Permit CITY OF TIGARD MECHANICAL PERMIT
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' 111 COMMUNITY DEVELOPMENT Permit #: MEC2009-00200
T I GA R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/1112009
Parcel: 2S 111 AB02400
Jurisdiction: Tigard
Site address: 9340 SW MOUNTAIN VIEW LN
Subdivision: Lot: 0
Project: Hern
Project Description: Replace furnace, add a /c.
Owner: FEES
HERN, MICHIKO Description Date Amount
9340 SW MOUNTAIN VIEW LN Air Conditioning or Heat Pump 05/11/2009 $14.00
TIGARD, OR 97224 Furnaces < 100K BTU 05/11/2009 $14.00
PHONE: 503 - 442 -5485 12% State Surcharge - Mechanical 05/11/2009 $8.70
Minimum Fee Adjustment - Mechanical 05/11/2009 $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 • ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification Center. os- • es are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
155 ed By: Permittee Sig � // ."
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.
5039687224 p.2
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• ° 1•lay 05 2009 3:01PM CLIMRLMT2 �P
Mechanical Permit Application MAY 0 5 2009 FoR atria: t,sh_ ONLY
City of Tigard Received /��
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13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGARD Date/sy: '`�f`%� Permit No.: H ee Zoo _ova?o0
N • . Phone: 5 03.639.4171 Fax: 503.598.1960 BUILDING DIVI I ! Other Permit:
T hm k i) Inspection Line: 503.639.4175 S �
Internet: www.tigard- or.gov lh ® See Page 2 for
Notified/Method: Suppteranra! information
TYPE OF WORK . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
' ❑ New construction i' Addition /alteration/replacement A e iwsical partner fees' are based oathe value of the work
❑ Demolition Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit
. • CATEGORY OF CONSTRUCTION Value: $
1- and 2-family dwelling ❑ Commercial/industrial RESIDENTIAL EQUIPMENT /SYSTEMS FEES* ❑ building .
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. .I Ea. I Total
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JOB "SITE INFORMATION AND LOCATIOON Heating/cooling
Job site address: C i l 0 5&i) ►1�DU n �,2 V ! , , I Air conditioning or heat pump
City/State/ZIP: 44 'J n n ,�
(requires site plan showing P��eat) 14.00 N
Og- `T -1 Y Furnace 100,000 BTU (duets/vents) t 14.00 , I LI
1(� Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. ./apt. no.: I Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work
10.00
Hydronic hot water system ^ 1400
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14,00
Subdivision: I Lot no.: Flue/vent for any of above 6.80
Tax map /parcel no.: Other: ' 10.00
• Other fuel appliances
DESCRIPTION OF WORK Water beater 10.00
re-pr_Ae4- A.1 # /) A/c-- Gas fireplace 10.00
!J Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove ' 10.00
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Wood fireplace/insert 10.00
pr PROPERTY OWNER I • ❑ TENANT Chimaey/linerl8ue/vent 10.00
V 1 1 tJ�
Other: 10.00
Name: 9 t ! l C_./-h ' � „ , " `
1 � iU Environmental exhaust and ventilation
Address: � L O '3 1& O I, r � Vi Bank Range hood/other kitchen
City/State /ZIP: � �D � Cr) V ( equipment 10.00
% 1.2__1 Clothes dryer exhaust 10.00
Phone: ( y2., 5 I Fax: ( )
Single-duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80
APPLICANT ❑ CONTACT PERSON Attic!crawlspace fans
I 1 10.00
Business name: ri LI yrgpre- ZI el pL /n L • Other: 10.00
Contact name: Fuel pipes
R ° �1 `' S 55.40 for first four; $1.00 for each additional
Address: ) o S o . Sr l'a-h O iii/r. Furnace, eta
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City/State/ZIP: Po rr t n 97 2-'D- Gas hear pump
WalVsuspendedhlnic heater
Phone: (Saj ) Li S -t-1 q 22 I Fax: : (6773 )
( { 9t� - y Water heater
E -mail: fb / e 1, en of 4-e (.c)/1 I I/)G . C nge
1 Cu { ►'� Range
CONTRACTOR Barbecue •
Business name: � o 4.7.64_, I n G Clothes dryer (gas)
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Address: 16500 Sena -7.2--'1° 41 Other:
MECHANICAL PERMIT FEES*
City/State/ZIP: PO (Han d or 4
u p I p , , gas Subtotal rd
Phone: (5013) L�3 ( 7iZ f ( 7a' ) `7 ... 2-2-4i
Fax: Mi nimum 25% permit r it fee �a.
Ph
qV CCB lie.: . I G u Plan review (23% o f permit fee}
(�F State surcharge (12% of permit fee) G. 2 0
Authorized signature: /ILI -jr/a TOTAL PERMIT FEE 8 a:m 1 " , This permit application aspires if a permit is not obtained within 180
Print name: days after It has been accepted as complete.
Y/YS I Date: ciS,a g i • Fee methodology set by Tri•County Building Industry Service Board
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lia 05 2009 3:01PM CLIMATE CONTROL INC 5039687224 P.3
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ic:::::' CLIMATE CONTROL 16500 SW 72nd Avenue Portland, OR 97224
• Phone: 503-453-4822 Toll Free: 866-453-4822
• HEATING & AIR CONDITIO....N....l._:.G Fax: 503-968-7224
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SYSTEM DESIGN -- INSTALLATION SERVICE MAINTENANCE
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