j� ( n -
is Date: 7/2q/ / 6 I . Fee methodology set by TCounty Building Industry Service Board
1: 1BuildinglPem ,itsV�C- PermilApp.doc 10/07/09 : 4 6177 2 /COIWWEB)
PO C t -1 el---0
Jul 29 2010 7:14AM CLIMATE CONTROL INC 5039687224 p. 3
CONTROL SW 72nd Avenue Portland, OR 97224
Phone: 503- 453 -4822 Toll Free: 866- 453 -4822
HEATING & AIR CONDITIONING Fax:503 -968 -7224
Cr /ASS — 8/0/66
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