Permit t CITY OF TIGARD MECHANICAL PERMIT
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m COMMUNITY DEVELOPMENT Permit #: MEC2009-00680
1 i ' : Date Issued: 12/23/2009
T (G rIRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 133DA02700
Jurisdiction: Tigard
Site address: 12825 SW GLACIER LILY CIR
Subdivision: Lot: 0
Project: Meredith
Project Description: Replace furnace
Owner: FEES
MEREDITH, MICHAEL D & KATHLEEN M Description Date Amount
12825 SW GLACIER LILY CIRCLE
TIGARD, OR 97223 Furnaces < 100K BTU 12/23/2009 $46.75
12% State Surcharge - Mechanical 12/23/2009 $10.80
PHONE: 503 - 524 -9241 Minimum Fee Adjustment - Mechanical 12/23/2009 $43.25
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
TIGARD, OR 97224
PHONE: 503 - 453 -4822
FAX: 503- 968 -7224
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
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 Notif . '• -:-.. er. 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 •uestions to 0 ' C b .fling 503.246.6699 or 1.800.332.2344.
Issued B • 1 " i � r 1 Permittee Sign. ure: , I . , ' - � � .-- ' i. •
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.
Dec 23 2009 8:23AM CLIMATE CONTROL INC 5039687224 p.2
_ 1�fl echanical Permit ApplicatIO RECEIVE") ...
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^, 4 iv 1 OR't)I I IC:E l S1 f) \ I 1 3 r I ti� ;
�. City of Tigard Received w �� °;,�
a ° 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: /,Z 3�0, i s ..�t�/ Permit No.: r,LI�o9� OOIp
II
II D Phone: 503.639.4171 Fax: 503.598.1960 DEC 2 3 2009 Plan Review �`' 7
y Other Permit:
"1 tC;7ich i3 Inspection Line: 503.639.4175 Date /B
D Date ender o ] ais: FO See Page 2 for
Internet: www.tigard - or.gcv CITY OF TIGAR
Vot fled Melhod:
s 1 \ G DIVISION --
Supplemental Information
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Mechanical permit flues' are based on the value of the work
❑ New construction TgAddition/alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:
�lTl(.� ,4* u,- aa � s *; -.ft �r .
mechanical materials equipment, labor, overhead, and profit.
N k tr 7 74: asw�a ' a ` . MM91 . ` a sz - Via. =lu'e S
Ts). and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building a � A � " � ' - � sr
For special information use checklist_
❑ Multi - family ❑ Master builder ❑ Other:
ww lh� 1 . I +f *t, �r Y'ti o us t t Description Qty.
1 I
Ea. t, r�s a a� 3 : 'r _ _ ' a ' _ ` =s a H earin I Total -
-
w
MMERI' .r, s ' Heating/cooling
Job site address: In - w ,. r� + � Cyr Air conditioning
C -� p p Q I'. f ZZ (requires site plan showing placement) 46.75
ity /State /ZIP: -1
Furnace 100,000 BTU (ducts /vein) 1 46.75 yip•7r
Suite/bldg. /apt. no.: Project name:
Furnace 100,000+ BTU (duets/vents) 54.91 _Ed CYI� 1 Heat pump .
Cross street/directions to job site: 61.06
Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydrooic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision:
1 Lot no.: Flue/vent for any of above 23.32
Tax map/parcel no.: Other 23.32
-
Other fuel appliances
1 4 .-4-I c5- s`�'}a3 ni' t m ° ji i .r, f j f a (�,.I �k ,' "'�v., �� II }`�rm`S. { - D,1 f , = g •v �. rc max:
�rt�x YC.�GstR,c. c ^ceF . }..�tTa:�z}rs ^rY� X414 k,' Water heater 1 23.32
_g � G4CC ..,y.' N 4f Gas fi e 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) _ 23.32
Wood/pellet stove 3339
_ Wood fireplace/inse n 23.32
'u 1't',t,'wlf ae F.x !You l•r lr f* k � h4 - t ,` . 'f icf: d{ r t "; �*- GW. •; - ChitM /1iner/flue/vet' t 23.32
.,r, #. ?11.,af ,.3 -2aFkr rt^+ 1an. ri,d_,�;ti;g-14; ri!i i-7 �rkrkspz ;:i:,1,2-§-14,4;i4- '
��` 23,32 1
K4-71--- A I .
Name:
r��1 'v` - - - Environmental exhaust and ventilation
Address: J 2i37-5 '5 6 (AC-d i# - 1, 1+ ( G/!t�
Range hood/other kitchen
ui men[ 33.39
City/State/ZIP: ' & k r -0 f • 1 -2./.3 Clothes dryer exhaust
)
Phone: : ( 5 1 .2 Lt J Fax: ( )
Single -duct exhaust (bathrooms, 33.39
r (
t� Y ?: u `�l� y +i ��+ a ii v c �h ri � � " ' ' r3 6 1? � q 7 `1 �'' "�,kra . toilet compartments, utility )
� 'li rooms 23 32
�._,,. .11„a l._ e-E ..tea <ia v <, .t,� r �xa let,,4_: t Auicicrawlspace fans 23.32
Business name: LI U MA re- Ao n rroL Inc
other: 23.32
Contact name: �{ Fuel piping
r is $14.15 for first four; $4.03 for each additional
Address: 1 (050t) rS ` " A , , � Furnace, etc.
City/State/ZIP: l 1 KV Gas heat pump
r r
I CL 0 r 9 - 1 2-2-3 Wall/suspended/unit heater
Phone: ( 5 - 4 5'3 ) y53 LI B a z. Fax:: (Sb3) 9(428 -7 Z Zt/ Water heater
]rrnail 7 Fireplace
r ec..itmo --�c o r 4 -
���• " v n £. 4 - w , �. r1G Conn �
'u. • l p r-m , ' � :. `. `u ze 4 rov�r 1 ity d ' Barbecu
Business name: C,l"..1 yV) 4-r-- 6o,n Inc - e
Clothes dryer
Address: f S o --7,1."9 Other:
tC4_.) A V 6- _ li- M M
City /State /ZIP: 'Dore - 1 0. P[ CJ or ci-) z 1 :. w ? � M t �; ar
Subtotal y )1 ,
Phone: Z Fax:
Minimum emit fee $90.00
(� > X 153 - � Z (sb , ) ° rlo 4 -7Y p ( ) go. as
CCB lie.: 2.-1
Plan revicv✓(25 %of permit fee)
, State surcharge (12% of permit fee) 1 0./t t,
` 444.41,b TOTAL PERMIT FEE 10 0 SO
Authorized signature; This permit application expires if a permit is not obtained within 180
i Print name: days after it has been accepted as complete.
/�o y j for //S L Date: I if 2.--3/ c I • Fee methodology set by Tri - County Building Inetuury Service Board
1 : 11 iuildi °g \PermiIt\MEC- PemvtApp.doc 10/1i/09 / ! ^
440.4617T (I I/02 f()6 14 ceO r-