Permit n CITY OF TIGARD MECHANICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: MEC2013 -00725
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/04/2013
Parcel: 2S 111 CC22300
Jurisdiction: Tigard
Site address: 10350 SW GREENLEAF TER
Project: Edwards Subdivision: SUMMERFIELD NO.5 Lot: 281
• Project Description: Replace furnace
Contractor: CLIMATE CONTROL INC Owner: EDWARDS, WILLIAM K & SHIRLEY ANN
16500 SW 72ND AVE 10350 SW GREENLEAF TERR
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503 - 453 -4822 PHONE: 503 - 670 -0950
FAX: 503 - 968 -7224
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/04/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/04/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/04/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
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 otifci _if_
Cent@r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir ct questions to OUN • : • Ilin. 503.232.1987 or 1.800.332.2344. F
Iss ed By: ' I / //14--4/-1,-;° Permittee Signature: •
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 03 2013 1:58PM CLIMATE CONTROL INC 5039687224 p . 2
Mechanical Permit Appll i;s: ch.
• ' , CEI.VED
1.()1,: or 1.1( I. SF.
City of Tigard Received.
0 17/11 Permit No.:
.11 . 13125 SW Hall Blvd., Tigard, OR 97.1120 r 3 z013
Flan Review
Phone: 503.7182439 Fax 503.5984460" Data/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By Seth: 15 See Page 2 for
Internet www.tigard-or.gov CITY OF - 11GARD ramified/method: Sopplemental Information
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' ' , `ii:',..:;:'': :i- ,. ,.': ' - :- ,- ' " - ''' ' • ' ',.- ' Tibia .. - ,-.:., ,::.. -;:. ' :,: '.',.*::'.; ,,,,:i. .4.:,49..cril;.AiL4.,
, r.,, .,- - : '' " . ' ' I . ' - 6--i - , - ' ,- '---- - ” - :. - 4.. '' ''''''''' '.' '' ':!. ' -." 'r ''''' ."-'' ''' ''' . t.'''''' Mechanical permit fees' are based on the value of the work
0 New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition El Other: mechanical materials, equipment, labor, overhead, and profit
Value: $
- 4.4' W 1.6,';+: ;‘,://7;,;1: 'F":11?;416";.
,,: 1....,4,(-*AiikiV;.Otr.0.40itito*:Mikop-ig:,;.;4
E ri CI
- and 2-family dwelling Commercial/industrial 0 Accessory building For spedel is{formorion use checklist
Multi-famil 0 Master builder 0 Other: Description f Qty. J Ea I Total
:-; ‘., .7 -;:': ;';',' Resting/cooling:
j . -4 *.'O t : t '* - it 4 k 4 :*f$. -1 AW'i :074 V- 007 -'' - '.:''' '',.-,-..--, 1, :;- k_. Air conditioning 46.75
Job site address: /0 - 3 - D $r:J (-I' ■ Ter-e Furnace 100,000 BTU (ducts/yenta) 1 46.75 4 LP 75
_...
City/State/ZIP: T 6A oc 9 Z--1-9 Furnace 100,000+ BTU (ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt. no.: I Project name:
Duct work 2332
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 46.75
Fluelvent for any of above 23.32
Subdivision: 1 Lot no.: Other 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
EIRSCRIPliON OF WORK . i :. :. - . Gas fireplace/insert 33.39
. .
Flue vent for water heater or gas
reeplACIR iVe-NACG fireplace 23.32
Lo : IL. , r Y 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ppROP,ERTY OWNER:.. ' • : • - . . Other: 23.32
1:144 ,I, :
Environmental exhaust and ventilation:
Name: (b.n t 6 Vp P- e e;ibkzeaZQS Range hood/other kitchen
equipment 33.39
Address: I h3 ) v.) e 1f2- Clothes dryer exhaust 33.39
City/State/ZIP: m bp, 0\a_ On 2-2-q Single-duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: ( ) (5/C) - Or3C,) Fax: ( ) Anic,/crawlspace fans 23.32
•::: Other ,.: : *tii000MOk . :: , ..::.::: er:
ql 2332
piping:
Business name: Lb on fv Fuel -Ve_ C \ \ n c _
$14.15 for first four. $4.03 for each additional
Contact name: R01.- VA I 5 Furnace, etc.
Address: ) (COCD 6 72-- Ilt-0-- Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: eo,a 01/4 ei cl, 0,12._ o 27- water heater
Phone: ( 563 ) 1-1; ,(/i C 2 2_ I Fax: : (9)3 ) C \ 4 B .... 2 Fireplace
Range
E-mail: o tE c rlickA.e c42,‘"....,„
Barbecue
;.'n;;'ii ";,'::. , 3 :; . : ' , 49;HP.410. , ,P0 FL: Clothes dryer (gas)
Business name: 3 ywAe _ ts, plp eV+ Other
Address:
,,.. j :16 ;V ° :".,;r::i ',:, 's.::.!`"i' ' .• 3 :) :
Subtotal (4 to• 7 5
City/State/ZIP: Minimum permit fee ($90.00) Cif) cip
-
Ph Fax: ( Plan review (25% of permit fee)
one: ( ) )
State surcharge (12% of pennit fee) i 0 BO
CCB lic.: Cod, \ 9 1.4
TOTAL PERMIT FEE
This permit application aspires ifs permit Is not obis within 180
dap after it has beer accepted as complete.
Authorized signature: %---. C6414.4,..LA...0-.." I Fee methodology set by Tri-Couuty Building Industry Service Board
I Print name: ( . 141,rt 1 rerii Date: I i) 3/13 1 f15 075/V
1:11uildingTemniti3EC_PermitApp_040113.doe 440-4617T (11 /02/COWW1113)