Permit CITY OF TIGARD MECHANICAL PERMIT
1:1111• I: • COMMUNITY DEVELOPMENT Permit #: MEC2009 -00577
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/30/2009
Parcel: 1S134BD08500
Jurisdiction: Tigard
Site address: 11542 SW WOODLAWN CT
Subdivision: Lot: 0
Project: Davidson
Project Description: Add A/C and replace furnace Must maintain 3' rear and side yard setback
Owner: FEES
DAVIDSON, KAREN & VICTOR Description Date Amount
11542 SW WOODLAWN CT
TIGARD, OR 97223 Air Conditioning 10/30/2009 $46.75
12% State Surcharge - Mechanical 10/30/2009 $11.22
PHONE: 971 - 355 -4069 Furnaces < 100K BTU 10/30/2009 $46.75
Contractor:
CLEAN AIR ACT, INC.
16582 S. CARUS RD.
BEAVERCREEK, OR 97004
PHONE: 503 - 632 -1563
FAX: 503 - 632 -7158
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
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 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:A e Permittee Signature: try
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.
Oct 30 09 05:36a Rodger Brown 503 632 -7158 p.2
Mechanical Permit Application RECEIVE i FOR OFFICE USE ONLY
City of Tigard !! Received permit N Date/By: cit(EC p9- CJU 5li
II 13125 SW Hall Blvd.. Ti ard. OR 97223 OCT 3 0 2009 Plar. Review
C • Phone: 503.639.4171 ax: 503.598.1960 Date/By: Other Permit:
T I G R D Inspection Line: 503.63 .4175 CITY OF TIGARD Dam Ready/By: Jul Id see Page 2 for
Internet: www.tigard- or.rov B DIVISIO, efted/MethoJ: Supplemental Information
19''PE OF WORK COMMERCIAL FEE* SCHEDULE - CSE CHECKLIST
tion /replacement Mechanical permit fees' are based on the value of the work
❑ New construction ® pddition/altera.
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEG CONSTRUCTION Value. 5
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I- and 2- family dwelling ❑ ommercial/industrial ❑ Accessory building
For special injonnailon use checklist.
❑ Multi - family ID Master builder ❑ Other: Description Qty. Ea. Total
+ JOB SITE 111 ORMATION AND LOCATION HcatinrJcoolinn i
r I Air conditioning
Job site address: / I 46.75 C /� 5
Karen & Victor Davidson (requ s p s placement) . 75
Cit y /State/ZIP: i Furnace 100.000 BTU (ducts'verts) 46.75 `7 )J
11542 SW Woodlawn Ct
I :• Furnace 100.000+ BTU (ducts/vents) 54.91
Suitelbldg.lapl. no.: Tigard,OR 97223
r Heat pump 61.06
Cross street/ directions to job : Duct work 23.32
971 - 355 -4069 Hydronic hot water system 23.32
- - - Residential boiler (radiator or
hydronic) 23.3 2
•
Unit heaters (fuel -type, not cltxtric).
in -wall. in -duct. suspended, etc. 46.75
Subdivision: I Lot no.: Flue /vent for any of above 23.32
Other: 23.33
Tax map /parcel no.: Other fuel appliances
DEdRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Add AC and replace furnace • . Flue vent for water heater or gas
. fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insen 23.32
❑ PROPERTY OWNS$ 1 ❑ TENAN'T Ot y.9iner /illleiven[ 23.32
Other 23.32
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: 1 I• equipment 33.39
City /Statc/ZIP: Karen & Victor Davidson Clothes dryer exhaust 33.39
Single - duct exhaust (bathrooms,
Phone: ( ) 11542 SW Woodlawn Ct toilet compartments, utility rooms) 23.32
❑ APPLICANTTigard, OR 97223 'ERSON Attic/crawlspace fans 23.32
Other. I _ 23.32
Business name:
Fuel tin
971.355 -4069 p p p
Contact name: _ -_ .. - $14.13 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State/ZAP: Walllsuspended/unit heater
Phone: ( ) Fax:: ( )
Water heater
Fireplace
E -mail: Range
NTRACTOR Barbecue
Business name: Clean Air Act Inc
Clothes dryer (gas)
Other:
Address: 16582 S Carus Rd • MECHANICAL PERMIT FEES*
City /State/ZIP: Beavercreek • Subtotal , 9 3 s-6)
Minimum permit fee (590.00)
A. Phone: (503) 632 - 1563 Fax: (503) 632 - 7158, Plan review (25 of permit fee)
j P I CCB lie.: 144650 q Kb, 10 State surcharge (12% of permit fee) it 2 Z
11 + III TOTAL PERNL1T FEE / E Y 7 1
This permit application expires if a permit is not obtained withIn 180
Authorized signature: days after it has been accepted as complete.
Print name I Date: 4,6) - 30_09 I ' Fee methodology set byTri•Couaty Dei:ding Industry Service Board'
I:U iuildhg `J'amilslMFC•PaamitAp:.doc :0/01/09 :an -.is 17T (I I,DJCOM/WEBI
503 632-7158 P•4
Oct 30 09 0537a Rodger Brown
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Karen Victor Davidson
11542 SW WDDdiaWRCt
Tigard, OR 97223 ' -
503-521-0410 971-235_4069KAREN h
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