Permit CITY OF TIGARD MECHANICAL PERMIT
_ COMMUNITY DEVELOPMENT Permit #: MEC2012 -00164
TI G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2012
Parcel: 25111 DD02100
Jurisdiction: Tigard
Site address: 15700 SW 88TH AVE
Project: WORMWOOD Subdivision: STRATFORD Lot: 37
Project Description: Furnace replacement.
Contractor: CLIMATE CONTROL INC Owner: WORMWOOD, CHAUNCEY & HEIDI
16500 SW 72ND AVE 15700 SW 88TH AVE
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503 - 453 -4822 PHONE: 971- 275 -0382
FAX: 503 - 968 -7224
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/03/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04 /03/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /03/2012 $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.
Apr 02 2012 7:11AM CLIMATE CONTROL INC 5039687224 p.2
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71, City of Tiga R E 1.. ?.... I r :11 I) D R q 2 a an- Pam it /17 End la- - ncl
13125 SW Hall Blvd., Tigard, OR 97
' Phone: 503.639.417! Fax: 503.598.'/ 1R 0 2 202 Date/By: t?dxrPumrt
1( Ai, 1 , Inspection Line: 503.639.4175 F1 R Dan Ready/By: mom: See Page 2 ter
Internet: Www.tiga d- or.gov
CITY OF TIGAFD "°add: - fi n Supplemental lt>fo,�,�
• • 3.. 6 2)4:441-A-1 t44.-,- • . - . --.- -"- -r. -� -
❑ New cOnStlrtution Additiem/alteration/replacement Mechanical peneit fees* are based on the value either work
❑ Demolition performed. I ne
Indicate the value (rounded to the west dollar) of all
_ mechanical matetial6, equipment, labor, overhead. and profit
��, •: -^;;;I; .- �. ` _ s: _ �` ,.... t. " 4' z♦ ,�,..; , t +�ci4e fir- Se+ .` - _ Value: a
..t` +'u�„fil4vth` d i -"� f ~'r � M X .illi k s T r r :c.-.77).;,,
vri _ and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building t . � � �cl1 fx 1 i4 y_� l a_ � S ■
❑ Multi-family 0 Master builder ❑ Other For rpeclal fgJornratton use checklist. -
__ _ _ - Dassiptioo ( Qty. ( Ea. { Total
. '. (r` ` if,r;; �,,t}��y� ' ` iwcgzit l ;, ,- i T- 1 ,:. , : 11 : t °' s � 1 . f „
iJ: SS_ �!5 ,. __a i r r � 3 eQ f � , L.1? � 'a� 1�01�a ItWr- �? ta1�r .` Uattlat�loeUnp
Job rate address: � z .�Lti (JS ' Air conditioning
o s
(eegatea site oleo altowirt(pteexmenil 46.75
City /State/ZIP: 7J � y � r �
,. g ZZ m
? 3 Furee100,000 BTU (duaeheer� 1 46.75 4 .(b • ?
•
Suite/bldg./apt no.: Pro ject name; R/01 �� d Furnace 100,000+ BTU (dow/vea►s) 6
Flea IMP 611 6
Cross street/direction to job site: Duct west 2332
Hydronic hot water system 23.32
Rceideatial boiler (radiator or
hydroids) 23.32
Unit heaters (feael-type, not electric),.
in-wa0, in -duct, suspended etc. 46.15
Subdivision: I Lot coo.: Flue/vent for easy of above 23.32
Tax map/parcel no.: 1
Otter:
_ r Other Ited appliances
4? i s 'Flai r i ac . r � ' 1 I �' .. 0 1) ^ : -' r ti.. Water heater - 23.32
L /"�-�rc.s_ n4e ,4c r �>i ce 33.39
Flea vent for water beater ar gas
fireplace 23.32
Loft liallter (Jos) 23.32
Wood/pellet stove 3339
Wood firephadmsat _ 23.32
�e-"� •
; .er r p 6 �� ¢ ! : `I t .5 Y �{ ti fi J _Z e 5Y7Z Gbtrrmey /lma/t
23.32
r k €.` OIto 23.32
Name: // 3 IW /• 1/.123 V1 k,,,,, / Environmental exhaust and vrndladon
�.
Address: /S-7 sty j g' W- /.1..w r � + Range hood/other kitchen
, , Mittman 33.39
City/State/ZIP: 776 � e� /' 2 3 3 Clothes tbyereachans! 33.39
Phone ( 97/) ¢ 7 fr 392-- Pax: ( ) Single -duct mtbauust (bathrooms,
compartments, n toilet compartments, utility rooms) _ 23.32
, Q, ... : _ t ? � . �:`t- , 1 3 6 T ... ` 7,:3..1.:,,7:7,1-'?":":."
[ .� ._..�.. y . � ": `ti , s;'r ' ' ' , t ; . eq.. Atticlerawlapace fans 23.32
Business name: 61.1 MATE to n Thai I rte.- 23.32
Contact ame
n: 1Ro 4 t-414r f' IS ran Dieing . r
n E F514
/ 514.15 for Ora four; $4.03 for each adeadditional Address. 1 6500 5G0 72,'" AN etc.
heat
City/State/HIP: I^�rrland. r r C !223 Gas
l! pump
Phone: ( � 3 j ) 1 1 5 3 "" yep ZZ Fax:: ( - Walaheater sit beater
E r0 G t Fireplace
3� 7� o..-k-e . c o ^4-ro L Inc , cowl , Range
of aim I F - .8.741 : ,i (1 'i fir` -> 1 ti4 7,E VE:i3H.2 a!l;` Barbaa=a
Business name: 61...t YV1 Co ln*,)L In c . Cloths dryer (gas)
Address: j l0 500 S GV ?� ^ ° /A V t� Other: : ,,' - t
City/State/ZIP: 'part-.10, n [I or c'7 • Z z q subtotal • t. • it
Phone: () qs -- L Z L I Fax: (PS) °I 10 V . -1 Z Z of Minimum permit fa 0) q b .m• d
CCB lie.: 1 7....t GI Plan review (2396 of permit it ] ffee)
State surcharge (12% of permit fee) /0• ti 0
TOTAL PERMIT FEE 00. so
Authorized signature: � . _ Tole permit application expires ilia permit b not obtained Within 140
r v! /a� days afar it ba been accepted as complete.
Print name: Ado ( i4 "S I Date: 5/y, 2._ 1 ' Fee methodology set by TO-County Building Industry Service Board
1 : tBui1emetPermalt `INEC•Pen®App. 10/01109 440.4617T(1 In2/COM•WEB)
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