Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00513
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2009
�GARL� Parcel: 2S110DD07700
Jurisdiction: Tigard
Site address: 10435 SW GREENLEAF TER
Subdivision: Lot: 0
Project: Forbes
Project Description: Replace furnce and a /c. keep a/c unit minimum of 3' from side yard property line.
Owner: FEES
FORBES, CAROL Description Date Amount
10435 SW GREENLEAF TER Air Conditioning or Heat Pump 09/30/2009 $14.00
TIGARD, OR 97224
Furnaces < 100K BTU 09/30/2009 $14.00
PHONE: 503-624-1131 Additional Permit 09/30/2009 $44.50
12% State Surcharge - Mechanical 09/30/2009 $8.70
Contractor: (manual)
CLIMATE CONTROL INC
16500 SW 72ND AVE
TIGARD, OR 97224
PHONE: 503 - 453 -4822
FAX: 503- 968 -7224
Type of Use: MF
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: � ('(I (1, I Permittee Signature:
\ �^� 000��� CCC
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.
Sep 28 2009 2:06PM CLIMATE CONTROL INC 5039687224 p.2
r ' Mechanical Permit Annlic
EIVED . l:t,I:O!:!lC;E eSI: O.1.1-
City of Tigard Received
Permit No.:
13125 SW Hall Blvd., Tigard, OR 9722 Date/By: j 20 a q C5�3
11111 I Phone: 503.639.4171 Fax: 503.598.1 'EP 2 9 2009 Plan Review Other Permit
[ns ection Line: 503.639.4175 Dale/By:
T 1 A K L) p Date Ready/By: o r
Internet: www,tigard- or.gov Cl OF TIGA Notified2Nathod
•
Supphem ®See Page eato 2 I l rare tion
BUILP DI VISION
TYPE • OF WORK COMMERCIAL FEE' SCHEDULE - USE CHECKLIST
1:1 New construction ' Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
❑ Demolition performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials, equipment, labor, overhead, and profit.
. . CATEGORY OF CONSTRUCTION . Value: $
• „ 1- and 2- family dwelling ❑ Commercial/industrial 12 Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES *. -
For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other;
I
Description I. Qty, I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / 3, car _ 1 6 F E - e � Air conditioning or heat pump
Jj / (requires site plan showing placement) ( 14.00 00
City/State/ZIP: 7 7 / 141 r -46/ ?-72-2-4/ Furnace 100,000 BTU (ducts/vents) ( 14.00 ) ( 1, «)
Suite/bldg. /apt. no.: Project name: , tg.isE� Furnace 100 ,000+ BTU (ducts vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 1000 -
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 f 6.80 („ JEb
Other: 10.00
Tax map/parcel no.: Other fuel appliances
'DESCRIPTION OF WORK Water heater 10.00
� .y�/4 Ci r- e N4-C L� �r C - Gas fireplace ent 10.00
'�I " � /� `" / WC - Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
ji Zr PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 10.00
e) L Other: 10.00
Name: �,5
Environmental exhaust and ventilation
Address: /�-6�Cse- Range hood/other kitchen
/o y.�s Get /
c� equipment 10.00
City/State/ZIP:
7-/64y,,, f / 7 2z y Clothes dryer exhaust 10.00
Phone: ($153) 4 y - i/a/ I Fax: ( ) Single duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80
• igt APPLICANT • . 0 CONTACT PERSON Attic/crawispace fans I b 00
Business name: ^�Li rt ,r7� d i J in Other: 10.00
C �T t C- Fuel piping
Contact name: RO r rl $5.40 for first four; $1.00 for each additional
Address: )10S00 1-22") Furnace, etc.
�� Gas heat pump
City /State/ZIP: ('P (r- -(u r) d O 97 2-
Wall /suspended/unit heater
Phone: (5b3 ) t1 S 3 _L{ 2.2 i ." I Fax:: ( ) Cj 6 '._.--7z21.1 Water heater
E -mail: fl t/} e- L 11 al A � G.LI 1''14- l Inc 1 R a n g e -
ace
. I co C O'1 Range
CONTRACTOR Barbecue
Business name: al a ....- /i 1 L i n Clothes dryer (gas)
Address: o5c) � � � 1. X13 Other:
ho �7,2Y 4.1/ 61...--- MECHANICAL PERMIT FEES*
City/State/ZIP: )) r rI i n d Q 4 � 2Z
V I Subtotal 3 5. eo
Phone: 633) 1 l s - 2 LJ !e uZ I Fax: ( j ) g 6-8 "' 7 2Zy Minimum permit fee ($72.50) 7 2, .5 0
CCB lie.: `� / ✓ , � U 1 l ' S ! Plan review (25 % of permit fee)
t(/ State surcharge (12% of permit fee) g, -7 e7
oi �J TOTAL PERMIT FEE $ i. o
��I \ \\
Authorized signature: R4V� This permit application expires if a permit is not obtained within 1 180
J r' C days after it has been accepted as complete.
Print name: kat J G
Date: ! 245 f Fee methodology set by Tri -County Building Industry Service Board
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Sep 28 2009 2:06PM CLIMATE CONTROL INC 5039687224 p.3
16500 SW 72nd Av enue Portland, L OR 97224
H I: A l N G & AIR C O N 1 T 14 W I N G Phone: 503 - 453 -4822 Toll Free: 866- 453 -4822
Fax:503 -968 -7224
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