Permit CITY OF TIGARD MECHANICAL PERMIT
114 q
2 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00429
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 09/28/2011
Parcel: 2S114BCO3800
Jurisdiction: Tigard
Site address: 10372 SW BONANZA WAY
Project: THOMAS Subdivision: RIVERVIEW ESTATES NO 2 Lot: 75
Project Description: furnace replacement
Contractor: CLIMATE CONTROL INC Owner: THOMAS, JOSHUA W
16500 SW 72ND AVE THOMAS, LAUREN M
TIGARD, OR 97224 10372 SW BONANZA WAY
TIGARD, OR 97224
PHONE: 503 - 453 -4822 PHONE
FAX: 503 - 968 -7224
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/28/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 09/28/2011 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/28/2011 $43 25
Occupancy Grp:
Stories:
Fuel
Fuel Types
Gas Pressure
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503 232 1987 or 1 800.3 44
. 11111b
Issued By: Permittee Signature:
Call 5''.. 9.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Sep 28 2011 8:06AM CLIME CONTROL INC � 5039687224 p . 2
t City Of Tigard aa(so1 Re ived
w 13125 SW Hall Blvd., Tigard, OR 97223 ® Date/Ry: 1 0/
Perm" N°.. ry�� +��? l /'� l�K abl
II Z Q I I Date/By. Other Permit.
Phone: 503639.4771 Fax: 503.598 196Q G �P 2 8 Plan Review / i "°` Jr
1 I G \ . I r, Inspection Line: 503.639.4
Intones: wvew.tigard- or,gov Date Ready /BY: runs; S ee Page 2 /w
CITY OF TIGAp Notified/Method: Supplemental Information
"�a „$.y. :".e.rgl ..�., 1 ,.7riY;' � .a ar s ``- '44.f7Ye';0F,,21,e:., 1,4; e I I .. d' a.N +l `t' I q' '°r'•',,r_,
❑ New construction �;Addition/alteration /replacement Mechanical permit fees* are based on the value of the work s .,.,
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:
¢ u a f,: mechanical materials, equipment, labor, overhead, and ft,
.. ,. t z ; . 444 . 4 }
a.•.:3r- 4- .0;n, � 04. 4+°,r -L•e, ' � >~# t . a f 3 it a, <, .«, tu g� ' t Value: $
igl- and 2- family dwelling ❑ Commercial/industrial _` ' ", 1 '`°` to ut�_
❑ Accessory building � � i s . _ - 1 i !
0 Multi- family ❑ Master builder 0 Other: For special information use checklist,
.a y�� y z , :;3 Description a.
mt+ - Srr` i' _t y y t tj� � f i ' r�l [ zZ e �' ti :`r *sq.'r xs , Qty I E Total
r ” ��'s�atCC =:�fi ••�..aMy�� �. j•�'• . HEatiAp,/ODDiIn�
Job site address: / )3 / 72. �r� ,ZA c . � Air conditioning
1 (11xPti es the plan shaving placement) 46.75
7767
City/State/ZIP: ex �22� Furnace 100.000 BTU (ducts/vents) f 46.75 yL `/f
Suite /bldg. /apt. no.: Project name: O s Furnace 100,000+ BTU (ducts/vents) 54.91
Cross street/directions to job site: Heat pump 61 A6
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: l Lot no.: Flue/vent for any of above 23.32
Tax map/parcel no.: Other: 23.32 ,
r r/st s: ev ty 3� cy"5 v ; y .t
Other fuel appliances
�s . s.:. rxa: +s, ...r ��) , . '��;�`/ t lei W r r w F , w, w . Water heater 23.32
Gas f
,..7%,./4-C6— /4//%N4eirr Flue vent for water heater or gas 33.39
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove _ 33.39
F Wood fireplacelulselt 23.32
�` N r6 . S+�t � `7't C ,. #, -,�` • w I; Chinmpy/line /flue:/vent 23.32
Name: - other 23.32
�v„e« 0,5'4 • f Environmental exhaust and ventilation
Address: /a37z 0 ,�,, n, A... y Range hood /mllea kitchen
City / State/ZIP: equipment 33.39
�f c 97 1-- � Clothes dryer exhaust 33.39
Phone: (
Single-duct exhaust
) yy.' phi, g � ,
. €r(z , , Fax: ) toilet compartments utility
- _ 21 3 - � r` „..:1 * gy p r N ' ri-a ' .•I ?� s yx ,..=:_ -' y t t �`C ,' 1 ,,, , A7 ' >a ? ,,, lapace fans rooms) 23.32
h.��r�. , y . �- r s a At tidcraw 2332
Business name: In it/het re- e n NbL, Inc-
Other 23.32
Contact name: '� ^ Fuel piping
O 4 ,r tS S14.15 for first four; $4.03 for each additional
Address: i (050C) 5k) `?` .'" �Ue
Furnace, etc.
City /state/ZIP: `rf and r Gas heat pump
'RD( Wall/suspended/unh heater
Phone: (563) L/53 - L 18 ZZ I Fax:: (503)9( - Water heats
E -mail ro e G t l fY3d.4-e. c o -'4 - . Rang
,<...z.. , .. A,, fl ,.421_ f� 3 T '' Barbecue
Business name: CL.1 rvi 11, Tr Co n$*vL. inc , Clothes dryer (gas)
Address: 1 �j St�O S -7., n D Other-
I A V < r ' a ', K�'�, : ii �r`��'S�` °i i i �"' c .
City / State/ZIP: -parr- l a fl Cl C( ,Z, 2 y * ,� 4 _ ,
o'r Subtotal Lit 7 . ) ----
Phone: (503) q— L/ ZZ I Fax: (5 on v -7z25/ _ Mmmu ' j "
tm permit fee (590.00) op
CCB lic.: Co 749 O Plan review (25% of permit fee)
State surcharge (]2 %ofpermit fee) /rJ
liZ TOTAL PERMIT FEE /G��D
Authonzed signature: This pe emit applleaoon e xpires If a permit Is ant obtained within 180
f Print name: (� d ays after it bas been accepted as complete.
AID tt #0,41.( Date: �} Z0/' • Fee methodology set by Tri- County Building Industry Service Board
I.c Building \PenmieskMEC•PermicApp.doe 1 0'01!04
440-4617T 1! 1f02 weal