Permit CITY OF TIGARD MECHANICAL PERMIT
11111
COMMUNITY DEVELOPMENT Permit #: MEC2009-00113
Date Issued: 03/18/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S1 11 DC01400
Jurisdiction: Tigard
Site address: 15920 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 461
Project: Vanderpool
Project Description: Replace furnace and A/C.
Owner: FEES
VANDERPOOL, JERRY E & JANET F Description Date Amount
15920 SW ALDERBROOK CIR Air Conditioning or Heat Pump 03/18/2009 $14.00
TIGARD, OR 97224 Furnaces < 100K BTU 03/18/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 03/18/2009 $8.70
Minimum Fee Adjustment - Mechanical 03/18/2009 $44.50
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
TIGARD, OR 97224
PHONE: 503 - 453 -4822
FAX: 503- 968 -7224
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 (�J l�.rtr a' Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
r
Issued By: `�,Jf Q nl Lli lt(, n App Permittee Signature: /1 p titI \;!1 cA
h K./` r/ LK.f'
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.
Mar 16 2009 12:59PM CLIMATE CONTROL INC 5039687224 p.2
•
Mechanical Permit Application sou clhrlc i- us': ONI.1 •
• City of Ti r •
Tigard � r. � � � Permit No.:
• 13125 SW Hall Blvd., Tigard, OR 97223 i�'1� ` �O O Olt
, III
ll • Plan R
Ph one: 503.639.4171 Fax: 503.598.1960 MAR OtherPermitc
/ 1 6 Rate/
T I G A R f) Inspection Line: 503.639.4175 � o I? ate Ready/By: r rte. El See Page 2 for
Internet: xwx.tigard -0r.gov C , OF Notified/Method: ""t Supplementallnformafion
• B UIL DIN nG' n
TYPE OF W OR K V DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees• are based onthe value of the work
performed. Indicate the value (rounded to the nearest dollar) of all �
❑ Demolition ❑ Other:
mechanical materials, equipment, labor, overhead, and profit. i
CATEGORY OF CONSTRUCTION Value: $
and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1
y g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family 0 Master builder
❑ Other: Description i Qty. I Ea. Total
•
JOB SITE INFORMATION AND LOCATION Heating/tooling
Job site address: ) 51z0 .5i s1 I J /� r broo A. c Air conditioning or heat pump (,
/ etc (requires site plan showing placement) 1 14.00 I 1
City /State /ZIP: 7"J 6/41 ar C -- 2_.Zp j Furnace 100,000 BTU (ducts /vents) '( 14.00 ) +-f
Suite/bldg./apt. no.: Project name: V60,1 J 7 Furnace 100,0001-BTU (ducts/vents) 17.90
d�c P60 L Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 1400
Unit heaters (fuel -type, not electric),
in -wall, in-duct, suspended, etc. 14.00
Subdivision: J Lot no.: Flue/vent for any of above 6.80
Other: 10.00 _
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10
L- & N 4< ey I _ Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10,00
Wood/pellet stove 10.00
• Wood fireplacelinsert 1 0.00
Chimne liner /flue/vent 10.00
s PROPERTY OWNER ❑ TENANT
Other: 10.00 _
Name:
" C n Via h e f - eopL- Environmental exhaust and ventilation .
Address: 1 5`C1 �� q ( d breb `�, cl 2 r Range hood/other kitchen
! +T 1 F equipment 10.00
City/State /ZIP: —y-7 G a ,,- e 7 -24/ _Clothes dryer eechaust 10,00
Phone: ( ) tP /14,3 ! 2 Fax: ( ) Single-duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80
ist APPLICANT ❑ CONTACT PERSON Attic/erawlspace fans _ . 1 0.00
ess name: /,_ L4 f e�i- f � O .r „ } 4 i n � Fuel 10.00 .
Busin
c 'T Fuel piping
Contact name: R p ti /M r1 S $5.40 for first four; 51.00 for each a dditional
Address: ) (C S QO —"° A--I4— Furnace, etc. .
Gas heat pump
City/State /ZIP: Po rr (u n I t ' �� i
( WalUsuspended/unit healer
Phone: (93 ) `i S3 -Li 2 27 Fax:: ( 3 ) 9 L � -7lZ 4 Water heater ,
e C
E -mail col col rrn a 1 } C ,
Fireplace
I i-� Ll� r1 't YZ� 1 1 nG v in Range
CONTRACTOR Barbecue
Business name: t-M yi 1 , L 16 . Clothes dryer (gas)
'Q'r� �a 'r l its Clh -
Other:
Address: j(5oo 5 —1.221C Q MECHANICAL PERMIT FEES*
City/State /ZIP: 1e) r r 5 n ci or 4 '- ) 22- e, q _ Subtotal 2.
Phone: (4,") 3) + J 5 --3 Li (i z _.� Fax: ( ) ci -7 .2...-2.1 Minimum permit fee ($72.50) ^7.2- SZ)
CCB lie.: "� � ?..1 / z O 7 G� Plan review (25 % of permit fee)
/� 6 1 State surcharge (12% of permit fee) E3,-71)
p�/ ,� TOTAL PERMIT FEE l / • �a
Authorized signature: i \\ y % This permit application expires ill permit is Pot obtained within 180
Ra 7 �� ` days after it has been accepted as complete.
i Print name: t4 ri j Date: /4 /0 7 ' Fee methodology see by Tri -County Building Industry Service Board
11 Building \Permits\MIC- PermitApp,doc 01/10/07 440 - 46177 (11 /02/COMWEB)
Mar 16 2009 12:59PM CLIMATE CONTROL INC 5039687224 p. 3
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