Permit CITY OF TIGARD MECHANICAL PERMIT
- : 3 COMMUNITY DEVELOPMENT Permit #: MEC2009-00669
T [ G R Q 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/16/2009
Parcel: 1S134AC04000
Jurisdiction: Tigard
Site address: 10817 SW 111TH AVE
Subdivision: HART'S LANDING Lot: 11
Project: Dick
Project Description: Replace furnace.
Owner: FEES
DICK, GARY R AND DARLENE J Description Date Amount
10817 SW 111TH AVE Furnaces < 100K BTU 12/16/2009 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 12/16/2009 $10.80
PHONE: 503 - 639 -5526 Minimum Fee Adjustment - Mechanical 12/16/2009 $43.25
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 $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuanc- • 1 work is so : -nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Center. Tho - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or . irect questions to OUNC by - ng 503)4•...99 or 1.800.332.2344.
sued By: i �'
/, Permitte• �ture:
f� 9 =- •N L�
CaII 503.639.4175 by 7:00 a.m. for an inspection that • ess day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
- • Dec" 15 09 11:45p Clackamas Heating &Cooling 18885002912 p.1
Mechanical Permit AppjkAtE FOR OFFICE USE ONLY
City of Tigard Received
II . llace;B} /2 / DC Permit Nc: �� q� G / /_ �`
] 3125 SW Hall Blvd., Tigard, OR 97223
DEC 16 2009 Plan Review / vu/ ! V ( O(G /
Phone: 503.639.4171 Fax: 503.598.196 Date/By Other Permit:
'f I G A R D Inspection Line 503.639.4175 Date Ready/By hats El See Page 2 for
Internet: wtvw.tigard- or. gov CITY OF TIGARD Notifeed.'Llethod Supplemental information
BIM DING DIVISION 'Co
... i
TY#>✓ o>F Rzs>[� _ : iKl�ec -I�►1 rr� �: sc$�nui.>: �.0. cur00 z0:
i ❑ New construction ® Adttilion /altcration/replacement t Mechanical permit f cs* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATER at _O1 (Or' STA1. i?1(H+ - .:
Value $
1- and 2- family dwelling El Commercial/industrial ❑ Accessory building
2ZESI L QiJIf'M 17 /:$0 l2S N'ECS*
['Multi ❑ Master bililder For special information use checklist.
❑ Other
JQ11 $11'4iil!;:t01 utA1i0N A f 3 L 3f2:20ON tZty. En , Total
Description
..... .... ... . :: Healing/cooling I
Job site address: 10817 S%%' 111 I AVE Air conditioning
kt i
(requires ate plan shoG.no placemcrt) ! 46.75
City/State LlI': PORTLAND, OR 97223 Furnace 100,000 BTU (ducts/vents) I 46.75 46.75
-. Furnace 100.000+ BTU (duos/vents) 54.91
Suite /bldg. /apt. no.: Project name: rD t C
Heat pump 61.06
Cross street directions to job site: Duct work i 23.32 1
-- Hydroni c hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
-- • Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 1
46.75
Subdivision: Lot no.: Ftueivertt for any of above 23.32 __
- Other. I 23.32
Tax mapiparcel no.: Other fuel appliances
D1 Ctill' TIUV .d32� :WQR :' ... R'alerheater 23.32
Csts fireplace 33.39
FURNACE REPLACEMENT Flue vent for water heater or gas
fireplace 23.32
- - - - -- - -- Log lighter (gfts) 23.32
Woodlpellet stove 33.39
Wood fireplace/insert 23.32
ner. flue /vent
I� PROPE12a"X O'irtl 2 er
Chimney/liner/flue/vent 23 32
... > .. < : Oth 23.32
Name: DICK:, GARY F.nvironrnenlal exhaust and ventilation
Range hood/other kitchen
Address: 10817 SW 111TH AVE
equipment i 33.34
City /State'L1P: PORTLAND, OR 97223 Clothes dryer exhaust 33.39
Phone: (503)6395526 Fax: s
( ) toil ( compartment utility I y rooms) I 23.32
E o APPLIG 4M1< .
;CON1ill?1.PIFASl3It - craalspacefittts 23.32
Atli
: i Other 1 23.32
Business name: I Fuel t m
PP g
Contact name: I $14.15 for first four; $4.03 for each additional
Address: Furnace. etc.
' Gas heat pump
City/State/ZIP: WalVsuspendediunit beater
Phone: ( ) . Fax:: ( ) Water heater
i - - ---- Fireplace
E- mail: -
Range
..:.. > :. :. CION'fRACTQIi :: ::- ... :' -. .... :,. -. i Barbecue
Business name CLACKAMAS HEATING & COOLLNG LLC Clothes dryer (gas)
Other
! Address: 15115 SE PENN'' LEE CT MEGHA\11Cs,L PEftlflTTci+TS'
Gi v bta[e'LIP: CLAC1 'NL1S, O1. 97015 Subtotal 46.75
I'hOtic: (511316523-11108 , 'ra>;'. (1:1111115Q11-212, Minimum permit fee (S90.00) 9G.U0
Plan r01. km. (25 % ofpennit fcc)
1 CCD he.. 1656311 State surcharge (12% of permit fee) 10.80 1
111
TOTAI, PERMIT FEE 100.80
S . . C G - _ jr �' This pctmit application ezpt cs if a permit is not obtained within 160
Authorized si nature: DDD /
days after it fins been accepted as complete.
1/ / k hi47 . i