Permit C�TY �F T'GAR® MECHANICAL PERMIT
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' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00221
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/20/2011
. Parcel: 25111 CA00103
Jurisdiction: Tigard
Site address: 9449 SW LAKESIDE DR
Project: Jackson Subdivision: ALDERBROOK FARM Lot: 13
Project Description: Replace furnace and A/C. Unit must meet 3' minimum rear and side yard setbacks.
Contractor: CLIMATE CONTROL INC Owner: JACKSON, DAN & MARLA
16500 SW 72ND AVE 9499 SW LAKESIDE DR
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503 - 453 -4822 PHONE: 503 - 684 -8901
FAX: 503 - 968 -7224
FEES
Specifics: Description Date Amount
Air Conditioning 05/20/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 05/20/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/20/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
,
Issued By: Permittee Signature: e / / - �, /ems j 04)
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.
M ay 1 9 201 1 3 : 52PM CL YMA{ = Ed TR - O L aI NC 5039687224 p . 2
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City of Tigard Received �'/ 17
n 13125 SW Hall Blvd., Tigard, OR 9722 AY 9 2011 Date/By: a// �� /� ermii No ra �O& - -- �t.'2 /,
Phone: 503.639.4171 Fax: 503 59B.1 0 Plan Review/ �(.0�(J
is 503.639.4175
D Inspection Line. ((`� � Daterey, Other Permit:
Internet: Line. gard- or.gov �� OF T�i�° tl Date Ready /By:
I I G A �/ 2
BUILDING DIVISION Notified/Method:
1 ( aPPlemen[al See Page infofor rraadaa
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- mo w - a.. �� � _ :`4 • � ': „.:Y'.
❑ New construction Addition /alteration /replacement M echanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:
Y >,, , , , }; : -: -, ey e . mechanical materials, equipment, labor, overhead, and profit.
a *-,*''' ?: 10,T;t * ;' T l i-3??4 :d 5 3?Y•o g .«Cs1ceteetlrl R't; -14 Value: $
Fri- and 2- family dwelling El Connnercial/industrial` ` °JJ II t + %� le
❑ Accessory building � ....,..g�.y.,.�. .a.... - _ Y.' + � ,
Mold-family ❑ Master builder [] Other For special information use checklist.
°'► -. Descri ion 1 Qty 1 Ea. 1 Total
'` fT>4 e .L'',rg i t a ai �"Y ti eo pa � ' 3 Y.t +�'
wv,,. ">r w. 4l i , e t= Heating/cooha
Job site address: 9 9 H ( I . P4i -y��J r� . 0 C Air conditioning
t 1 Cr (requires she plan showing placemen J l) 1 46.75 I .7r
City/State/ZIP: `16 ( -CD ei� 97 ' 22-11 Furnace 100,000 BTU (duets/vents) ) 46.75 4y.7
Suite /bldg. /apt. no.: 1 � Project name: �� 6� Furnace 100,000+ BTU - 54.91
Heat pump 61.06
Goss street/directions to job site: Duct work
23.32
Hyd onic hot water system _ 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent of above 23:32
Tax map/parcel no.: j 23.32
Ktr a',} e..., " a-'n - r i�''- e ;, = Y ; S _..,�:, - j -. ; Other fuel appliances
,ig ; „; Water heater 2332
LA-c 1 rNA C' AlG Gas rent for water heater or gas fireplace 33.39 -
Flue vent
fireplace 23.32
- Log lighter (Ras) 23.32
Wood/peIlet stove 33.39
T y r; �+ Y Wood fireplace/insert 23.32
y .` -v - = ; ji ?' I_i , " _ _ is sir W y F _ Chimney/lfiner /flue/vent 2332
- , . (( " , w :�.. . + ... W. _ _ DA IQ A ACM- , 7 'it'GF-� ` Environ mental Other:
23.32
Name:
Address: u /�+ mental exhaust and ventilation
L -[ �S j L,�.- Si Oc-- ,D1 Range hood/other kitchen
City/State/ZIP: l 6�� cy equipment _ 33.39
Phone: ed it)/ � Sin le-
dui exhaust sbathrooms, 33.39
Fax ( ) toilet compartments, utility rooms) 23.32
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r ;; ��� � a- '� ' 7 �,
n v; . P, ., . r } a te, C °sY Lm.' , g;s us,t2 Yc c i•,_o`ar 4 1 �"''" ^ 4rny�" f r. Attic/eraw clans 2332
.�f,.,q.--+ 4r�:e.�s �
Business name: 61.1 MATE- Ao n rrcL 1,74.- Other: 23.32
Contact name: Ro 4 t Ln [ r 15 Fuel piping
�� � $14.15 for flint four; $4.03 for each edditonal
Address: , (050 5(A) -ono A „ Furnace, etc.
City /State/ZtP: ( -land r C Gat heat pump
9, Z°Z3 Wall/suspeoded/unit beater
Phone: ( ) y - LI13 Z2 I Fax:: (Sp3)C1(08_ -7 zzy Water heater
E -mail G ( 7 Fireplace
f P t M o -re.. Co nd L t ri Conn Range -
'c_ s 7 , ; . uw ?: ak 5 4 U, IT? J * Barbecue
Business name: a L,l ,,, „e � tr'1 L / N. Clothes dryer (gas)
Address: 1lDSG3o 61.4....) 7 Av6 _
city /state/Zip: porr a n d r Z� s4� 1t -g -:... � u ,)
o
Phone: ��rr��22 ) `' p � Subtotal � 3_S-p
( D 3 y s-3°- 8 ZZ I Fax: (03) f l0 - - 1 z z y Minimum permit fee (S90.00)
CCB lic.: ( 7_1 ci i Plan review (25% of permit fee)
/ surcharge
Z State surcharge(12%ofpermit fee) 1 I. iz
�/�"" TOTAL PERMIT FEE i O9.
Authorized signature; / ,/?tom 444.4...t: is permit applies ex This �
V
/ l expires if a permit is not obtained within 180
f Print name: .,r days after it has been accepted as complete:
0 y i'zr f7s ' Date: 5Il4,V q I ` Fee methodology set by Ti i•County Building industry Service Board
1 \N EC- PcroutApp.doc 10'0i /09 I
44 0.4617T (t 1/02.'COM WEB)
May 19 2011 3:52PM CLIMATE CONTROL INC 5039697224 p.3
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