Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2010 -00601
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
TIGARD ARD Parcel: 1S136CA90121
Jurisdiction: Tigard
Site address: 10900 SW 76TH PL 12
Project: Wischmeyer Subdivision: TIGARD WOODS CONDOMINIUMS Lot: 12
Project Description: Furnace replacement.
Contractor: CLACKAMAS HEATING & COOLING LLC Owner: WISCHMEYER, SARAH M
15115 SE PENNY LEE CT. 10900 SW 76TH PL #12
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 658 -4808
PHONE: 503 - 443 -3931
FAX: 888 - 500 -2912
FEES
Specifics: Description Date Amount
•
Furnaces < 100K BTU 11/19/2010 $46.75
Type of Use: MF 12% State Surcharge - Mechanical 11/19/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/19/2010 $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: ' •rmittee Signature: .
_ --
Call 503.63 i b by y 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.
Nov 19 10 02:27p Clackamas Heating &Cooling 18885002912 p.1
INISD
Community DevelopmenOCEA
Request for Permit Action tv,
T < j,R'D Nov
c r O
TO: CITY OF TIGARD �v1, OFT I` Nisi
Building Division Services Coordinator
13125 SW Hall Blvd, Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM ❑ Owner ® Applicant ® Contractor ❑ City Staff
(check one)
REFUND OR Name: CLACKAMAS HEATING & COOLING LLC
INVOICE TO: Bus sor individual) •
Mailing Address: 15115 SE PENNY T.F.F CT
City /State /Zip: CLACKAMAS, OR 97015
Phone No.: 503.658.4808
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ®
® CAN CFT ,PERMIT APPLICATION.
►1 REFUND PERMIT FEES (attach receipt, if available). r / / j /
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). �.
Permit #: MEC2010 -00601
Site Address or Parcel #: 10900 SW 76TH PL #12
Project Name:
Subdivision Name: Lot #:
EXPLANATION: IMPOSSIBLE REPLACE FURNACE BY MECHANICAL CODES
Signature: / Date: 11/19/2010
VLADTM R FIATS
Print Name:
Refund Policy
t • The Director or Building Official may authorize the refund o£
a) any fee which was etoneously paid or collected
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than - 80% of the building - pan review fee when an application is canceled before any plan review effort has been expended
e) not more than SO*4 of the building pennit fee for issued permits prior to any inspection requests_
2. Refunds will be returned to the original Payer in the same method in which payment was received Please allow 1 -2 weeks for processing refunds.
... A dmin Date , OFFICE Rt e to Bid: Admin: Date
RbetnS �� $• � �
Refund Processed: Date /1a B ' / Invoice Processed: Date S
/0 Date Method Amount $
\ Building ` Forms \RegPcniutAction .dot Rev 07/2 V07
Nov 19 10 12:54a Clackamas Heating&Cooling 18885002912 p.1
Mechanical Permit Application ED w. I: 1 SE 0 \ /
• Tigard, OR .1
City of Tigard MEW
Rwcived I m Arm ...it-Ho.: --
Date/By: GPM la."--1 —• , , 1
11 13125 SW Hall Bl 97223
• e
' Phone: 503.639.4171 Fax: 503.598 9 7 .1960 lc \I 1 (
I: • ; 1 Plan Review
Dam/By: °the:Permit
inspection Line 503.639.4175
Tit.;ARD Date Readylliy: kris: F9 See Page 2 for
Internet ISNrw.tigard-or.gov
rfrY OF TIGAR1) Notifie,vmethod: -..a. Supplemental lefonatalion
..., nw iSION
:rpik , 0.P:.v.,611*)__ IL: • :, ..::: .:: ' comm44' (710::':F**. writpiA.F.::- vsE:cnEa41 ..)
Mechanical permit 6;es' are based on the
0 New construction 1Z1 Addition/alteration/replacement value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other mechanical materials, equipment labor, overhead, and profit
Value: $
• .. . . : . , , - '
: 1 *Sit*. 34 7* **0$
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist
CE Multi-family 0 Master builder 0 Other:
Desaiption 1 Qty. 1 Ea. 1 Total
. . : : ' : .,.• ' , l' : .. ?. - !.'44i . .. 1 *,# 4 0 76 4 1 41 1( *:, 0 410 44c47.ncw:: .: ::.: , ',' :. 'E: :-: Heating/cooling
Air conditioning
Job site address: 10900 SW 761TIPL (requires site plan showing placement) 46.75
City/State/ZIP: TIGARD, OR 97223 Furnace 100,000 BTU (duets/vents) 1 . 46.75 46.75
Furnace 100,000+ 131U (ducatvents) 54.91
Suite/bldg./apt. no.: 12 Project name:
Heat pomp . 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),
in-wall, in-duct, suspended, etc. ,..,, 46.75
Fluehrent for any of above 2132
Subdivision: Lot no.:
Odzer: 23.32
Tax maplparcel no.: Other fusel appliances
- .. - :1 ... .: -: : i [,:: :. littelite4 bFORIC :': I .." : ;. :: . •: ' : :.: Water her 2332
Gas fineplace 3339
FURNACE REPLACEMENT Flue vent for water healer or gas
fireplace 2332
Log Heller (gas) 2332
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
chimneviinf-r/flue/vent 23.32
::; El IiROPERTY.OWNtER l'.... l'..: ,.: .:- .1 I: '''. ' : : . ' : : : EU 'IENANT .: ",...; ',.. '..2: .. ..: ....:
. : . . , .
Other: 23.32
Name: WISCHMEYER, SARAN Environmental exhaust and ventilation
Range hood/other kitchen •
Address: 10900 SW 76111 API' 12 PL equipment 33.39
City/State/ZIP: TIGARD, OR 97223 Clothes dryer exhaust 3339
. ' Single-duct ex (bathrooms,
Phone: (503)4433931 Fax: ( ) toilet compartments, utility rooms) 23.32
itiem‘64:,:-::::: I: -::::' : :.1,::..-: : ''s :::...::•:-.:::•. •:tkokypkerritikiii*4 -..:,: : - :. ': :- Andanrawis fans 2132
..,
Business name: CLACICAMAS HEATING & COOLING LLC
Other
Fuel pipi 23.32
ng
Contact name: VLADIMIR IVRICHATS 514.15 forfirst roar; 54.03 for each additional
: Address: 15115 SE PENNY LEE CT Fanace, etc.
. Gas heat pump
City/State/ZIP: CLACKAMAS, OR 97015 Wall/suspendedAmit heater
Phone: (503) 6584808 I Fax : (888)5002912 Water heater
Fireplace
E-mail: CH ctic@conicA ST.NET Range
Business name: CLACKAMAS HEATENG & COOLING LLC Clothes dryer (gas)
Other:
Address: 15115 SE PENNY LEE CT , . :. , -
''. ':.., :±...:' ri*
CitylState/ZIP: CLACKAMAS, 012 97015 Subtotal 46.75
Phone: (503)6584808 Fax: (888) 5002912 Minimum permit fee (590.00) 90.00
Plan review (25% of permit fee)
CCB tic.: 165630 State surcharge (12% of pennit fee) 10.80
/
TOTAL PERMIT FEE I 00.80
Authorized signature: /(1 i," This permit application rapines if a permit is not ebtaised within 150
days after it has beta accepted as complete.
[print name: VLADIMIR MI1CFIATS [Date: 11.18.2010 I * Fee methodology set by Tri-County Building Industry Semi= Board
I: \Buitcling1PermitSMEC-PermitApp doc 10101/09 440-4617T (1 I (472/CONCWEB)