Permit CITY OF TIGARD MECHANICAL PERMIT
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' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00207
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012
Parcel: 2S104CCO2500
Jurisdiction: Tigard
Site address: 13969 SW HILLSHIRE DR
Project: Nigam Subdivision: HILLSHIRE ESTATES NO.2 Lot: 131
Project Description: Installation of A/C. Unit must meet 5' minimum rear and side yard setbacks.
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Contractor: CLACKAMAS HEATING & COOLING LLC Owner: NIGAM, INDRA B & NEELIMA
15115 SE PENNY LEE CT. 13969 SW HILLSHIRE DR
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 658 -4808 PHONE: 503 - 579 -1159
FAX: 888 - 500 -2912
FEES
Specifics: Description Date Amount
Air Conditioning 04/26/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/26/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/26/2012 $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: ew PG� e42_77-49N
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.
Fm: Vladimir Mikhats (15035981960)
17:26 04/23/12 EST Pg 1 -3
Mechanical Permit A licatio l .,, tt, cart tf r: , ,,: c,. t_,
City of Tigard DE CEIVED yQ rM Permit No,i yECao, — ea- 07
.� - • 13125 SW Hall Blvd., Tigard, OR 97223 p Review
Phone: 503.639.4171 Fax 503.598.1960 APR 2 3 2012 Other Trait,
- r I G A it L0 Inspection Line: 503.639.4175 Date y/By_ ® See Page 2 for
Internet: www.tigard•or.gov CITY OF TIGARD Notifiecliblethod: En strppiemeatal Information
� } j � B LRING I]� ! sipt , , •fy tti- y,
' ;—'21''''''':'.2' : i* . } �- , , v. . '%'L .t.f -,.`'3' P {,, is { .., . ...,�� ,. .,, i ; -.: ! •! ; : t? - 7 ,.,.r ' . "°.w. .„., z_„...., � :. :
N construction (Mechanical permit fees° tiro based on the value of the work
❑ ® Adtiition/aheration/repltrcanert
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
F ak :b� . ., :'F" 4 < o . Value $.
®1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building r��
El Multi-family Description special ir{formation use checldist
y ❑ Master builder ❑ Other: ir .J,�./(.j�( _ DescDescription � Qty. j Ea. (iota)
St. A , . ..-F .t ti~ .:-;-` ` , A 1 ft .. 'Y - .k .;: -::' T':,'. 11"tillgi lint
Air conditioning
Job site address: 13969 SW ii I L 1_ S N 1 RE NZ.. (requires site plan allowing plauanent) 1 46.75 46.75
City /State/ZIP: TIGARD, OR 97223 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/veins) 54.91
Suite/bldg/apt. no.: Project name:
Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydranic) 23.32 _
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
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Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other. 23.32
Tax map/parcel no.: Other fad appliances
L t 1R r, 110 oiE w(F,K,` i; ' ;� y ' , 2332
water heater
A/C ADD-ON
.. ; Ges fireplace 33.39
Hue vent for water heater or gas
fireplace 2332
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
*0g# 6 , , Y ' i : s / k : ° ..`0'A11tT .r .Ju ` o yfliner/HLLelvent 2332
v _ � - . t - -' � f . .. Other, 2332
Name: MOAN', INDRA Environmental exhaust and ventilation
Address: 13969 SW Hfi.l CAARF. DR. Range hood/other kitchen
e9tuipatcef .. 33.39
City/State/ZIP: TIGARD, OR 97223 Clothes dryer exhaust 3339
Phone: ( )5035791159 Fax: Single - duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 2332
�'.. _-. ;`? : 1 �;� < ra 7 :'�'.; Y .} 9 r. ;OstA0 00 ,, Attic/cmwlspace fans 23.32
Othe 23.32 _
Businms name: CLACKAMAS HEATING & COOLING LLC
Fuel piping
Contact name: VLADIMIR MI HATS 114.15 for first four, 54.03 for each additional
Address: 15115 SE PENNY LEE CT Furnace. etc.
Gras hat pump
CityIStatc/ZIP: CLACKAMAS, OR 97015 Wall/suspended/unithealer
Water
Phone: (503) 6584808 I Fax: : (888) 5002912
Fireplace
E - mail: CHCLLCo)COMCAST.NET Range
K , + r ,� at ' t:I r,,ssi its 400 } ; r aT i ,c._
Business name: CLACKAMAS HEATING & COOLING LLC Clothes dryer (gas)
Other:
Address: 15115 SE PENNY LEE CT t �� +� 5-T` N,x ( j *)' :, 4&
City /State/ZIP: CLACKAMAS, OR 97015 Subtotal 46.75
Phone: (503)6584808 Fax: (888) 5002912 Minimum permit fee ($90.00) 90.00
Plan review (25% of permit fee)
V CCB lie.: 1636301 1 State surcharge (12% of permit fce) 10.80
,, �C TOTAL PERMIT FEE 100.80
Authorized signature: r te " 4 /f i bis p ermit application expires if a permit is not obtained within 180
days after tt has been accepted as complete.
Print name; VLADIMIR MIIa3ATS I Date: 04.22.2012 • Fee methodology set by Li Building industry Service Board
I: uidinglPcrmimUlEC- M7mitApp.dee IWA0tA19 4464617r(I1/07/C'OM/WEB)
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