Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00526
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009
Parcel: 1 S 134AC06000
Jurisdiction: Tigard
Site address: 10884 SW 109TH AVE
Subdivision: HART'S LANDING Lot: 31
Project: Wallace
Project Description: Furnace and A/C replacement Must maintain 3' rear and side yard setback
Owner: FEES
WALLACE, WILLIAM Description Date Amount
10884 SW 109TH AVE
TIGARD, OR 97223 Air Conditioning 10/07/2009 $46.75
Furnaces < 100K BTU 10/07/2009 $46.75
PHONE: 503 - 624 -9535 12% State Surcharge - Mechanical 10/07/2009 $11.22
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 $104.72
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: SAAA/61 Cdr Permittee Signature: a.p10 lc(1
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
"Oct 08 09 11:32p Clackamas Heating &Cooling 18885002912 p.1
. Mechanical Permit Applies NED ► t tr, l )I I It I t , I ),I 1
lig City of Tigard I VY RAY IN 1/1Ik NOM E d-07yq- �DS�(o
■ 13125 SW Hall Blvd., Tigard, OR 97223 Revkw
2 Phone; 503.639.4171 Fax: 503.59$.6 0 2009 DDateIB OtherPenni::
Inspection Line: 503.639.4175
I I (i A RD QF T [G jj n Date Ready/By: 21 See Page 2 for
Internet: www.tignrd -or.gov .`�`/ l l NR Notified/Method: Supplemental Information
CITY lI ING D �vISION
TPPE WORK COMMERCIAL FEE* SCHEDULE - 115E CHECKLIST
❑ New construction ® Addition/alteration/replacement Mer]tanical permit fees` are based on the value ofthe work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. .
• CATEGORY OF CONSTRUCTION Value: $
RESWENT AL EQUIPMENT /SYSTEMS FEES* ,
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist. _
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea Total
JOB SITE INFORMATION AND LOaCATIOtOl. Heating/cooling
lob site address: 10884 SW 109111 AVE Air conditioning
Tres cal or heat lacer
(requires site plan showing placement) I 14.00 ' 14.00
City /State/ZIP: TIGARD, OR 97223 Furnace 100,000 BTU (ducts/vents) 1 14.00 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronie hot water system 14..00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duet, suspended, etc. _ 14.00
Flue/vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Waled /eater 10.00
Gas fireplace 10.00
FURNACE & A/C REPLACEMENT Flue vent for water heater or gas .
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert _ 10.00
Chimney/liner /fiudvent 10.00
El PROPERTY OWNER {❑ TENANT Other: 10.00
Name: WALLACE, WILLIAM Environmental exhaust and ventilation
Range hood/other kitchen
Address: 10884 SW 109TH AVE equipment 10.00
City /State/ZIP: TIGARD, OR 97223 Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: (503)624 -9535 Fax: ( ) toilet compartments, utility rooms) . 6.80 ,
E APPLICANT 0 CONTACT reRSoN Attic/crawlspace fans 10.00
pater 10.00
Business name: CLACKAMAS HEATING & COOLING LLC Fuel niftine
Contact name: VLADIMIR M1KHATS 55.40 for first four, $1.00 for each additional
Address: 15115 SE PENNY LEE CT. etc
Gas heat pump
City/State/ZIP: CLACKAMAS, OR 97015 Wall/suspended/unit heater
Phone: (503) 658 -4808 Fax: : (888) 500 -2912 Water heater ,
Fireplace
E -mail: CHCLLC@COMCAST.NET Range
CONTRACTOR Barbecue
Business name: CLACKAMAS HEATING & cOOLING LLC Clothes dryer (gas)
Other.
Address: 15115 SE PENNY I.F.F CT. 14l1IANICAL FERMI' Fes*
City /State/ZIP: CLACKAMAS, OR 97015 Subtotal • 23.14-g 3.5
Minimum permit fee ($72.50) .2250
Phone: (503) 658 -4808, I Fax (888) 500 -2912 Plan review (23% of permit fee)
CCB lie.: 165630 .! State surcharge (12% of permit fee) f .8.70 i (2y
f TOTAL PERMIT FEE 1;L20
This permit application expires if a permit is not obtained within ISO
Authorized signature: �.4 - man after it bas been accepted to complete.
Print name: VIADIMIR TS / [ Date: 10.06.09 I • Foe methodology set by Tti-County Building Industry Service Board
a;aBuldingWer nitsl)1EC -Pe nitApp.doc 01/19/07 440-4617r (11/02/COMIWEE)
Oct 0.5 09 11:33p Clackamas Heating &Cooling 18885002912 p.3
10!05/2009 15:31 5036126725 SEARS PAGE 07!07
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