Permit CITY OF TIGARD MECHANICAL PERMIT
IS COMMUNITY DEVELOPMENT Permit #: MEC2009 -00161
T I GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/15/2009
Parcel: 2S112BCO3600
Jurisdiction: Tigard
Site address: ( 14700 SW 83RD AVE
Subdivision: HAMBACH PARK Lot: 20
Project: Goeres
Project Description: Replace furnace and heat pump.
Owner: FEES
GOERES, MARK W & SUZANNE R Description Date Amount
14700 SW 83RD AVE Air Conditioning or Heat Pump 04/15/2009 $14.00
TIGARD, OR 97224 Furnaces < 100K BTU 04/15/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 04/15/2009 $8.70
Minimum Fee Adjustment - Mechanical 04/15/2009 $44.50
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 $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
Issued By: I, ` \ 0 \ ` ` 16 Permittee Signature: `��r`
,, 40
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.
Apr 10 2009 12:12PM CLIMATE CONTROL INC 5039687224 p.
Mechanical Permit ApplicaticRi ECEIVE 1 roR or'.icy t:St: oNi_,
City of Tigard Received , ,
• 13125 SW Ball Blvd., Tigard, OR 97223 APR 10 2009 Date/By: .09.
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date/By: Other Permit
l 1 c: n h u Inspection Line: 503.639.4175 CITY OF TIGARD
Internet: www.tigard- or.gov Date Ready/By: ® See Paget for
BUILDING DIVISION Notified Method:
NMI Supplemental Information
TYPE OF WORK . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based onthe value of the work
❑New construction' Addition /elterationfreptacomrnt
❑ Demolition performed. Indicate the value (rounded to the nearest dollar) of all ,
0 - mechanical materials, equipment, labor, overhead, and profit.
. ' CATEGORY OF CONSTRUCTION Value: $ `
•
.INC1- and 2- family dwelling ❑ Cornmeacial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Multi- family ❑Master builder ❑ Other:
special information use checklist, -
Description 1 Qty. I Ea. I Total
JOB SITE INFORM ATION AND LOCATION Heating/cooling
Job site address: 75/ 7 e' 5 J l 3 rol es Air conditioning or heat pump u
(requires site plan showing placement) 1 14.00 / 7
City / State/ZIP: Tome", net ey .2 2 y Furnace 100,000 BTU (ductm/ven s) / 14.00 / S/
Suite/bldg./apt. no.: 1 Project Warne: ! O6 S Furnace 100,000+ BTU (ducts/vents) 17.9D
Gas heat pump 14.00
Cross street/dire ctions to job site: Duct work
10.00
-Residential hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
•
Unit beaters (fuel -type, not electric),
in-wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
Tax maplparcel no.:
Other: 10.00
Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
/4.405144:— ti< Z7 / / Gas fireplace 10.00
�/o7, Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Woodfpellet stove 30.00
Wood fireplace /insert 1000 _
E`PROPERTY OWNER I ❑ TENANT. Chimney/liner/flue/vent 10.00
Name: � 4 C oe r ... 5 -
_ � 10.00
/���c9 �` Environmental exhaust and ventilation
Address: /4/70,0 • 544...1 8-3 ,--,0 � Range hood/other kitchen
equipment 10.00
City/State /ZIP: 7-7/6„4/41 !n'e 77ZZy Clothes dryer exhaust 10.00
Phone: ( ) �,� Single -duct exhaust (bathrooms,
/ � F es ' ( ) toilet compartments, utility rooms) _ 6.80
APPLICANT ❑ CONTACT PERSON Atticictawlspace fans
Business name: /� l 1 Other: 10.00
(1 I n - T ZIP I -h-oL I i') (r 10.00
Business
piping
Contact name: Rolf r/ s
$5.40 for first four; $1.00 for each additional
Address: ) 10 S 0 �J - 7 V- /114
l v 4- Furnace, etc.
( �y y Gas heat pump
City/State/ZIP:
� ( - a d� r� 2 " ') - 1 Wall/suspended/unit heater
Phone: (S73 ) Li S -LI $ 22 l Fax:: (3) 9(a F( - / Z z Water heater
•
E -mail: r01. a c..1, Mal 44 C - 0 r1 1 } I nC . CO 4,1 Range ce •
CONTRACTOR Barbecue
Business name: Are" Oo 1 _ _ I L Clothes dryer (gas)
Address: i 10 r Other: ,
50� s
�� 4-1/L----
V L MECHANICAL PERMIT FEES*
City /State/ZIP: f)) r 1---(0 A d t /-7 ` 'L Z
(� (' "f /�j Subtotal 2i,/
Phone: (503) (,r 3 I b ?ice I Fax: (53 ) $ ...7 Z2 y Minimum permit lee ($72,50} 7.2-5V
CCB lit.: �' Plan review (25% of permit fee)
State surcharge (12 %of permit fee) , ? 6
4 i
TOTAL PERMIT FEE. / • g0
Authorized signature: Th permit application expires If a permit is not obtains within 180
Print name Rot. 4- Y� � Date: �� ' fQ days after H )as been accepted AS complete.
j�,(/ v/ F ee methodology set by Tri-County Building Industry Service Board
1' atiildinatpamitatEC,Permitapp .do out 9/C7
440 -4617T (1 )/o2 /COMJwEB)
Apr 10 2009 12:12PM CLIMATE CONTROL INC 5039687224 p. 3
Ci 16500 SW 72nd Avenue Portland, OR 97224
HEATING d, MR CONDITIONING Phone: 503 -453 -4822 Toll Free: 866 -453 -4822
Fax: 503 -968 -7224
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SYSTEM DESIGN — INSTALLATION -- SERVICE — MAINTENANCE
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