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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2009 -00318 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/30/2009 Parcel: 1S 133CA03800 Jurisdiction: Tigard Site address: 11472 SW LOMAX TER Subdivision: Lot: 0 Project: Foland Project Description: NC add on. Must maintain 3' rear and side yard setback Owner: FEES FOLAND, JOHN Description Date Amount 11472 LOMAX TER TIGARD, OR 97223 Air Conditioning or Heat Pump 06/30/2009 $14.00 12% State Surcharge - Mechanical 06/30/2009 $8.70 PHONE: Minimum Fee Adjustment - Mechanical 06/30/2009 $58.50 Contractor: CLACKAMAS HEATING & COOLING LLC 15115 SE PENNY LEE CT. CLACKAMAS, OR 97015 PHONE: 503 - 658 -4808 FAX: 888 -500 -2912 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 O / C by calling 503.246.6699 or 1.800.332.2344. Issued By: `I / Permittee Signature: Qom //N"""'" ��, 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. . in 30 09 12:25a Clackamas Heating &Cooling 18885002912 p.1 r Mechanical Permit Applicatit ECEIUE ) I t lh t,, 11t 1. I `1. t l' I \ Remised City of Tigard ,, Permit �O Ec U3 - 01)318 13125 SW Hall $Ivd.. Tigard, OR 97223 Ph JUN 3 0 2009 arc Renew one. 503.639.4111 Fax 503598.1 %0 One/11T. Other Permit ,. I ci \ I , Inspection Line: 503.639.4175 CITY OF TIGARD [M e Rc r Judtx 1 ® See Pagr2 for I » www.t BUILDING DIVISION � ■a TYPE of WORK CW, SEE' 9CHEDUA:E �= USE CHECKLIST ❑ New construction ® Addition/ alteration /replacement Modr�ical permit fees' am bred on the value of the work 01d. Indicate the value oun (rounded to the nearest dollar) of all ❑ Demolition ❑ Other mechanicl materials, equipment, labor, overhead, and profit. CATEGORY : OF aloe: $ ® 1- and 2- family dwelling ❑ CommerciaUutduslrial ❑ Accessory bolding ! l V El Multi-family ❑ Master builder ❑ Other For '°�°'°'�O°""� cheeklia Description I Qty. I Ea- I Total RIB SITE,INFORMSTREI AND IIACAT1004 Jur Job site address: 11472 SW LOMAX TER („t,a,a„ yshowing or heat pump 1 1 14.00 14.00 City /Statc/L[P: TIGARD, OR 97273 Furnace 100.000 BTU 0=0/scuts) 14.00 Furnace 100,000+• BTU (daeasWrn+s) 17.90 Suite/bldg/apt. no.: Project name: Cis hear pump 14.00 Cross street/directions to job site: Duct 'auk 10.00 Hydrant tat vizier system 14.00 Residadial holler (radiator or hydronic) 14.00 Unit beaus (5s! -type, not dectric), in-waq mid, suspended, etc. 14.00 Subdivision: t tom: Ftne>tvent for any of above 6.80 Lot t Other _ 10.00 Tax map/parcel no.: Other fad appliances _ DESCRIPTION OF WORK: . . Water heats 10.00 A/C ADD-ON fireplace 10.00 Flue vent for water beater or gas fireplace 10.00 Loa lipilter (gas) 10.00 l Wood/pellet stove 10.00 I Wood f replaoormsat 10.00 ❑ PROPERTY °w ick. r ❑ maw. . ch�yn;n�eta�.e<tt 10_00 _.> ] Other. 10.00 Name: FOLAND, JOHN Eavooammtal exhaust and ventilation Address: 11472 SW LOMAX TER Range hood/other kitchen - eqlilmaad 10.00 City /State/LIP: TIGARD, OR 97223 Clashes dryer exhaust ' 10.00 Single duct e> (badttooms, Phone: (503)3481065 Fax; ( ) toilet camp , utility moms) 6.80 - Attitlasa1spaoe fay 10.00 .. . . . . © �4P�•><GA :. . . ' C `ta41vY'!ILGI` .... O1ha: 10.00 Business matam: CLACKAMAS HEATING do COOLING LLC Fadpip6g Contact name: VLADIR,IIR M1KHATS $5.40 for that emu; 51.00 for e:eh additional Addr 15115 SE PENNY I.EE CT. Furnace, ate ee - . Gas beat pomp City/Stata21P: CLACKAMAS, OR 97015 Wal Vomit hater Phone: (503) 658-4808 Fax:: (888) 500 -2912 Water heater Flambee E-mail: CHCLLC(o]COMCASI•_NET Range O V 7A ClYNt .. Barbecue • R Business Business name: CLACKAMAS HEATING & cOOLING LLC Clothes darer () Other. Address: 15115 SE PENNY LEE CT. 1 . ■. . city!S+»trrLIP: CLACKAMAS, OR 97015 Subtotal 14.00 Phone: (503) 658 -4808 Fax (888) 508-2912 Minimum permit fee (572.50) 72.50 Mat review (25% of permit fee) CCBIie.:165630 7 /t5! 1 1 1; State surcharge (I2% afpermitfee) 8.70 TOTAL PERMIT FEE 81.20 Authorized signature: 6E- `� `� Ms permit ■ppiotim =pins tea per is am obtained within 180 elm oft= it Los bra steepled as complete. Print name: VLADI MIR MATS I Date: • Fee methodology as byTri.fir Sadism lo4,►sur Senice s«o<t t:utikbospovitorec-ta.typ et r19.177 440.+617T(+1n02aCOM WFIO • w m ,Q m o N m I . . . 3 . F es' TO . : t P13R.TY I r , e 91 0 cri f-- --4 U 1 4 ... C . ] en 1 N N RI 0 U, n O 2 BEES TO SIAM' ROPER.. O TY LINE � . • • OD • • • . nET F.RT .OPE.T o . • CO l N PLEA P.AX PLICLATIVN wrriR RIZy . r W • m v . m v