Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2009 -00123
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/24/2009
Parcel: 2S114BB06400
Jurisdiction: Tigard
Site address: 16081 SW 104TH AVE
Subdivision: SWANSONS GLEN Lot: 5
Project: Chambron
Project Description: Replace furnace, install a /c.
Owner: FEES
CHAMBRON, JONATHON & Description Date Amount
ROSE, 16081 SW 104TH AVE Air Conditioning or Heat Pump 03/24/2009 $14.00
TIGARD, OR 97224 Furnaces < 100K BTU 03/24/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 03/24/2009 $8.70
Minimum Fee Adjustment - Mechanical 03/24/2009 $44.50
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 $81 20
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
Issued By: '+ 'n Q C;nA Permittee Signature: ` )� f l C} O
���JJJ ` 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.
Mar 23 2009 8:06AM CLIMATE CONTROL INC 5039687224 p.2
Mechanical Permit App o h ( IVED FOR OFFICE' t 51: O\L1
City of Tigard Received
Date/By: Pumit Nu
1 10
dq . Da
13125 SW Hall Blvd., Tigard, OR 9722VAR 2 3 2009 f "�
Phone: 503.639.4171 Fax: 503.598.1960 p lan Review
DateBy: Other Permit:
ltri,o Inspection Line: 503.639.4]75 CITY ®R TI Date R B:
Internet: www.tieArd- or.gov TIGARD Notified �X y See Pane 2 for
U1� ®I �� /Method b1. SupplemeatalIn[arnoation
C DIV ;Sr 1
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work ,
❑ New construction ' Addition /alteration/replacement
❑ Demolition performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
.<1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building RESEDENITAL EQUIPMENT I SYSTEMS FEES'
❑ Multi- family ❑ Master builder 0 Other: For speciesl information use checklist.
Description Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / bpg/ 54) V 9r r Air conditioning or heat pump
City/State/ZIP: �r 7 v I v (requires site plan showing placement) I 14.00 y
6 7 �? 2 7.2' Furnace 100,000 BTU (ducts /vents) I 14.00 i y _
Suite/bldg. /apt. no.: Pro ject name: (y Furnace ]00,000+ BTU (duets/vents) 17.90
`' �� ~ Gas heat pump 14.00
Cross street /directions to job site: Butt work 10.00
Hydronic hot water system 14
Residential boiler (radiator or
hydronic) 14,00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
�`L1e� Gas fireplace 10.00
/ `°eiv e- ��i/ Flue vent for water heater or gas -
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
•
Wood fireplace /insert 1 10.00
10PROPERTY OWNER I 0 TENANT Chimney liner /fue/vent
Other.
r1 10.00
Name'. c.3U 10.00
1 k at) Environmental exhaust and ventilation
Address: I / / /I � .- Range hood/other kitchen
10015�i ' SIiV Met equipment
City /State/ZIP; 7 / r1 —/t �/ 10.00
lJ�7a" ��J/ 9 7 x-2y Clothes dryer exhaust 10,00
Phone: ( ) �J _ 7/7_r Fax: ( ) Single-duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80
0 APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 10.00
Business name: / 4 117 Ay-re 4 3 ci 4 1 i [� -
Other: 10.0
�I rT r r~ Fuel piping
•
Contact name: DZ1 1 1 , _ r l S �Mr S5.40 for first four; 51.00 for each additional
Address: ) t CJ 00.___, .) -- D d_.. iy- Furnace, etc.
City/State /ZIP: FAO f - j -- t o or- / � Gas heat pump i Lf WalUsusp _
Phone: (563 ) LI S --'-I i 22 Fax: : ( )
9 - _ I n � q (o � -7Z2 1 Water heater
('VU era 7e (-6/14N-01 t_' . ang
E -mail:
1 e C-1, co s- � Range
CONTRACTOR Barbecue
Business name. V Ll y d r OD n ) „ L l n L . Clothes dryer (gas)
Address: )10500 ^ S� �.Z- nD ry Other:
Kf 7 r T v i MECHANICAL PERMIT FEES*
City /Stale /ZIP: PO r rl a (I 0) or C"7 -22
Subtotal 2 g -
Phone: (y)3) q 5-3 yg tz.... t Fax: ( ) Min im um permit fee $72.50
5�3 q45 ` 7 2-2-V p ( ) 7 3 ..sue
CCB ha,: (P ?-1 CI Plan review (253'a of permit fee)
State surcharge (12% of permit fee) - g. 7e:
61 '�tN �' "� TOTAL PERMIT FEE 8/. .2-0 ALLthDrlZed signature: Tbic permit Application expires if a permit is sot obtained within 180
Print name:
j� days after ii has been accepted as complete.
I- ( rr,j l Date: t?3 / ' fiee methodology set by Tri -County Building Industry Service Board
t\ Hmldrns Vermirs/S¢C.PerrnitApp.d f4617
0 -
oc 91/19,09 17 � 7
4r (1 1 /02/COM'w'EB)
.Mar 23 2009 8:06AM CLIMATE CONTROL INC 5039687224 p.3
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