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Permit • r MECHANICAL PERMIT CITY OF TIGARD Permit*: MEC2009 -00389 - COMMUNITY DEVELOPMENT Date Issued: 07/29/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134DC01400 Jurisdiction: Tigard Site address: 11735 SW 114TH PL Subdivision: 114TH PLACE Lot: 7 Project: Kluempke Project Description: Add A/C unit. Minimum 3' side and rear yard setbacks apply. Owner: FEES KLUEMPKE, PETER Description Date Amount 11735 SW 114TH PL Air Conditioning or Heat Pump 07/29/2009 $14.00 TIGARD, OR 97223 12% State Surcharge - Mechanical 07/29/2009 $8.70 PHONE: 503- 720 -7925 Minimum Fee Adjustment - Mechanical 07/29/2009 $58.50 Contractor: COLUMBIA HEATING & COOLING INC PO BOX 230397 TIGARD, OR 97223 PHONE: 503 - 624 -2704 FAX: 503 - 598 -0270 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 or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Pennittee Signature: k 1.9-1,04, ,\,/ 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. . . .. Mechanical Permit Apptic CEIVEID FOR OFFICE USE ONLY City of Tigard J Received /•' plumy, •"' 14° 'Wre r olag7lag, 7 -2 9 13125 SW Hall Blvd, Tigard, OR U L 28 2009 , P 9'7223 1•111 Kra Ravi - le Phone : 503.639.4171 Fax: 5 03.598M OF TIGARD Date/By: Other Permit: Inspection Line: 503.639.4175 TIGARD BUILDING DIVISION Date Ready/By: Juns: liff See rage 2 for Internet: www.tigard • Notified/Method: 7-/ Supplemental Information 1 • TYPE OF WORK I_ • : :;; .' :::!:': ;.*:',.:',•-,;.:::: :'-;;:c024,11,1LERCIAL: ywo Mecharrical permit fees' are based on the value of the work 0 New construction ge4di t ion/alteration/replacement performed. Indicate thc value (rounded to the mama dollar) of all 0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit ___. CATEGORY OF CONS ::Y-.; 1- :.:• : ';!..' :::' . 0.. , - .. - • Value: $ • :'...r:TI*40..014040.06.0i4T / BVBT*NP. !E ‹- 2-family dwelling CI Commercial/industrial 0 Accessory building For special Wornsation we checklist. 0 Multi-family 0 Master builder 0 Other Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION . - :. : ...; Heating/cooline Air conditioning or heat pump 1 Job site address: i i 7 35 ..-- .5cti j l q.e t pi.vc.4_ ' (requires site plan showing placernent) i 14.00 City/State/ZIP: - ,,,f a •(.. q 7Z-ty Furnace 100,000 BTU (duetstvents) 14.00 Furnace 100,000+ BTU Oluctsivears) , 17.90 Suite/bldg./apt. no.: 1 Project name: Gus heat pump 14.00 Cross street/directions to job site: Duct work 14.00 Hydronic hot water system 14.00 , Residential boiler (radiator or hydrottic) 14.00 - Unit heaters (fuel-type, not electric), in-wall, in-duct, suspended, etc. . 10.00 - Flue/veal for any of above 10.00 Subdivision.. Lot no.: Other: 10.00 Tax map/parcel no.: Other fuel appliances DESCRIPTION OF WORK . . s' • Water heater 10.00 - Gas fireplace 10.00 4.4ser AZA Cevr‘et-c-nZ..-- , 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 . • . • • ChinineyAinerldue/vent 10.00 a.EROPERTY OWNER 0 TENANT , - . . Other: 10.00 , Name: 7,_"..,_ c „, , 11 0 ,...,,k_t_ ______. Environmental exhaust and ventilation -- _ Range hood/other kitchen Address: // - ss- _s c ...) 1/ Y Pk f(46. .<._ -c_ equipment 10.00 City/State/ZIP: - Tr .,..,,f o x c3.-/a-ty Clothes dycr exhaust 10.00 3 s Single-duct exhaust (bathrooms, Phone: (50 ) 72.0 . ...79 7 ,r Fax: ( 1 toilet compartments, utility rooms) 6.80 1 0 APPLICANT 0 CONTACT PERSON . Attickrawispace fans 10.00 _I Other 10.00 1 Business name: i . Fuel .I. Contact nameri .. 7) A I b r $SA for Ord four; $1.00 for each additio 1 Furnace, etc. Address: Gas heat pump City/State/ZIP: Wall/suspandediunit heater ._ Phone: • 3 )4„9. - ---, • Fax: ; 93 1S - & 7 7 0 Water heater E-mail: . . , . .. CONTRACTOR • . ..-.4: Bar becue • • Business name: (?.0 ivy), b/ a-■ fri...t.4..ber_ t e.-0 11.6 c;911(..," Clothes diver (ites) Other: I Address: 1 ;3 0 x . 23 0 3 9 - : : . .-,:. ;1401A141CAL PERMff FEFS* City/State/ZIP: --17 c, ) / q - 7.2 Subtotal - Minimum permit fee (S72.50) 1,A , 0 Phone: (,M) (.9 2 L I - ..,- 7 $ Fax ( 5 7 5 - ' 5 ) S --' - ' ? --- ,--.) . Plan review (25% or permit fee) CCB lie.: 7k 35? ' / state surcharge (12% of perniit fee) k• 70 1 TOTAL PERMIT FEE eq, AO This permit application expiry if a permit is not obtained within ISO Authorized signature: days after it has been accepted as complete. Print name: X Ly444 Exkii Date '7 (1 i /0 5' I • Fee metliodclou set by Tri-County Building Industry Service Board I maidieorereihsVAEC-PerriAAndoe N106106 443.4.617T (11/02/COMAVE111 Z d OLZ0 13upo3/6ugeeH spur dZC:Z L 60 ez inc • • • HEATING & COOLING, INC. P.O. BOX 233397.• TIGARD, OR 97281 (503)624 -2704 SITE PLAN 2 's ADDRESS: //1/H/4_,,, £'d OLZO - £05 6ui�o ©O/6ui }eeH eiq�unioO dZ£ Z6 6082Inf