Permit •
CITY OF TIGARD MECHANICAL PERMIT
I 13 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00193
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/04/2009
Parcel: 2S114BB05700
Jurisdiction: Tigard
• Site address: 10010 SW SERENA WAY
Subdivision: Lot: 0
Project: Rummel
Project Description: Replace furnace, replace a/c with heat pump.
Owner: FEES
RUMMEL, BRADLEY G & LORI A Description Date Amount
10010 SW SERENA WAY Furnaces < 100K BTU 05/04/2009 $14.00
TIGARD, OR 97224 Gas Heat Pump 05/04/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 05/04/2009 $8.70
Minimum Fee Adjustment - Mechanical 05/04/2009 $44.50
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
TIGARD, OR 97224
PHONE: 503 - 453 -4822
FAX: 503 - 968 -7224
Type of Use:
Class of Work: 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
applicabl- . • two will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issu- ce, or if work is susp- •ded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
U ity Notification Center o• - • e set forth in OAR 952- 001 -0010 through OAR.952- 001 -0100. You may obtain a copy of the rules
•
ssued By: ' Permittee S nature: %? - / ,f ,i/
r i
Call 503.639.4175 by 7:00 a.m. for an inspection that b ' ess 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.
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;. Apr:29 2009 '1`0 :43AM CLIMATE CONTROL INC 5039687224 p.2
M Per Applica �
,M ® r -. � ' , I•UI'.l)1 I I( 1; 1 tiF (.)VI
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City of Tigard
t f' Received
• 13125 SW Hall Blvd., Tigard, OR 97223 ' ���rrr ✓ DatdB ,t9 o`/ /9/ Perron No.. Mfe�DO -al /9
-'' C Phone: 503.639.4171 Fax: 503.598.) 90P Plan Review
i itl; :kRD Inspection Line: 50509.639.4175 R 2 9 2009 Dat�By: 0[herPermit:
Internet ww d or.gov Date Ready/By kris 65 See Page 2 for
R CITY OF TIGARD Notified/Method: Supplemental Information
TYP of �� DIVISION
. COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition /altetation/replacement Mechanical pernilt fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other:
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mechanical materials, equipment, labor, overhead, and profit
. CATEGORY OF CONSTRUCTION .. Value: $
•
,g -and 2- family dwelling m
Comercial /industrial 0 Accessory building RESIDENTIAL EQUIPMENT /,SYSTEMS FEES*
[] Other; For special information use checklist
❑ Multi- family ❑ Master builder
JOB SITE INFORMATION AND LOCATION ' Hesciiptico Qty. I Fs. I Total
HeaHng/cooling
Job site address: /a% j 5c 41 4.14-(7/ Air conditioning or heat pump
City/State/ZIP: �L .il /JiJ (reQnQeS duo plan showing placement) t 14.00 /y
6 , K/ co2 7222 y Furnace J00,000 BTU (ducts/volts) / _ 14.00 1 y
Suite/btdg. /api. no.: I Project name: �v�rP7 Furnace 100,000+ BTU (duets/vents) 17.90
Gas heat pump 14.00 1
Cross street/directions to job site:
Duct work 10.00
Hydronic hot water system 14.00 •
Residential boiler (radiator or
bydronic) 14.00
Unit healers (fuel -type, not electric),
in -wall, induct, 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 heater 10.00
'4fj , /V - • �fi z � , /Y .� ® ^Gas fireplace r _ 10.00
,
/
G �j rl Flue vem for water heater or gas -
fireplace 10.00
Log lighter (gas) i 10.00
Wood/pellet stove 10.00
Wood fireplacc/insert 10.00
PROPERTY OWNER I ❑ TENANT Chimney/liner /nue/vent 10.00
Name: 4-d ,- f17 l e Other: • 10.00
G Environmental exhaust and ventilation
Address: f, r27 /Q 3 J 567467714 ''y Range Hood /other idtclioa
City/State /ZIP: ai -.' 10.00
T76Ag.� � 972_5/.• z . Clothes dryer exhaust 10.00
Phone: ( ) 6 /- /.3y •
1Fax: ( ) Single -duct exhaust (bat rooms,
/ ❑ CONTACT PERSON toilet compartments, utility rooms) 6.80 I
st APPLICANT • Anic /crawlspace fans
lb,00
Business name: ❑,- 4 1 -v� t r Other: 10.00 -
u 144E-
TT p,, T1� _Fuel piping •
Contact name:
Ro 1 ' ' " . ri S 55.40 for first four; SI.00 for ea ch additional
Address: J (S OO ' 5 7 2 O Furnace, etc
• City/State /ZIP: PO (-Hu ci. 2--)- Gas heat pump
Wa]IisuspendeNun;t heater
Phone: (513 ) ti S - --Li Cd 22 I Fax:: ( ) q (o - 1 Water heater
E -mail: ( 9 C- t I on at 4-e- Co � t I C Range r1 n Co � O°1 Range e
CONTRACTOR Barbecue -
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• Business name: I E- Co n � 1 n L . Clothes dryer (gas)
Address: )050 SM.) ,.lp Other:
1� L MECHANICAL PERMIT FEES*
City/State/ZIP: P 4 r r 11 d 0 4 2 V
Subtotal ,1 $"
Phone: (5 3) s3 1I !i 1...z... I Fax: (Sri.) M � CQ .. - •
Minimiml permit fee (572.50) 5y
CCB lie.: �� `I Plan review (25% of permit fee)
State surcharge (12% of permit fee) 9. 7 O
Authorized signature: � ,y ,, �J TOTAL PERMIT FEE 2f3
� rVW"' �� This permit application expires if a permit is net obtained d within 180
Print name: r �' days after it has been accepted as_ complete.
�' l r y1 , Yi-ij I Date: � � 9 I • Fee methodology set by Tri•County Building Industry Service Board
I: 1 BuildinglPermitstl�C- PertnitApp.eot 01/19/09 44 O - 617r (11/02/COMWBB)
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