Permit CITY OF TIGARD MECHANICAL PERMIT
I I COMMUNITY DEVELOPMENT Permit# MEC2011 -00476
Date Issued 10/26/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439
Parcel 2S 111 CA05300
Jurisdiction Tigard
Site address 9480 SW LAKESIDE DR
Project Keswick Subdivision SUMMERFIELD NO 12 Lot 673
Project Description Replace furnace
Contractor CLIMATE CONTROL INC Owner KESWICK, BEVERLY
16500 SW 72ND AVE 9480 SW LAKESIDE DR
TIGARD, OR 97224 TIGARD, OR 97224
PHONE 503 - 453 -4822 PHONE 503- 639 -8681
FAX 503 - 968 -7224
FEES
Specifics' Description Date Amount
Furnaces < 100K BTU 10/26/2011 $46 75
Type of Use SF 12% State Surcharge - Mechanical 10/26/2011 $10 80
Class of Work ALT Type of Const Minimum Fee Adjustment - Mechanical 10/26/2011 $43 25
Occupancy Grp
Stories
Fuel
Fuel Types
Gas Pressure
Total $100
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 q ions to Oh • C b . mg 503 232 1987 or 1 800 332 2344
Issued y / / if/ ! Permittee Signatur= d • 1a
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
Oct 25 2011 7:24AM CLIMATE CONTROL INC 5039687224 P -2
City f Tigard Received Dase+eY ��� 0�� /��
; 1 131 SW Hall Blvd, Tigard, 0W21 p �/L Pemut No /lee / � Lf7 /_
0 Phony 5036394171 Fax 50 %5�'190Ojtam 11 Plan Review Other Pensut cF �
TIcAI rD Inspection Lino 5036394)75 � ` ` �A ' C 9Q Dale Ready /By ;mu Fa See Page 2 for
Internet wwW ttgard -or.gov r 1 l l Nouned1dedrod Supplemental Information
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ED New construction XAddition/altera 11 an/ieptlac%rnent Mechanical pcmitfees are based on the value of the work
❑ Demolition ❑Ocher. �U
pm Indicate the value (rounded to the nearest dollar) of all
,+ N _ mechanical materials, equipment, lake, overhead, and profit
v. 1 s +. 4 .,- r,cij Eli 1 . 6 'err re.i. r Value S
4;rr i1 a tlr y a t t�`k, t 1 ec• -',
�1- and 2 -family dwelling ❑ Commercial /tedusmal ❑ Accessory building � Y�"' •-�"� r ='�'' ' '-"- ' ^.: r''^"' 1
o Multi-family ID Master builder 0 Other, For special information use cgechn E
Description 4 Qty I Ea. I Thal
fr,T )t .. ^'.rat. , , r` it w w. iS .� • IZ . 0 '', - r >t . ° xjrt"t . ay
' _ `ky_�j�_Ni<7�`r,"„`� Heating/cooling
lob ale address: '114 SO 5- LA tES i be- Dr Air conditioning
(,f (requires m e plan shonmg placement) 46 75
City /State/2CP fl (-7 n.ro or 9 - 7 z 2•�'I Furnace 100,000 BTU (ducts/masa / 46 75 4(p, - 7c
Suite/bldg. /apt no,. Project name. .K ej w (
Furnace ]OO,OOtI+BTll (ducts/vents)
54 91
Heat pump 61.0 61,06
Crass street/directions to job site: Duct wort 23.32
Hydronic hot water system 23 32
Residential boiler (radiator or
hrdronic) 23.32
Unit heaters (foci -type, not electnc),
in -wall, in-duct suspended. etc 46 75
Subdivision Lot m Floe/vent for any of above 23 32
Tax map/parcel no Other, 23 32
Other fuel appliances
W :lies ii
E W7 .- 0 + l -;+: r- 7 1.f,.c:1
. (.a 9.: rW + ` 7 .. "l 1 Weta heater 2332
1
Gas .. C >z ,l Mq Flue v vplace 3339
(1-� ' r � Flue vent for water heater or gas
fireplace 23.32
Log lighter (Ras) 23.32 _
Wood pellet stove 33 39
Wood fireplacetmsert 23 32
v -".
._r ::i''4 s..?):FIA�J�l!�t::ro T,f ig r �.,, ,'._ �r ��� hR'p -: s 4 ' 1k/� Chi ®heynmer/lhselvmt 23 32
7 :'V le e
t a y d: ..z Olha 23 32
Name ��t'f Li 3 L/( Environmental exhaust and ventilation Address. A Li S sic) / � , $ C i +1 r Binge hood/other kitchen -I"r f-+� !J cowman 33 39
City/State/ZIP 7-76,4-O o r r.. Z Zrp Clothes dryer exhaust 3339
Phone ( ) � i /JJ/ Fax 77 Singleduct exhaust (bathrooms, -
1s n v . ,-,2� % c x' ( ) toilet compartments, utdlty moms) 23 32
r>; r.,, , 'r tY p- - illsie eek.;; i ;::L*i 4 -C { i rr � �
)s Y other fans 23 32
Business name L tonrr ( I1L Other 2332
Fuel piping
Contact name R014 t r 15 514.15 for flirt four; 54.03 for each additional
Address' l 650n Sea - TA P° A , +C Furnace, etc.
�'�1/ Gas heat pump
City/State/ZIP; Da) crin.nd C 8 7 223 Wall/suspended/unit heater
Phone (CO3) I/5'3_ 48aa elFax.:( Sp3ig( o g_7 2 9 Wataheater
c
E-mail. ro @ G (t 1 Fireplace
w , _ 'I 'OLItIG C OIV^ Range
'1 ., r -iku. "' s 2`;5�,• any, e } o' er —I 4• 5 e tu '' , 5 Y ' r Esi I, ,li '(i3
, _` .a��' bu 1... w:Z- s�s�'u�fi Barbecue
Business name' CL( 0/I ar C O n4'rvL j nC , Clothes dryer (gas)
Other
Address: t (0500 SIN -ra (1 A v pk `-' ,
C71y /State,ZIP ?on -land or c ZZC/ 'f YS *" ubtotal
Phone (5-D3) 453 — y$ZZ Fax'( $) Minimum pains f 9 (0.7 1'
( PS ) q�� fizzy qa'
J O 7.4 9 elan review (25% of permit fee)
CCB he I
0 - Z . f State sracbargep2 ofpemvt fie} /U 9
aide TOTAL PERMIT FEE (Cc). w
Autbonzed signature. - V b TAh permit application expires Os permit h net obtained within 180
I �� / _ / it ° 7/ ' Fee methodology her by Tn -C County Building Indus days after it has been accepted as complete.
I F
Print name' Qc S Date D r /23 ng try
1 Service Board
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