Permit =e
CCTV OF TIGARD MECHANICAL PERMIT
:a. COMMUNITY DEVELOPMENT Permit #: MEC2010 -00622
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2010
Parcel: 1S133CD16300
Jurisdiction: Tigard
Site address: 11574 SW TALLWOOD DR
Project: GALLOWAY Subdivision: PEBBLECREEK NO. 3 Lot: 53
Project Description: Furnace replacement.
Contractor: CLIMATE CONTROL INC Owner: GALLOWAY, MICHAEL C & CAROL A
16500 SW 72ND AVE 11574 SW TALLWOOD DR
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 453 -4822 PHONE:
FAX: 503 - 968 -7224
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/01/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/01/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/01/2010 $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 1.80'.. 2434..
Issued By: �% Permittee Signature: _
Call 503.639.4175 by 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.
Dec 01 2010 9:40AM CLIMATE CONTROL INC 5039687224 p.2
_ �.....,...,,,a,a, i El AWL Ki,1.1111 - a!IUII ',
City of Tigard D1 j J ar
" 13125 SW Hall Blvd., Tigard, OR 97223 t±j Da ieJB y Received Pen"'t No.: r'
1,
i ' Phone: 503.639.4171 Fax: 503.598.19 Plan Review �� •
r� ! .'
'TIC; A F( i) lnspextian Line: 503.639.4175 Date /By. Other Permit
Internet: www.tigard or.gov 1 ��`O Dale Ready /By: Jmis: 6d See Page 2 for
:' } y Arm }we Ry- �� ` i �4 ' Nonfied/Metltod I Supplemental O PP l ormation J
s , or
�:,± d3'.a?.�2 ,.� otS r - �.,.a �:t 4 . Tv`� >rci� ,��,� f,�� y�.2� \& ■ �1n3 '�� ., - ' ` w�ez""'a �r
,7 -
❑ New construction °
n �i '
Addition ' alteration /t Y Mechanical petmit fees' are based on the value of the work
0 Demolition ❑ Other Bv1 11' Performed, indicate the value (rounded to the nearest dollar) of all
� .� itt ,°t, o- L mechanical materials, equipment, labor, overhead, and profit.
.a ..L.`F tr-.i'}8nr�v'k it * t4, 3 gOI' xs -.; q ,,. „ "k„4 :sviar 'ti J"_`ni+.++s�.J Value'
g l and 2-family dwelling [] Commercial /industrial 0 Accessory building 1' a ' ° e l l n ` q I ,
El Multi-family ❑ Master builder For special information use checklist.
_ ❑ other:
° _.s y =,Y t a 5`l' t ° t xn -., Description I Qt I Ea. j Total
= y, r . � `i i+ r 4o' - s Beating/cooling
Job site address: / /5-�i 7 / 5 // 1 1) Air conditioning
City/State/ZIP: : ( Oct (re site plan showing placement) 46.75
/l ! ` ne- , , 9 , 223 Furnace 100,000 BTU (ducts /vents) / 46.75 [.1& 2s
Suite/bldg./apt. no.: Project name: 6,4 / j y �” Furnace 100,000+ BTU (duets/vents) 54.91
Cross street/directions to job site: Heat punsp 61.06
Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 2332
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:
Tax map /parcel no.: 23.32
€ , r ht- Other fuel appliances
s M �`W, t Y y r � Water heater
/A- ft4C6.- Feirstllq-e �� w Gas fireplace 23.32
33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas)
23.32
Wood/pellet stove 33.39
Wood fireplac
4e/insert tia x t r x-� e/inserl 23.32
=.z.:e .s+_.., .' . t 3 sus «..ie6`; ' `ez . F ° te13 f' ° wpi Clliumey/liner /flue/vent 23.32
Name: C A-Cc, [ 4 A .-l1 23.32
to 1 eC� Environmental exhaust and ventilation
Address: 1 / S - Y 5 7-444 Range hood/other kitchen
v equipment 33.39
City/State/ZIP: 7 •76 , Q om- 9 72- 3 Clothes dryer exhaust
33.39
Fax ( )
Phone ( ) 5,2y 7 64,' (P Single duct exhaust (bathrooms,
,,,Lone:yls,.s c °O e'` r - a» x ."- _ - ,�a Toilet compartments, util' rooms
ri r. +�Is`� a „+Y e�r�"� a :.r� a �'+ -� �: ��� ":. v .bt tiw �`tt�'€�:., � ) 23.32
c tar„�s,:, E ny .x_" , ` #iaxsi IRIN:RTR -:sT.. �: h ;e�'tur s .sue°_ - fi Attic/craw!space fans 23.32
Business name: cu MA re - n D n rnb inc Other. 23.32
Contact name: o '1 t t 1,L 715 $14.15 piping
Address: �� ��[ 514.15 for first four; 54.03 for each additional
�5c J `7 1\O Ail C
Furnace, etc.
+
City /State/ZIP: r r1 O.nt� 0 l � � G l - 7-2-3 Wall/suspended/unit heat pump I F '
Phone: (503) q5 - � Wall/suspended/unit heater
I. Fax: :(Sp3)ej(4)8- 2211 Water heater
E t+p c.- it n , 1 p�.�� G } , Fireplace
I= a- .. c) r1 r-t7 L Inc Con-) Range
-- 'tc.: t -. re p > .y r ti '' i Y `t
",�,. � . �r�� ti.4 . `., E Barbecue
Business name, , _L y 'i 11. re-- 6 r 1 C- I ne ' Clothes dryer (gas)
Address: (p / f
Soo 644,--) eQ n v Other:
lr E ,��..�_,
City/State/ZIP €�pt'1 -1 a r1 w,, r e i , l M b ; : - f .
1 d o e (1.Z 2 Li Subtotal e !G 7s
Phone: (5-03) q - 2
t12Z Fax: (r',3) t� m
- T � J� � LD 8 - � 2 Z y Minimum fee (590.00) 90 • oa
CCB tic.: 7.1 Plan review (25% of permit fee) cl Lo
, -/ 7 _ State surcharge (12% of permit fee) IS.) .130
Authorized signature: � -/ TOTAL PERMIT FEE 1, D
. ,/ This permit application expires If a permit Is not obtained within 180
Print name: days after It has been accepted as complete.
�4•r /S Date: /2/00 " Fee methodology set by Tri- Carney Building Industry Service Board
7^ Budding +Pertrths.MEC- PcnvirApp.doc 70/01/09
44 0-46177 (I 1 /02:COMF WEE)