Permit CITY OF TIGARD MECHANICAL PERMIT
ffi COMMUNITY DEVELOPMENT Permit #: MEC2012 -00243
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/15/2012
Parcel: 2S 111 CA04800
Jurisdiction: Tigard
Site address: 9580 SW LAKESIDE DR
Project: Arditi Subdivision: SUMMERFIELD NO.12 Lot: 668
Project Description: Replace NC Must meet 5' side and rear yard setback requirements
Contractor: CLIMATE CONTROL INC Owner: ARDITI, RALPH V & NANCY KAY
16500 SW 72ND AVE 9580 SW LAKESIDE DR
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503 - 453 -4822 PHONE: 503 - 598 -1905
FAX: 503 - 968 -7224 •
FEES
Specifics: Description. Date Amount
Air Conditioning 05/15/2012 $46.75
Type of Use: SFA 12% State Surcharge - Mechanical 05/15/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/15/2012 $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.
H
..800.332.2344. /� J�
Issued By:
AktA144 J/ J .C. Permittee Signature: N. 'PPLI C V'.!
all 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.
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May 15 2012 6:55AM CLIMATE CONTROL INC 5039687224 p.2
City S of W Tiga L�! Phis Review
Y Permit r� : X101 -DD,.
13125 SW Ha11 Blvd., Tigard, OR DaWB
Phone: 303.639.4171 Fax: 503. 8.
Date/By: Otiose Permit
1 1 ( , , , , i : 1, Inspection line: 503.639A175 75 MAY 15 2012 Date Ready/By: i
Ready/By: , : la See Page 2 for -
Intern Www.ti _ dM
Notifieethod: t t 1 � I Sappkmam lefw l m aim
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ett� i�J.V +.,., -. �. . _E7 ..: ° „ = �..- 0. -,_ � ; �
❑ New construction ;Addition/akerationhep M echanical permit fens' arc based on the value of t wale
CI Demolition Indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials, ui
-.,., ... ,. 7 r: - s'- '�?;'�'} �C- + e9 D®mt, labor. werhwd, and profit.
it1'ri titi�l�t'nt -r' j >;r , : . .c F.•a, r " . +� � � y. ° tip'. ' .� GY .u£ =., 7 e' itit.�ryI -��-, � '�' _�'�'}�, + 6 f4� � Value S
l/industrial ❑ Accessory building 7,,,,..,----r-
" = - '- - - - - -' .� - � _ c ' : - + s r_ " ?
el- and 2- family dwelling ❑ Conunercia
❑ Multi- family ❑ Master builder For spec information use enema:.
.
i ! ti - r _ ❑Other Description I Qty. I Ea. I Total
ei � ,p ", ` 1 .� `i o i�. , r : It ".��V- T -.1 + .G .nS thtgen
A��:I:�1.S_.�c'a .:- 7�G���S_ -L .�.:t .r��'` c+� o� ... _.SS.��if�- ra..�T�.` Reafenl '
Job site address: C i58o ..5(,,,„...) t A .V55 t ID r Air °° u s
(requires she p showing plae®eat) ( 46.75 Y!I' 7�,
City/Stale/UP: 1 (. ( 9 Zz� Furnace 100,000 BTU (ducta/vena) 46.75
t /bldg) /\ n Furnace 100,000+ BT11(dacurve,m) 54.91
Suit
apt. no.: Project n ame: t ' n �- (� l k ( pump 61.06
Cross street/directions to job site: Duet 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 Lot no.: Flue/vtr►16or any of above 23.32
Ot
Tax map/parcel no.: her 23.32
' _ _ Other hdappliances
•, i ' r . li 4 �i � \i%_' „: -i t - 7` ..
�: :y ..E ... �TL -1 .?4 r�. �e1,.- ° +'. _... _ ._�11_ 9 r? 1. Water beater 23.32
1ZE /4 c..._ 33.39
Flue vent fur water beater or gas
, fireplace 23.32
LDS liencr (Bs) 23.32
Wood/Della stove 33.39
Wood fneplaediasat 23.32
``�'�s_. ;1 � x�_ �r�! .� . �: y',. [ . S l � - ';'.:::=4::'::"-: plimaey/Iv1eHHllne/veat 23.32
- � Other; 23.32
Name: 'A.1 /1 h - N 1Ki ; Environmental exhaust and ventilation
Address: q '� ga 544.) LA+te I OS - I) r wm 33.39 hood/other t
^� equipment
CSty/State2IP: •'1-7 C - t Of 9-12-2-1-1 Galles dryer exhaust 33.39 -
Phone ( ) (l � - f �t7� Fax ( )
Single-duet exhaust (bathrooms,
toilet
R ,, r oostlpartinetns. utility rooms) 23.32
r' 4 /ji ✓ y am . �- f �J V 1 - - -- fir- r' -•-1.• � fi "-L'43-,p--7::: - I
r.
� .,,rt _ _ y4 . f . , 7 . i . ., AnieJaaWispaezta0.c 23.32
Business name: 6.1i MA - A o �� inc. � 2332 -
G Fael piping
Contact fame: R 1 + A .. .
4 . t s a �r 1S $14.15 for first four, S4.03 for each additional
Address: 1(0500 .S W --Tx"' Ayr Gas h en era.
Ciry/Stete/Z1P: c� beat pump
t� f Hand. r 97223 WallfrasspendedAmit heater
Phone. (R3) i15 gezZ. I Fax:: (9)3)C :a - 72Zy Watrheater
E -mail ro € e f t 'v- o..-�E c o. •. -�f-p Fireplace
aage
r Inc . coin
,v.rir_ ....r_ 1� l 7 iv,-. C9 W.J i , t " _ ( y j r .+ l rn r� ', - r _.S" 1 -� t iW Y '- Barbecue •
Business name: 6L1 ,V1 A- rE- Co n 4,„).... , ) e • Clothes dryer (gas)
Other
Address: RC 500 , - 77_^° ,a v C" , r a =w � .. , _. - -
x i �-d 1 ,- Vii g,
City /StateZlP: or7 -lan or c - .Zz V x ' ° , n �z-t l ( , .; r : .
Phone: () q S 3- L/ i 2 .. I Fax: ( 9 b le - 7 Z Z'f Minimum permit to ($90.00) q(, , eel
fifIC tic.: 7.4 q 1��� Plan review (25% of permit fee)
CB State surcharge (12% of permit fee) i O . so
` _ TOTAL PERMIT FEE , !cep • 350
Authorized signature: (J sy T66 penal. applkadoa expires If a permit is Not oEnlmd within 180
days after et has been accepted as complete.
Print name: A ? �[, Date: Fee
7 / �c - / S I D ���S �� Zi I methodology set by Tri•eounty Building Industry Service Board
I Bwham .PUinrMEt' RmwApp.doe I0/01'09 440 -4617T(11 /01MOM
fD44d33o/
C ° Building Division
Development Code Provision Review
T I G n R D Residential Projects
Building Permit No: PCP__ D /?.. 600
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ❑
Routed Plans: 5115-112--d
Original Plan Submittal Date:
1st Revision Submittal Date: ❑ Site Plan Only
2 Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (1) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
I
Staff: please check items along left on if approved.
Planning Review (contact -.Ai :' at 503 -718- or @tigard- or.gov)
Land Use Case No. I Name
❑ Zoning
❑ Setbacks:
Front Rear Side Street Side Garage
❑ Maximum Building Height Actual Building Height
❑ Visual Clearance
❑ Easements
❑ Sensitive Lands Type:
Notes:
Original Plan: Approved 7 Not Approved ❑ Date: V / IF / •
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope:
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
❑ Street Trees
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❑ Protected Trees
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard- or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes : -
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building:
Page 2 of 2
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May 15 2012 6:55AM CLIMATE CONTROL INC 5039687224 p.3
CUhATE CONTROL 16500 SW 72nd Avenue Portland, OR 97224
HEATING & A B I� CONDITIONING Phone: 503 -453 -4822 Toll Free: 866- 453 -4822
Fax: 503-968-7224
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SYSTEM DESIGN - INSTALLATION SERVICE MAINTENANCE
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