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Permit • CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2009 -00329 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/08/2009 Parcel: 2S111DC06500 Jurisdiction: Tigard Site address: 9480 SW BRENTWOOD PL Subdivision: SUMMERFIELD NO.9 Lot: 499 Project: Clemence Project Description: Replace furnace and A/C. Must maintain a 3' rear and side yard setback Owner: FEES CLEMENCE, FORREST W & SHIRLEY J Description Date Amount 9480 SW BRENTWOOD PL Air Conditioning or Heat Pump 07/08/2009 $14.00 TIGARD, OR 97224 Furnaces < 100K BTU 07/08/2009 $14.00 PHONE: 12% State Surcharge - Mechanical 07/08/2009 $8.70 Minimum Fee Adjustment - Mechanical 07/08/2009 $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 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: Permittee Signature: CA_ tom Call 503.639.4175 by 7:00 a.m. for an inspection that business day. f 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. JL1 07 2009 8:00AM CLIMATE CONTROL INC 5039687224 p.2 Mechanical Permit Applic 13125 SW Hall Blvd., Tigard, OR 97223 I olz:t►1.I It F'.�ar O (, y, :. : ' .:„.:-,- 14 City of Tigard 9� Received permnho.. I� '1 •• Date/By: !'e�G d(T(7� - ©03 - Phone: 503.639.4171 Fax: 503.598.19jUL U 7 2009 Date /B view bate/By: Other Permit: I1 G A lt')). Inspection Line: 503.639 Dare Ready/Fly Intl Internet: ww�••tigard or.gov Supplemental See Page 2 for CITY OF TIGARD Notified/Method: Supplemental Information �IbI DIVISI01� TYPP O . COMMERCIAL FEE" SCHEDULE - USE CHECKLIST Mechanical permit fees' are based onthe of the work ❑ New construction XAddition/alterationlreplacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead; and profit. . CATEGORY OF CONSTRUCTION , Value: S A1- and 2 -famil dweliin ❑ RESIDENTIAL EQUIPMENT /SYSTEMS FEES* , y g ❑ Commercial /industri Accessory building • ❑ Multi - family 0 Master builder For special information use checklist. ❑ Other: Description P Qty. I Ea. I Total • JOB SITE INFORMATION AND LOCATION Heating,,/cooling Job site address: ` 9Ao �c ,4 WOO d L Air conditioning ho or heat pump 1 L1 (requires site plan showing placement) ( ] 4.00 City /State /ZIP: T 1 C-on t-fl CN-- C .. -j -L-4-,9 Furnace 100,000 BTU (ducts/vents) I 14.00 - 1 y Suite bldg. /apt, no.: Project name: Furnace 100,000+ BTU ( ducts/vents) '• 17.90 C� .6— ME-h1C'r Gas heat pump 14.00 Cross street/directions to job site: Duct work 10 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), • in -wall, in-duct, suspended, etc. 14.00 Subdivision: Lot no.: Flue,/vent for any of above 6.80 Tax map /parcel no.: Other: 10.00 Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 � � �.r f�- Gas fireplace 10.00 C 1 L) ' )4,1c-- Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Woodlpellet stove 10.00 • Wood fireplace /insert 10.00 Chimney/liner /flue/vent 10.00 ® PROPERTY OWNER ❑ TENANT Other: 10.00 Name: U r! .- S1-) 1(zLey Q_L C� Environmental exhaust and ventilation � !!! - r - ' d pt, a 1 Range hood/other kitchen Address: C t4 Go S l rl-7 C� equipment 10.00 City/State/ZIP: "fl 644( 0.1 q 1 "Z.Zy Clothes dryer exhaust 10,00 Phone: ($63 ) (422.D_ 0 8 Fax: ( ) Single-duct exhaust (bathrooms, toilet compartments, utility rooms) _ 6.80 APPLICANT ❑ CONTACT PERSON Anicicrawispace fans 14.00 Business name: /1 H r�7 A., n v J in L Other, 10.0 c •^ Fuel piping Contact name: ROL./ ' ( ,• p /'l S 55.40 for first four; 5100 for each additional Address: ) S aQ h O 1 • Furnace, etc. �- �l vc Gas heat u City /State /ZIP: PO «'i- cj to r) d- or- - 2 pump 1 � W / suspendeNunit heater Phone: (52t3, ) t $ _-I is, 72 Fax:: (M) 9 G_ --72z t� Water heater E -mail: Col- I� C_ t i era I 1 lC / Fireplace - — Lt1 n C �-� Range CONTRACTOR Barbecue Business name: // 01A-re- 00 r 1 L 1 6 Clothes dryer (gas) Address: h e)5oL SA.) --- 7,2-''' 4 i other F MECHANICAL PERMIT FEES" City /State /ZIP: (� C r - fan �� 2Z''j • J Subtotal a Phone: (�7y 3 1 1 3 Li k , z_z_ Fax: ( el f5 Minimum permit fee ($72.50) 7 a -5D CCB lie.: ?•--1 t 1 `7+ '5 Plan review (25% of permit fee) r State surcharge (12% of permit fee) g r 7 O / / TOTAL PERMIT FEE C 80 Authorized signature: J This permit application expires if a permit is not obtained within 1 ' w 11 days after it has been accepted as complete. Print name: Yri3 Date: 7 �(o/D 9 Fee methodology set by Tn- County Building Industry Service Board I AHuildi \P ermastMF.C.PamitApp.doc 01/19/C7 4 40. 4 617T(I t cracorewEE) (- 9 3Rbl3 ,j!u1 07 2009 8:00AM CLIMATE CONTROL INC 5039687224 p. 3 ;;° 16500 SW 72nd Avenue Portland, OR 97224 r., Phone: 503 - 453 -4822 Toll Free: 866 - 453 -4822 HEATING & AIR CONDITIONING Fax: 503 -968 -7224 \. C%e,h,ce - d7 1 LI , N s _S ? i , '.--...,,, „1 p/ ..... • / r 1 / / / / ... i / bra / f / 4.. r - ' 6 -' *N3 / 1 ! 7 1 / � i / 2 l l \ ✓ I / I I 1 SYSTEM DESIGN -- INSTALLATION SERVICE - MAINTENANCE climatecontrolinc.com