Permit q CITY OF TIGARD MECHANICAL PERMIT
511 s : COMMUNITY DEVELOPMENT Permit #: MEC2012 -00673
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 12/19/2012
Parcel: 2S103ACO3100
Jurisdiction: Tigard
Site address: 12520 SW 112TH AVE
Project: Elsner Subdivision: MCMICHAEL HEIGHTS Lot: 4
Project Description: (1) NC and furnace replacement
Contractor: CLIMATE CONTROL INC Owner: ELSNER, IVAN & EDITH
16500 SW 72ND AVE 12520 SW 112TH AVE
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 453 -4822 PHONE' 503 - 639 -2037
FAX 503 - 968 -7224
FEES
Specifics: Description Date Amount
Air Conditioning 12/19/2012 $46 75
Type of Use: SF Furnaces < 100K BTU 12/19/2012 $46 75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/19/2012 $11 22
Occupancy Grp:
Stories:
Fuel
Fuel Types.
Gas Pressure,
Total $104 72
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 at 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 questions to by calling 503.232 1987 or 1.800.332 2344.
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Issued By: /1 '��( GQ / Ji \
Permittee Signature: O � f 4 PP �!/ /� i - DU 41
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.
Dec 19 2012 9: 14AM CLIMATE CONTROL INC 5 0 3 9 G 8 7 2 2 4 p . 2
RECEIVED ---w----- ----fame...,
City of Tigard Received
Dete/By: / 1 / / - / ;
q / r Pennil N tit-V,;101 3 - 00(e
: • '
III 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503 598 1960 DE- 1 9 2012 P1a Review
Dairiny: Other Penni'.
I I a. A I: I) inspeCtiOgl Line: 503.639.4175
Da te ReidyBy: -
1''.. ( s
CITY OF TIGARD N ; - top
lines wwwligard-or.gov otthamethod:
atapiPiv
Nqpv
f;,,... i
. c:x- - .-.;' - ...,44,:i. „ ::-.::, -.az: 01* ‘,.. to
171 : -5 W4.
Mechanical fees • arc baied on the vs Incofthe work
ID New construction NAdditiontaheration/replacement
. perfumed Indicate the value (rounded to the nearest dollar) of all
El Demolition D Other:
'mechanical materials, equipment, labor, overhead, and profit. ..
.,...,r::::a77:.i •qtar.. .-- :. 'IM,I :," ' Value: 5
4.:
Fn. and 2-family dwel]ing 0 Conarnerci al/industrial 0 Aocessory building
For special information use checklist.
0 Multi-family 0 Master builder 0 Other:
Description I Qty. Ea I Total ,
4 444'4, '-',c, --. '''-.7. ‘ 12 . 41 a 6--r6- -MIZ. - -..**SIA.Mit, 1 HesdnI/modiat •
Air conditioning i
l o b s ite address: I 5 ,- . -t- 2-e .,_ VO I 17-- 0 k...,,e_ nequires use Win showing placement) I 46.75 1 414 - 7 s,
citystatezw: - r - 1 6 4,-a cyy 9 t Face 100,000 BTU (ducuivents) t 46.75 Li & •-i II
Ftunace 100,000* BTU (uncut/vents) 54.91
Suite/bIdgJapt. no.: I Project name: E-1 5 eYl___
Res t pump 61.06
-
Cross street/directions to job site:
Duet work 23.32
I Lot no.: Hydronic hot water system
Residential boiler (radiator or
byctronic) 23.32
Unit heaters (fuel-type, not electric),
in-duct, -duct, -duct, Silspended, etc. 46.75
Flue/vent for any of above 2332
23.32
Subd ivi si on: -
Other: 23.32
Tax map/parcel no.:
Other fuel appliances
1 - ;797iir7...e.,,,..,,,S,-Xt171_,:-/7----1-4;.711.-, FAITA Woo heeler 2332
. Flue vent for water batter or gas 33.39
fireplace 23.32
Leg lighter (get) 23.32
Wood/pellet stove 33.39
Wood fireplacerinsen 23,32
14:181r---F. W -'etr.7417S7t7Z47:'; ChanD"fililet/fluevalt 2332
2332
Name: r„.4 y :- 60 1-4-)
Environmental exhaust and ventilation
Range boot:I/other kitchen
Address: I 2'5 2-0 5IA) 1 17_" ■tut--- 091193:Dem 33.39
City/State/ZIP: 7 61v-a ar 9 Clothes dryer =boost 33.39
Single-duct exhaust (bathrooms,
Ph one: ( ) ti? .r q "-- .2e3 - 7 Fax: ( )
loam comartments, utility rooms) 2332
iC EY 4 V1 tt.;77.7 ; 41:1L.N57479 [7:71-474TIMaW651 AftiCkr"115P6Ce haS 2332
Other: I j 23.32
Business name ei .
_wom4AT 1. to n Trot_ 10c_
;1;‹ 4.71-r- r is
Address 1(0500 51A-- 72, A
City/State/ZIP: pr) r rianci. e , r 972.23
Phone: (553) '1S - I /5ZZ- Fa ( 3)9(087 : : 0- 7. Z9
E - mail ro e G_ ti rirtex c ot Inc , cory--1 Fuel piping
Contact name:
nmacc, for first four; 54.6.3 for each additional
Gas beat pump
Wali/suspeadedhinit heater
Water beater
Fireplace
.ff41,7itkl,,,ca,-4,72aMiarir....BME,1 Barbee ue
Business name: ... 1..A rvi Q rE C n -kOL In c , Clothes dryer (gas)
Other:
Address: 110500 c) - 7 - 2,.. r19 4v LifejiME 77e:ZaZrc--"0:6--.. 7IriNkatilil
City/State/2/P. ?orr- I a ri d
5-0 cis-3.__ Lisa?... or cc) .zzgal
i Fax: ( ° flea - - 7 Z.
1 I Subtotal
Phone: (3)
Minimum pennii fee (590.00
CCB ht.: ) ---
Plan review of permit fee)
...1 9 LC
State sae (I2% of permit fee) 1 fT • 2 - 2 -
TOTAL PERMIT FEE 1 / "7 2 -
Authorized signature: 4, A,,....„....,.: nit permit application expires Ma perish Is act obtalaed within ISO
days after It bat bee. sawed et coma* te
I Print name A" # i D 1 a „... 1 • Fee methodology set by Tri-Couray Building industry Service Hard
I Biltiebnalitnials du. 10/01/09
4404617T (11 /02/MN:AVM) f o-Snial
Dec 19 2012 9:14AM CLIMATE CONTROL INC 5039687224 P. 3
'b.
CLIMATE CONTROL 16500 SW 72nd Avenue Portland, OR 97224
HEATING & AIR CONDITIONING Phone: 503 -453 -4822 Toil Free: 866- 453 -4822
Fax: 503.968.7224
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