Permit ,� CITY OF TIGA MECHANICAL PERMIT
` "' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00313
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2011
Parcel: 1 S134CB17100
Jurisdiction: Tigard
Site address: 12362 SW ANTON DR
Project: Drezen Subdivision: ANTON PARK NO. 2 Lot: 98
Project Description: Replace furnace and a /c. A/C unit must meet minimum 3' side and rear yard setbacks.
Contractor: CLIMATE CONTROL INC Owner: DREZEN, WILLIAM M & KATHERINE M
16500 SW 72ND AVE 12362 SW ANTON DR
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 453 -4822 PHONE: 503 - 579 -4936
FAX: 503 - 968 -7224
FEES
Specifics: Description Date Amount
Air Conditioning 07/01/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 07/01/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 07/01/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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 - •• . - ter. 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 .uestions to OU C b ailing 503.232.1987 or 1.800.332.2344.
Issued c • , I - ‘ A ,, , k ; Permittee Sit nature: ', , 1 "f
Call 503.639.4175 by 7:00 a.m. for the next available in • • ction 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.
Jul 01 2011 1:13PM CLIMATE CONTROL INC 5039 687224 p.
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City of Tigard YY Received gismiamml
13125 SW Hall Blvd., Tigard, OR 972 Date/By: 7l� " ( 1 - ' 3'3 IR
• 11 Phone: 503639.4171 Fax: 503.5 • .. 1" Plat Review
T I A I: ; r) Inspection Line: 503.639.4175 111 ( R {. Date Rea Otter Pmnit:
Internet: www.tigard- or.gov V Date Ready/Br
�� Yetis: 621 See Page 2 for
\\ dlkiethod:
fi 4 r 4 4",',,,, fc1 S,Q� NotiSe pp sentallnformanan
Sn le
' -,,^ 4y;�, St ,4: : :;,: c . 4 ,„ : ,,,,,, A �•ri I , - 17?"''''' ( i' q I Q 7.d
❑ New construction Addition/alteratiO4 cement
DD M echanical permit fees' are based on the value of the work
❑ Demolition ❑ Other: performed, Indicate the value (rounded to the nearest dollar) of all
r , - - � mechanical materials, equipment, labor, overhead and fa.
r; ..ham- u4...,= a r IW e r Valuo S
111 and 2- family dwelling ❑ Commercial /industrial 4 � � , , i +; -; i?'
12 Accessory building . : e:. . 1. `±L . . )1rr .A xP ` IXSNc;.i .- `d ,�e
❑ Muhi family 0 Master builder ❑ Other; For speciol information use checklist
e�'st� �b ` i i a r a '� i i r v t W r" " "' r r � 7 r t Description I Qty. 1 Ea. I Total
c IIENa - �e -ts : t'S ` Heednpfrnoling
lob site address: ' A c5 (p 2, �' .0 TO C1 A a.- Air conditioning
City/State/ZIP: MI n (requires tie plan snowing placement) t 46.75 yi.'.r
s ( ' ! 6 it "1- Z, -il Furnace 100,000 BTU (ducta/venu) I 46.75 1 4 .-7r
Suite/bldg./apt. no.:. Project name: Y-
Furnace 100,000+ BTU (ducts/vents) 54.91
Cross street/directions to job site: Heat p 61.06
Duct work 23.32
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: I no.: Flue/van for any of above 23.32
Tax map/parcel no.:
1 Other: 23.32
, t £ ; "> < ctrl t 2 5 + t a Other fuel appUances
H
W i P ., ,, f.L r ti ) ?.�h a te._` "W . . ? j l".•1 : Water heater 23.32
i�LJ-t t-• r � & d 6... ... Gas fireplace 33.39
The vent for water heater or gas
fireplace 23.32
Lag lighter (gas) 23.32
Wood/pellet stove 33.39
r , "N �, :�^ � ' �".'r fir '. { ¢ r, �; s r a s Wood fireplace/insert _
2332
1...: 'w,,.i 4 ... ''.,., T:., ^ �r . r.- � .: ba te ,T :Piz ^ :::$ : c* Chinmey /liner /flue/venl 23.32
Name: t b fGZ `v..�
Environmental exhaust and ventilation
�. ` Oth er -
I 23,32
Address: 1 23 )„ e j A _ _ . 1 p� Range hood/otherkitchers
City /State/Zip: " f `? 6A,(� ft� �i Yv L 3 {f equip 33.39
-1 �+ - `/ q or 2Z 7 Clothes dryer exhaust 33.39
Phone: ( 133) S'' / / 7 ✓ 4.' Fax: ( ) Single -duct exhaust (bathrooms,
r; s"� ' , �'\ - v w Yg" S : ' yc � toilet compartments, utility moms) 23.32
�,� : ° ate . Y: DI.4 F 5, ° .O t_} . a s _s- 77, Att c /crawlspace fans
,: c_� ...�., : � 23.32
Business name: LI 1.-11t41:11 ton T Yt?L. I nt✓ Other:
Contact name: 23,32
o 4 (� F r is Foal pipina
�( ( $14.15 for first four; 54,03 for each additional
Address: l oson esw - 7 -71n0 �t " , V , E Furnace, etc. 1
City /State/ZIP: RA-Hand r Gas heat pump
Phone: (9)3) �S3 - 4 223 Wall/suspended/unit heater
� B Z Z. I Fax: : ( )C�( 7 ' 1 v l ae Z9 Water heater
t►� + 7
Fireplace
E
C t Pr1 p�,4 - e
" �6 ' fit ' � 4 a a. ��,r,r"- -',^e- yi ax .L� ,e� C O r1 „� 'f't) L._ Inc C O rV"t Ran _� e
<a?.._. ,r� x�r�: t . Barbecue
Business name: CL+ Co 1n 4 _,L ire . Clothes dryer (
Addre Address: to Soo S i# - 77. � ° U A V t other.
ss: I
tatel7_IP: �of l'- 10. n G F ' ,�;, ' `�7y u"s' + .` t t
Phone: (5-03) yS y$2Z Fax: { Subtotal 03) °l b y _ Z Z �/ Min imum permit fee ($90.00) SAM
CCB tic.: 7_1 q
State surcharge (
/ Plan review ( of permit fee)
12% of permit fee)
Authorized signature: igZ, TOTAL PERMIT FEE
This permit application expires if a permit is not obtained µtibia 1110
MOM
I Print name: 0 U J 7 � j � days after it has been accepted as complete. T c 10 ,Date: 17 �` Fee methodology let by Tri -County Building Industry service Board di./ I! $tildintlPcrr lgsVdEC- PVmhAyp,do IOR)1N9
440-4 17T ( (02 /COM /WEB)
Pa/OCIIso
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