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Permit CITY OF TIGARD MECHANICAL PERMIT 111 11 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00284 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/15/2009 Parcel: 2S103BB03600 Jurisdiction: Tigard Site address: 12173 SW 125TH AVE Subdivision: BROOKWAY Lot: 36 Project: O'Neil Project Description: Replace furnace and a /c. Owner: FEES O'NEIL, AMANDA Description Date Amount 12173 SW 125TH AVE Air Conditioning or Heat Pump 06/15/2009 $14.00 TIGARD, OR 97224 Furnaces < 100K BTU 06/15/2009 $14.00 PHONE: 503-747-6092 12% State Surcharge - Mechanical 06/15/2009 $8.70 Minimum Fee Adjustment - Mechanical 06/15/2009 $44.50 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 $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 : cation Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or . • ect questions to Olio ' • •:Ili 503.246.6699 or 1.800.332.2344. ssued By: (1/011)21/ / � Permittee Signature C f�I 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. Jun 11 09 11:30p Clackamas Heating &Cooling 18885002912 p.1 Mechanical Permit Annlication TIT l ` " r , ( , r r 1(I I `1 i i\ I 1 City of Tigard ,may. 6 ,ffilailmi eta: /if e 9.,00 ' 13125 SW Hall Blvd_ Tigard, OR 91223 : Phone: 503.639.4171 Fes 503.548.1960 JUN 12 2009 rter Other Permit Ti . . \ 1: 1) Inspection Line: 503.639A175 dote teaadynty: Wil H See Page 2 far Internet ti CITY OFTIGARD Nodfrdtmeand= -- ' - - , Ir I D.WISIAN . TIME OF Me SCHEDULE -- 11.118E CHECKLIST ❑ New construction Addition/alteration/replacement ement P ' don the value of the work performed Indicate the value (mended to the nearest dollar) of all © D emolition Q Other: tnachaQical materials, equipment, labor, overhead, and profit value: S aastoornaLotwassaprrismzus ® 1 - and 2- family dwelling Er Commercial industrial ❑ Accessoty building 1 s* El r. Multi- family ❑ Master builder ❑ Other For � Description 1 Qty. 1 Ea I Total : 10B SITE INFORMATION AND ll.1191 QV faeautgfcooliig Job site address: 12173 SW 125th Ave Air conditioning or het pump (requires site plan shoeing plaorman) 1 14.00 14.00 City/StatelLIP: Portland, OR 97223 Furnace 100,000 BTU (daetstvests) ` 1 14.00 14.00 Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (domt ws) 1790 Gras (teat pump 14.00 Cross street/directions to job site: Duct wnrir 10.00 Hydtooic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel-type, not electric), in -wall, inset, suspended. etc~ 14.00 Fluefse t for any of above 680 Subdivision: Lot no Other 10.00 Tax matt/parcel no.: Other fed appliaaca Watch heats 10.00 Gas fireplace 10.00 REPLACEMENT FURNACES & voter A/C Flue vent for heats err gas - _ firapbce 10.00 i Lag lighter (gas) 10.00 Wood/pellet stove 10.00 _ / Wood tueplacclrrsat 10.00 L PROPERlY 1 U TENANT Oth e r 9oJuenr 10_00 Outer 10.00 Name: O'NEIL, AMANDA Environmental exhaust and ventilation kitchen Address: 12173 SW 125th Ave Range hood /othe W 10.00 City/State/ZIP: Portland, OR 97223 Clothes dryer exhaust 10.00 St, Phone: (503)747 -6092 • Fax: ( ) toilet compartments, utility rooms) 6.80 P ArIlICANT 1 . 0 coNTAFer Allick rawispace fats 10.00 Other: 10.00 Business name: CLACKAMAS HEATING & COOLING LLC Fuel piping Contact name: VLADI IIR MDCHATS $5.40 far first four; 51.00 for each additional Address: 15115 SE PENNY LEE CF. Furnace, etc Gas heat pimp City/State/ZIP: CLACKAMAS, OR 97015 Wall/suspended/unit beater Phone: (503) 658 -4808 I Fax:.: (888) 500.2912 Water heater Fireplace E-mail: CHCLLC®COMCAST.NEC R core itAcTua Barbecue Clothes dryer (gas) Business name: CLACK.__ MAS HEATING & cOOLING LLC Other: Address: 15115 SE PENNY LEE CF. MECHANICAL PE QTF>f i't* City/State/ZIP: CLACKAMAS, OR 97015 Subtotal 28.00 Minimum permit Lee ($7230) 7250 Phone: (503) 658 -4808 Fax: (8$8) 500-2912 Pfau review (25% of permit fee) CCB lic -: 165630 State surcharge (12% of permit fee) 8.70 TOTAL PERMIT FEE 81.20 Authorized signatnr e: %�,/ (per ^� _ Mk t application maim it a permit is not obtained within ISO LX�Is� days:fler it las been seerpied as essipiete. Print name: VLADIMIR MIKHATS I Dater 06.12.09 1 * Fee methodology set by 7ri- Cvmtty Balding ladiany Service Board I lauildi .doe 01l19RT7 444- 617T(11U2pcesv Ea) LO/LO 39Vd 8'd ZL6Z009888L S3S WV 0C 6OOZ /1I /9 ue panze'z'ad SZL9ZI9EGS LB :SI 680Z/I1/98 6ugooag6w}eeH sewm{oeo d L8: L L 60 LL unr