Permit CITY OF TIGARD MECHANICAL PERMIT
• a - COMMUNITY DEVELOPMENT Permit #: MEC2009 -00456
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/31/2009
Parcel: 1 S133DA01900
Jurisdiction: Tigard
Site address: 11055 SW SUMMER LAKE DR
Subdivision: Lot: 0
Project: Woodbury
Project Description: Replace furnace and install air conditioner. Must maintain 3' rear and side yard setback
Owner: FEES
WOODBURY, LOUIS Description Date Amount
11055 SW SUMMER LAKE DR Air Conditioning or Heat Pump 08/31/2009 $14.00
TIGARD, OR 97223 Furnaces < 100K BTU 08/31/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 08/31/2009 $8.70
Minimum Fee Adjustment - Mechanical 08/31/2009 $44.50
Contractor:
TRI- COUNTY TEMP CONTROL
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503- 557 -0919
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 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: e � �� K/\ Permittee Signature: Q/v thope.../
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.
AUG-27-2009 02: 00P FROM: TO: 5035981960 P . 1
1
Mechanical Permit Applicat 1 oR ( )1 1 •1( I 1 si lt \ I 1
14 City of Tigard AUG 2 7 2009 Received
Date/By: Permit hlo.: ve, - op 4..a,
13125 SW Hall Blvd., Tigard, OR 97 Plan Review
. Phone: 503.639.4171 Fax: 503.598,19) I., '' :■ ...,;'.,; -'.' 1 Date/By: Other Permit
Inspection Line: 503.639.4175 6 i ;i1 ri iN(A 74 :, Date Rattly/By: hiria: 1211 See Page 2 for
Internet: www.tigard-or.gOv ,. , „1.,..‘ . .1,,i;. 4.: Notified/Method: Supplemental Information
Nififfig!ft:Nai,,Viei-47J-c,:!itit*...*,0000,4k.:3.!;:-. ::.''',,; ';'-'-. ': • ; 7 : . ::,;: ;7' ci _ rilt,MXIMM7 of,4,, 7,
ed on work
ID New construction El Addition/alteration/replacement Mechanical permit few* are bas the value of the llar)
performed Indicate the value (rounded to the nearest do of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
-
.." Value:S
El 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special Wormation use checklist.
0 Multi-family 0 Mastcr builder 0 Other: - Description j Qty. I Ea. I Total
. 0 . ,.01; , AK*O*iti*• ; 0 1 0*:Oill:;0**.iiiii , i': :: - ' . ,'.' -,:. Heating/cooling
Job site address: I I 0 55 8 kig 6ur•rnor vutibrivc, Air conditioning or heal pump
(requires site plan showing placement) I 14.00
City/State/ZIP: Tigard, OR 4104i Furnace 100,000 BTU (duets/vent!) I 14.00
Furnace 100,000+ BTU (damevents) 17.90
Suite/bldg./apt. no.: 1 Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
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
Flue/vent for any of above I 6.80
Subdivision: I Lot no.:
Other Mon
Tax map/parcel no.: Other fuel appliances
1"2:0t4N:1 rfre•fafgrIOKOANIC' ' Water heater 10.00
a it D
Gas fireplace 10.00
l atc
Flue vent for water heater or gas
g " 111 - 6vtd it fireplace
Log lighter (gas) 10.00
10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
. . Chinmey/liner/flue/vent 10.00
hiti.t4JiaktaiM00.:4/:.
Name: I 0(115 WID)CIbarti Environmental exhaust and ventilation
Range hood/other kitchen
Address: aan) equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00 ,
Single-duct exhaust (bathrooms,
Phone: (0) ) 4 1(0i1 OM% Fax: ( ) toilet compartments, utility rooms) 6.80
A 1000
,i19MINWR ' ...; '. -.' i!.■: 4 :fil : ;0 1 5 - :': . : .
_ttic/crawlspace fans ,
Other: 10.00 _
Business name: Same as contractor Fuel piping
Contact name: Diane Mason $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump ,
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater ,
Fireplace
E-mail: Range
Barbecue
;i74'i,.. ,i.,,,.7 ..,- : , ... - ,'. ....:,.,. ..:.: , ,,,.. .; . ., , ,
Business name: Tri•County Temp Control
*
Address: 13150S Clackamas fUver Drive Clothes dryer (gas)
Other
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City/State/ZIP: Oregon City, 97045 Subtotal
Minimum permit fee ($72.50)
Phone: (503) 557.2220 I Fax: (503) 557.0919 Plan review (25% of permit fee) .
CCB lic.: 72623 State surcharge (12% of permit fee),„
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized Si gnature:
days after it has been accepted as complete.
I Print name: Diane Mason I Date: iii,k/i0(1 • Fee methodology set by Tri-County Building Industry Service Board
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CUSTOMER INFORMATION • 0 °
NAME La to 5 W oo b tk-�L'( m
ADDRESS 1 . .
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MA A o e— q7 y 3 _ PLEASE REPAX APPLICATION WITH SITE PLAN.
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