Permit ti
4 CITY 11GARD MECHANICAL PERMIT
�, DEVELOPMENT SERVICES PERMIT #: MEC2006-00036
9�'I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/23/2006
PARCEL: 2S114BB -07300
SITE ADDRESS: 16221 SW 104TH AVE ZONING: R -12
SUBDIVISION: SWANSONS GLEN LOT: 014 JURISDICTION: TIG
Project Description: Replace A/C unit.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
E ANN RAINS Description Date Amount
16221 SW 104TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 1/23/200€ $72.50
[TAX] 8% State Surcha 1/23/200€ $5.80
Total $78.30
Phone: 503- 453 -4822
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 453 -4822
FAX 503 - 968 -7224
Reg #: LIC 62196
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: .4 z L Permittee Signature: , Vo P
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business daaj. 1
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.
Jan 23 2006 10:19AM CLIMATE CONTROL INC 5039687224 p.1
Mechani Permit ApplicetioR FOR OFFICE USE ONLY
City of Tigard �� �\ / , Received en Permit N. - 9 4 • mar
13125 SW Hall Blvd., Tigard, OR 972 \1V►/ Da R . wig✓
Phone: 503.639.4171 Fax: 503.598. l9 !' " Date ewre�v
i5h � Date/By: Other Permit:
Inspection Line: 503.639.4175 1t 1 j. '�`iJ i
i � .,
Date Ready/By: Juris: B gee Page 2 for
Intentet wwtiv...t.tlgard.or.us I JAN 23 2011 Notified/Method: •l/r Supplemental Information
T . y / ll —
��, ' . .._ ,..,.. . CQ11 MERCIAI, FEE* SCHEDULE. USECHECKLIS7
❑ New construction Pte, .. , , • i msto Mechanical permit fees* are based on the value of the work
• it performed. Indicate the value (rounded to the nearest dollar) of a
CI Demolition ❑ • mechanical materials, equipment, labor, overhead. and profit.
.....:..
CATEGORY OF CONSTRUCTION -:; . ;;,--: ..,.: ' .. :: .:.. .:: :. :: Value: S
....
RESIDENTIAL EQUIPMENT SYSTEMS FEES*
and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For specia: information use checklist.
Multi- family ❑ Master builder ❑ Other:
Description. I Qty. I Ea, I Total
• JOB SITE INFORMATION AND LOCATIQN..,:.. - : Heating/cooling
Job site address (' 1 �/ � Air conditioning or heat pump R
W I (requires site plan showing placement) 1 14.00 1
City/State /ZIP: T d Furnace 100,000 BTU (ducts /vents) 14,00
` t Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: v Project name Q OC.5 Gas heat pump 14.00
Cross street/directions to job site: �ltJ . Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
• hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended. etc. 10.00 _
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
• Tax map /parcel no.: Other fuel appliances • DESCRIPT IN OF WORK . Water heater 10.00
iff r a _ �� Gas fireplace 10.00 e. . Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 1 0.00
Wood/pellet stove . 10.00
Wood fireplace/insert 10.00
ROPERTY OWNER El TENANT Chimney/liner/flue/vent 10,00
^ ^� Other: 10.00
Name: Vl Environmental exhaust and ventilation
Address: r a � I Q 1 /� Range .00d/other kitchen
{.(� U (,� equipment 10.00
City /State/ZIP: 0 ii ` • . 7adia. Clothes dryer exhaust 10.00
• Phone R a ► � ,r� Fax Single -duct exhaust (bathrooms,
r ( ) toilet compartments, utility rooms) 6.80
)am" APPLICANT >0 CONTACT PERSON Attie/crawlspace fans 10.00
i Business name: el t o � 6 1 Other: ]O.OD
t �+`r �_ ���1 �! (1�� Fuel piping
Contact name: S5.40 for first four: $1.00 for each additional
Address: EL. C)r- r �� 70)- ; Furnace, etc.
City /State /ZIP: l/ t.J Gas heat pump
ictj ll 4 A a.: AL, 7 - _ c).. Wall/suspended/unit heater .
Phone: l .. / Fax:: l♦ a. - p _ Water heater
E -mail:
• __ Fireplace
Range
CONTRACT R Barbecue
Business name 1 / cncL -- ( 6 \ Clothes dryer (eas)
Address: 1
Other. I
e MECHANICAL PERMIT FEES*
City /State /ZIP: J t" � , Mb. C a S ubtotal 44. et ,
Phone: ), t Fe ( ......
Min: :mum permit fee ($72.50) `7.95
L_.&— ♦ a fi Plan review (25% of permit fee)
CCB lie.: f9 1 1 t State surcharge (8% of permit fee) eau)
9 TOTAL PERMIT FEE
Authorized signatur : I Olk. .lM010 , This permit application aspires if a permit is not obtained within 180
�. _ days after it has been accepted as complete.
Print t tame: f_ III ,1,a�`-/ i. • • Fee methodology set by Tr -County Building Industry Service Board
I ` Building \PermitsV'.4EC- PermirApp.do . •• 440.461Tr (11/03 /COM /WEa) - .
Jan 23 2006 10:19RM CLIMRTE CONTROL INC 5039687224 p. 3
s CLIMATE 16500 SW 72nd Avenue Portland, OR 97224
Phone: 503- 453 -4822 Toll Free: 866- 453 -4822
HEATING & AIR CONDITIONING Fax: 503- 968 -7224
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SYSTEM DESIGN — INSTALLATION SERVICE MAINTENANCE
climatecontrolinc.com
1
CITY OF TIGARD pi L..--c-
BUILDING DIVISION ° PERMIT #:a06 _ U 0 0 3 co
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ��'�4Pi�Npiifl`'
Inspection Requests (24 Hrs.): (503) 639 -4175 —,.....0- .....
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / C -)., I / D T / CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 - i 6 ( P Pour Time: /I & (
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
i ) S
Cci.±(2_ ./'0'2d.,,,e
I
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspecto • '' Date: 5 ‘ 0 Phone #: (503) 718- 2 7E)6