Permit �t CITY OF TIGARD MECHANICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: MEC2011 -00065
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/11/2011
Parcel: 1 S133DC13500
Jurisdiction: Tigard
Site address: 13198 SW SHORE DR
Project: MARTINELLI Subdivision: ARI GREEN Lot: 26
Project Description: A/C replacement.
Contractor: CLACKAMAS HEATING & COOLING LLC Owner: MARTINELLI, PATRICIA
15115 SE PENNY LEE CT. 13198 SW SHORE DR
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 658 -4808 PHONE:
FAX: 888 - 500 -2912
FEES
Specifics: Description Date Amount
Air Conditioning 02/11/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 02/11/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/11/2011 $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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:! 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.
Feb 10 11 08:36p Clackamas Heating &Cooling 18885002912 p.1
Mechanical Permit Application I , TOR (II It I. I �1•.(l»i.)
City of Tigard Reoerv
Pewit No.:
• 1 3 125 SW [call Blvd., Tigard OR 97223'11 '- P1aa Review
1111 Phone: 503.639.4171 Fax: 503.598.1960
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Date/By: pi it
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T 1 C .A R f7 inspection Line: 503.639.4175 FEB 1 1 2
Internet: www.tigard -or.gov s �D Date Notified/Method: S See Page
Information
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TYPE OF 1,19103.".1-,\ 1;±10. tli4 SIGN. COMMERCIAL FEE* SCHEDULE — USE CHECKLIST."-.'
New construction
L./via-a- Mechanical
® Add permit fees' are based (rounded to the nearest value area work
❑
❑ Other:
performed. Indicate the value roundearest dollar of all
❑ Demolition Mechanical materials, equipment, labor, overhead, and profit:
CATEGORY OF CONSTRUCTION Value: S
El 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDE EC1t7QMErlP /ST EMS FEES
ID ❑ Master builder ❑ Other For special information use checklist.
Description I Qty. j Ea. I Total
• ,..• - 1013 SITE INFORMATION AND LOCATION. Heating/cooling
Job site address: 13198 SW SHORE DR Air conditioning
(requires site plan showing placement) 1 46.75 46.75
City /State/ZIP: TIGARD, OR 97223 Furnace 100.000 BTU (ducts/vents) 46.75
Suite/bldg./apt. no.: Project name Furnace 100,000+ BTU(duets/v�ents) 54.91
�A✓_ Ny . // t + Heat pump 61.06
Cross street/directions to job site: Duct work 2332
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
Subdivision: Lot no Flue/vent for any of above 23.32
Other. 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
A/C REPLACEMENT Gas fireplace 3339
Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood frreplace/insert 23.32
►:+ PROPERTY OWNER Chimney/lineriflue/vent 2332
[] TENANT Other. 23.32
Name: 1IART1NIELLI, PATRICIA Environmental exhaust and ventilation
Address: 13198 SW SHORE DR Range hood/other ldtchtrt
equipment 33.39
City/State/ZIP: TIGARD, OR 97223 Clothes dryer exhaust 33.39
Phone: (503)336-0785 Fax: Single-duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) _ 23.32
. > -+ APPLICANT 0 CONTACT. PERSON Attic/crawlspace fans 23.32
Business name: CLACKAMAS HEATING & COOLING LLC Other' CLACKAMAS
Fuel piping
Contact name: VLADIMIR MIKHATS 514.15 for first four; 54.03 for each_ additional
Address: 15115 SE PENNY LEE CT Furnace etc.
Gas heat pump
City/StaterZlP: CLACKAMAS, OR 97015 WaWsuspended/unitheater
Phone: (503) 6584808 Fax:: (888) 5002912 Water heater
if -mail: CIICLLC®COMCAST.NET
Fireplace
Range
CONTRACTOR Barbecue
Business name: CLACKAMAS HEATING & COOLING LLC Clothes dryer (gas)
Other:
Address: 15115 SE PENNY LEE CT :MECHANICAL PERMIT FEES*
City /State/ZIP: CLACKAMAS, OR 97015 Subtotal 46.75
Phone: (503) 6584808 I Fax: (888) 5002912 Minimum permit fee ($90.00) 90.00
Plan review (25% of permit fee)
CCB lie._ 165630 State surcharge (12% of permit fee) .' 10.80
� ' J TOTAL PERMIT FEE 100.80
- I This
Authorized signature: :G�l permit R pplication expires ii a permit is not obtained within 180
days afar it has been accepted as complete.
Print name: VLADIMIR MSKHATS Date: 02.11.2011 ! • Fee methodology set by Tri County Building Industry Service Board
1 : I3.uileinglPermltrWEC- Feroitapeeicc tONtris) 440 -4617T (11UM/COM WEB)
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