Permit CITY OF TIGARD MECHANICAL PERMIT
!= COMMUNITY DEVELOPMENT Permit #: MEC2011 -00549
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/TIGARD
Parcel: 2S 109AB03700
Jurisdiction: Tigard
Site address: 14256 SW 133RD AVE
Project: Strba Subdivision: THREE MOUNTAINS ESTATES Lot: 30
Project Description: Replace furnace and heat pump. Placement of heat pump unit must meet 5' side and rear yard setback.
Contractor: CLIMATE CONTROL INC Owner: STRBA, JAROSLAV P &
16500 SW 72ND AVE STRBA - CECHOVA, KATRINA
TIGARD, OR 97224 14256 SW 133RD AVE
TIGARD, OR 97223
PHONE: 503 - 453 -4822 PHONE: 503 - 579 -1497
FAX: 503 - 968 -7224
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/30/2011 $46.75
Type of Use: SF Heat Pump 11/30/2011 $61.06
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/30/2011 $12.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $120.75
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 questi NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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.
Nov 30 2011 9:13AM CLIMATE CONTROL INC 5039687224 p.2
City W Hall Tigard
ivd., Tigard, dR CENED Received � � M / -a J
W all Blvd., Date/Hy: / 0 Permit No,: s
• 13125 S
Phone: 503.639.4171 Fax: 503,598.1960 Plan Review
lc; 1 f: r) Inspection Line: 503.639.4175 (' V / 0 O i Date/By: Other Permit.
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Internet: I I O y v I Date Ran l i
www.tigard-or.gov
3.63 gov Ready/By: lens: ®See Page for
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Notified/Method. Su le
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Mechanica
❑ New construction Addition/alteration /replacement l
❑ Demolition Other: permit fees are based the value of the work
❑ perf Indicate the value (rounded to the nearest dollar)
4 x?t' `< c Demolition
<: _ mechanical materials, of all
t''L'° + "M ir, 3 Q r c t r t`tt. ' "'''`pima labor, overhead, profit.
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-V���` , erhead, and pro
En - and 2 dwelling building
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Y B ❑Commercial /industrial 0 building < x - s ~...r. ). ` I ' " , tee , ,)
❑ Multi- family _ = ;‘
Y ❑ Master builder ❑ Other: special information use checklist
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Description I Qty 1 Ea. ] Total
` u .s• " Headng/eoo8ng
Job site address: /7251,9 g /33 . Ave- Air conditioning
City(StateJZIP; �� 2'21/ (requires site plan ahoy/ism placement) 46.75
4 4 4 dr 97 Furnace 100,000 BTU (ductsivents) t 46.75 W •7,r
Suite/bldg./apt. no.: 1 name: � 4 Furnace 100,000+ BTU (duets/vents) 54.91
Cross street/directions to job site; Heat 1» _ 61.06 60.06:
Duct wort 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydrvntc) 23.32
Unit heaters (fad-type, not electric);
in-wall, in -duct, susneatded, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Tax map/parcel .:
2 Other: 23.32
H a z . , l Other fuel appliances
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i �..s,.,- ux x f tF : r l r r i s l " - `t �-- z - -'
:.,* i t j ..� ti ' _: ' Water heater 23.32
- 'YN�e'�` /-v -62,x- 0, Gas vent for water beater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
, Wood a.. 1 a q ) einsert
23.32
.- , ,.` s' `'.. ... :,', ,�-': i ��s_... >...a sy -..%.1-:,77.,7;,F.!1-, .. Chimneey/liner/fl t 23.32
Name: y— 4 L A- ....s w Other.
V A r05 4 - 4 V `1 l <- r- ARIN°q. �..�' 1"7�f3,¢ - 23,32
Environmental exhaust and ventilation
Address:
/4/2.610 sLtJ /33 Y."' A1/4, Range hood /other kitchen
City/State/ZIP: 6, -i equipment , 33.39
�� 9 - 1 z Clothes dryer exhaust 33.39
Pbone: ( ) e 1g _ f'�g Fax: ( )
Single-duct i exhaust (bathrooms,
4 ;�,L s� ,� .� ,��,� <"°,{''" m ,- toilet ctmltlnrlrtlrnts,utility moms) 23.32
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. ,... ®.c� `• :S: ,�L,..r?` €,�Fx �'n v -r,+- I .II; c� '. G �� a y . "#'' s.
Atnc[
-_,..J �,. !� � r a> 5 a : crnwispace fans
. �...a:.t..� - 23.32
Othe Business name: L► M4 r.- Ll o f T7oL I AIL Fuel 23.32
Contact name: RD k 4 l�Z �'Z'1 r 1.S S14.15 piping �
Address; 1 _ 514.15 for first four; S4,03 for each additional ,
tP 500 Jul'.' r -fro /� /t V , Furnace, etc.
Gas heat pump
City/State/ZIP: e j -l an d
972.2-3 Wall/suspended/unit heater
Phone: ($ j) 963 _ `1BZ2. I Fax::( )9(08_ -72.29 Water heater
E-mail: (' p @ G ( !! Fireplace `
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: "t�'t'���s _.,,a 7 tu_s � �p 91F� I� k �'� --�- e'� 1�k ��rr.o T'a•vz� Range C "5...,.. : r h -! a ''' . i- . ;zsV zl 1: �"i':r �` ,-.l yl �° Barbecue
Business name: e__LA )1!1 47-E- Co n L ire. Clothes . - :as
Address: ! Sc D n d Other:
(ilk ^7
Address:
ZIP: C A V i'; s .�_ ' ` v v t '` -' , 1 f n �a 7r`' .::
?or or q-).17}-1 , S ; t tta / /
Phone: (5-03) q- Lj V Subtota / p7, �/
1 Fax: ( �3) ° r �D b - `jz z y - Minimum permit fee (590.00)
CC1B tic.: 2,...i O(� Plan review (25% of permit fee)
State surcharge (12% ofpemdt fee) 1,2 .9$1
Authorized signature: •/ ��
� _ TOTALPEDi tob t? d gyp. 180
days
�i/(/!. This permit t i aspires if a permit k is not upWae within 180
Print name: � days aAer t has been eecepaed as complete. IY_/fr►'f'�/
0 if ,4r l /S D ate: / / ` Fee methodology set by Tri- County Building Industry Service Board
1: 1Buming \ Permits tMfC- PcmirApp.doc I 0/01/09
40.46 (I I/o ,COM WEB)
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