Permit Ai CITY OF TIGARD MECHANICAL PERMIT
'! • ` COMMUNITY DEVELOPMENT Permit #: MEC2011 -00270
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/15/2011
Parcel: 2S112BB11900
• Jurisdiction: Tigard
Site address: 14095 SW FANNO CREEK PL
Project: Vorvick Subdivision: COLONY CREEK ESTATES NO.4 Lot: 99
Project Description: Replace a /c. Unit must meet 3 foot side and rear yard setbacks.
Contractor: CLIMATE CONTROL INC • Owner: VORVICK, PAUL D & ANDREA A
16500 SW 72ND AVE 14095 SW FANNO CREEK PL
TIGARD, OR 97224 TIGARD, OR 97224
•
PHONE: 503 - 453 -4822 PHONE: 503 - 620 -9022
FAX: 503 - 968 -7224
FEES
Specifics: Description Date Amount
Air Conditioning 06/15/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/15/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/15/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
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 : i work suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification 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 • rect questions to OUNC b +3.232.1987 or 1.800.332.2344. c------ •
I sued By: k i // / - P ermittee Si ature: �; %/� 4� ��-, t
Call 503.639.4175 by 7:00 a.m. for the next available inspec ion 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.
5039687224 p. 2
Jun 13 2011 7:18RM CLIM.RTE CONTROL INC
City of Tigard �
EI 13 A Received GA /J
13125 SW Hall Blvd., Tigard, OR 97223 Date/By. �(/ /� � ' Permit No.: GC OKJ r/r/�?
Phone: 503.639.4171 Fax: 503.596 .1 60 Plan Review
Inspection � 2011 Datels OI]IerPermit:
Til.At ;t) P line: 503.639.4175 y'
Internet: www.tigard or Date Ready/By: 7u<+a: See Page 2 for
OF TI y Notified/me
1 I ��' 1® d10d' Suppletrental
:1 :•F Rx N;.;rt , 2 Ar�.a+y.yT..,,
*,-* '. �`.. : 4 g;kk•ii �p � Ice a 'O r(
❑ New construction XAddition/aheration /replacement Y 6' ?'
Mechanical permit fees' are based on the value of the work
❑ Demolition Other: performed. Indicate the value (rounded to the nearest dollar) of all
Y�""b?z °• Demolition
h' c: �w w mechanical materials, and
�µ t. x3t�:�r° ;�� � ,�,;•. �, ,,.,„� ..,,,,,,.,,,,�, equipment, labor, overhead,
fi4 _3; ;st�tfr:: GA (, x:`}�?. s, y profit.
z•.,. :3it - K".-`aay v AnM ... at'�e"iral : ; i, aloe $
�l . and 2- family dwelling ❑ Commercial/industrial " �' '1.t _ °° ° I�- v '
❑ A ccessory building - rara7. .. ..• £ ;•+ a . y a. g ..+� . , _
❑ Multi- family ❑ Master builder ❑ Other: For special rnjormnrion use checklist.
x 1�A ` r te °_ ° �? .. '` I r d er c i ° r � y n Description I Qty I Ea. I Total
.: f s.92 a r 1 ® �i'�"'`� ""`�� ° HeeN ft/cooling
el 09 sw .ra. n no Cf .. pL. Air cond;doning
Job site address: u
Cit /StatC/ZIP: qq (requites site pbn showing placement) 1 46.75 -1 tr -7r
4 rr4 r'C 0 q Furnace 100,000 BTU (ductahents) 46.75
Suite/bldg./apt. no.: 1 Project name: Vo iev I �1� Furnace 100,000+ BTU (duets /vents) 54.91
Cross street/directions to job site: Heat 61.06
Duct work 23.32
Hydronic 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.:
Other; for any of above 23.32
Tax map/parcel no.: + Other' 23.32
-'.4 '� , Other fuel appliances
' : EP: - ...,?/ K , ..k�' 3 r 1 .l2: �.J.c �� :' .ii Water
�: ' .. a+ .a: heater 2332 _
�G�' Gas fireplace
e - 7 c - L i r � /<c 1A tcG AA" Flue vent for water beater or gas 33.39
AO CA -t
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 3339
Envirmunental exhaust and ventilation
.• ry' r 1 r! i � Wood fireplace/insert 23.32
A =
‘,--.,,..t ..r...37.% ` _ , mo� _" / ...__. , ._ ? __.,.. - A r �� Ot h e r ey l ner /IIue/vent 23.32
/ewere -7q- V �1 _ _ Other 23.32
Name:
�/ ,,,,
Address: Not cis- co Ski M -1,74a � `. aft Range hood /otherk;tchesm
City /State/ZIP: �� � equipment 33.39
04 97 z- / Clothes dryer exhaust 33.39
Phone: ( ) Z Z Fax ( ) Single -duct exhaust (bathrooms,
° x toilet compartments, utility rooms
. 9 5i F u Ell `N r °a c+e, r w r ti T r tY ) 23.32
.^..__ .,. ,.,., , , ? #t:,_,, -,, c. p i ry " ,d 7 oT ' s t 9 i . Attic /Crawls ace fans 23 32
! 1 ,:- ..it i - .a - .±_?S ti'�twF>r„�, p
Business name: 61 +L 1 MAC �l p n rrQL t nL Other: 23.32
Contact name: Ro r -Ln r Fuel piping
Address: 1 6500 Sw . 1"' r Fumacea 15 for first four; S4•03 for each additional
� rland ! � r '� V Gas beat pump
1 223 WalUsuspended/pnit0eater
Phone: (9>3 ) L 153 - L($ZZ Fax:: ( Sb3)9(OS - 2Zy Water heater
E -mail t;+p G t Fireplace
1 re) t7► c a L Inc Cart
1 ° ot� o " N t) � , 4 3 te a. Range be
...��^ ^ �,'al.„ ��� a � ."r _y, ` t "t,�'' I '��'; Barbecue
Business name: e_L,t vvi A,rr- Co to f r n c ' Clothes dryer (gas)
Address: f 10500 ca-) 7� na AVM other:
City/State/ZIP: ?Orr rl U r Z i $ ` I a `� total `r :-
- l a o � . �,�:
G� � � S ubtota l
(� q5�" y$ Fax: - 44.1c ( 9't i - Z Zy Minimum permit fee ($90.00) q
Phone: p . 06
CCB tic.: 7,...t review (25% of permit fee)
/ State surcharge (12% of permit fee) L0. SO
Authorized signature: /1�� i :).. _ TOTAL PERMIT FEE / ,g0
�f� //LLiLLbb This permit application expires if a permit is not obtained within 180
L Print name: y "�� v days after II h as been accepted as complete.
0 i4 - 7,5 j Date: 6///3/4// I * Fee methodology set by Tri- County Building Industry Service Board
I: IBuddinAiPernitso vI;C- PeimitAmsdoc I 0:01/09
440.46171 (J n /OZ:COM. WEB)
A 4 ,40- po7, v
Jun 13 2011 7:18AM CLIMATE CONTROL INC 5039687224 p.3
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