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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2009 -00138 Date Issued: 03/31/2009 TtGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103BC07700 Jurisdiction: Tigard Site address: 12237 SW LANSDOWNE LN Subdivision: Lot: 0 Project: Volk Project Description: Replace furnace. Owner: FEES VOLK, RANDY J & SHANNON 0 Description Date Amount 12237 SW LANDSDOWNE LN Furnaces < 100K BTU 03/31/2009 $14.00 TIGARD, OR 97223 12% State Surcharge - Mechanical 03/31/2009 $8.70 PHONE: Minimum Fee Adjustment - Mechanical 03/31/2009 $58.50 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: • c am! 1 1, Permittee Signature: . Q ) 1i C' S o r Call_ 503. 639. 41. 75_ 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. '„r _.. -Mar 30 2009 9:27AM CLIMATE CONTROL INC 5039687224 p.2 Mechanical Permit Application 1 C �'oR.orr,< I: 1,.SF ONLY City of Tigard Received .24 Q A 1'-itNo.m c -Q'a L3n 1, , 13125 SW Hall Blvd., Tigard, OR 97223 30 , 09 Plan Review Phone: 503,639.4171 Fax: 503 598.1960 3 • Date/13y: Other Permit. 1 i'''A it D Inspection Line: 503.639.4175 Date Ready/By. 1_1r-is See Paget for Internet: www.tigard- or.gov Notified/method: I h j f ® Supplemental Information • TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction; Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. . Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ,I1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family 0 Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling . Job site address /2 2 3 7 ) 5 O &A w LA) Air conditioning or heat pump (requires site plan showing placement) 14.00 Cit 7 /G,4 40 4R g722 3 Furnace 100,000 BTU (ducts/vents) 1 14.00 pi, iw Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Y© L-K Gas heat pump 14.00 _ Cross street'diredions to job site: Duct work 10 -00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronie) 14.00 Unit heaters (fuel -type, not electric), • in -wall, in -duct, suspended, etc. 14.00 • Subdivision: Lot no.: Flue /vent for any of above 6.80 Other: 10.00 Tax map/parcel no.: Other fuel appliances . DESCRIPTION OF WORK ' ' Water heater 10.00 Gas fireplace 10.00 Flue vent for water heater or gas �� fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 PROPERTY OWNER ❑ TENANT Ot y /liner /tiue/vent 10.00 Other: 10.00 _ Name: A y 4 / �i� �r� Environmental exhaust and ventilation Address: _ Range hood /other kitchen Add �22 3 7 _7.' L 1 7}ui � /e Z./t/ equipment 10.00 City /State /7.IP: 7444D 0 22-3 Clothes dryer exhaust 10.00 Single-duct exhaust (bathrooms, Phone: ( ) 5 0 AC Fax: ( ) toilet compartments, utility rooms) 6.80 At APPLICANT ❑ CONTACT PE RSON Attic/crawlspace fans 14.00 Business name: ' LI 1 0 e . ) -L / %j (� , Fuel pi ing 10.00 i tf p Contact name: RD 1/ -Ti S 15.40 for first four; $1 :00 for each additional Address: 1(DS 00 L.t.) - fi t+ O A--r12 Furnace, etc Gas heat pump City/State /ZIP: Po ri -ra n ci t 97 �� Wall/suspended/unit heater _ Phone: (513 ) t-i S - ` - I' 22 Fax: : (ST5) 9 (o ('r.1Za 1 Water heater _ . t } Fireplace E -mail: f b - C-1 I , 1 a 7-e. C.O - � 1 i n C . Co A'1 Range - CONTRACTOR Barbecue Business name: im 4.7-k-- cyC3 ri `l L i 1y L Clothes dryer (gas) Other. Address: )11150 5 '1) 4 fa MECHANICAL PERMIT FEES* . City /State /ZIP: Pe) r_r(a n a1 a" q-7 22-'7 Subtotal j �l OD Phone: ((3) �3 L , Fax: (5n ) q ..- 2_21 Minimum permit fee ($72.50) 7,2 .'z% Plan review (25% of permit fee) CCB lie.: (pLIco. l j State surcharge (12% of permit fee) 2. 71? TOTAL PEIL'VI[T_FEE_ t / -...z - - Authorized signature: Tbis permit application expires if a permit is not obtained within 180 lea �� days after it has been accepted as complete. Print name: "11 ( rY'l S I Date: / � 4 A ' Fee methodology set by Tri- County Building Industry Service Board .� . Gt /' ?y , 1:1auilding@ermit?Jv C- PerrnilApp doc 01)19)07 440 -4617T (11 /02/COM/WEB)