Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00268
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 1 S 135ACO5000
Jurisdiction: Tigard
Site address: 10940 SW 95TH AVE
Project: Donahue Subdivision: 1993 -040 PARTITION PLAT Lot: 1
Project Description: Furnace replacement
Contractor: CLACKAMAS HEATING & COOLING LLC Owner: DONAHUE, LINDSAY
15115 SE PENNY LEE CT. 10940 SW 95TH AVE
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 658 -4808 PHONE: 503 - 292 -5630
FAX: 888 - 500 -2912
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/23/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/23/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/23/2012 $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. e/' / �
Issued By: AAA/ /� Permittee Signature: r'f PPLid 4 / !D04
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) 02:48 05/23/12 EST Pg 1-2 51'
. .
Mechanical Permit ApnliRKFIVED roc: (,I I: R r ( SI: 0 \ 1.1
Received
City uf Tigard Daleia'f 5 3112- Sr Pannit I getwr131?•* 0 °( 0)7
! • 2 3 2012
13125 SW Hall Blvd., Tigard, 00 972 NAy Plan Review
0 • Phone: 503.639.4171 Fax: 503.598. Date/By: Other Permit
I - I c, , n E .,
Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
Internet www.tigard CITY OF TIGARD liotified/Merhod: TI ( # 9 1 Supplemental information
BIJILDV.G DIVIS!ON
t fi k z* ,, *,.. .
Mechanical permit fees* are based on the value of the work
0 New conotruction g Additiotiteration/ .... eminent performed. knlicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other mechanical =knots, equipment, tabor, overhead, and profit
q airtigtoot tooi*, „ ,
Value:
.........„.„,,„ ...„..., .,,,,..•,,, .,„..„.„, „,.:.._,.„3-„—„,!,:_,„..... ,, ro—.17-:,...44kk..-.kiwkviikti,:ciii-,rr-74-.--,v..„45.47,shIgi,—.. ..,,,:..4.2,...
- 5 . -i■V; ',.... --*.., :”,.... NI,T.,-..,,..',::47:rlfrtg •;,o-K.Iii.,!-..
0 1- and 2-family dwelling 0 Conunercialfmdustrial 0 Accessory building Far special lilfonnation use checklist.
0 Multi-family 0 Master builder 0 Other: Description I . Qty. I Ea. I Total
401144(.0070101071,440****:.o.f*?,:veigit-gz.:Af.Y-,;',. Heatiogimihig
Air conditioning
Job site address: 10940 SW 95TH AVE (regains site plan showing etacemen0 46.75
City/State/ZIP: TIGARD, ORR 97223 Furnace 100 BTU (ducts/vents) 1 46.75 46.75
RIM= 100,000+ BTU (duets/vent° 54.91
SuitribldgJapt. no.: I 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
hydronic) 2332
Unit heaters (fuel-type, not electric).
in-wall, in-duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other. 23.32
Tax map/panzl no.: Other fuel appliances ,..
44?0,i4i.l'i'1:35-'4t'"'71, k-rj,i,,.:,.15Veitrit*tiltar-Vr:Arri:2,W.;:=`'0' Wate heater 23.32
33.39 7---,_
Q. ,,,,,,,...,,,,„,„:„,,,,,:„.,,..„,,,,,,,..,,,,„,,,,,,,,,,,,,,,,,,„,..,„...,,_,, -,I, ,.r.. A' 7 --.--", ,,,- +10,g i.".. =,,,, Gas scot
FURNACE REPLACEMENT Flue vent for water heater or gas
fi • ,Iace 23.32
Log lighter (gas) 23.32
Wood/pelkt stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
fit i:s:1:.,1R-t - ',......---„.,,_ .,. ... ,:: ,,,.., :‘ — • ;,.:4 in .;,,,, , ,,,,,.,,,, , it! .,,,,..„,:it,.. 0 ,„,,,. I 23.32
Name: LINDSAY DONAHUE Environmental exhaust and ventilation
Range hoed/other kitchen
Address: 10940 SW 95TH AVE equipment 3339
City/State/ZIP: TIGARD, ORR 97223 Clothes dryer exhaust 3339
Single-duct exhaust (bathrooms,
Phone: ( )503292.5630 Fax: ( ) toilet compartments. utility moms) _ 23_32
'P-",:;W•Vt.=::: ... fe :- 4E AllickrawlsP film 2332
, .., _, ,.,.:, cr ,....4.t.4. , :F., , ,, , — , .. , ;.•;..... , ..;,r,4 - _f:„....,, . ..-.. .... . ... :,.....,,,,, . w.:-..,
Other. 23.32
Business name: CLACKAMAS HEATING & COOLING LLC Fad piping
Contact name: VLADIMIR MIKHATS $14.15 for flat four; S4.03 for each additional
, . ,.. etc.
Address: 15115 SE PENNY LEE CT
, ,,,
City/StateJZIP: CLACICAMAS, OR 97015 W: ..;,... ..; heater
Phone: (503) 6584808 [Pax:: (888) 5002912 Water heater ,
F• 'lace
E-mail: CHCLLC@COMCAST.NET Range
.-,-,-,"--,":-.:-.,.. 7,
-al.,--?.<-era:1,-,dkre.. *1•4i;"'„,;": Barbecue
i:v. r:,;.,i,.;,,‘t.;',.,•gZ,V..--F.,,,,.•!:•';e::::'..:v1:-5.6-,..;;.-..,-,...-.,.,....,,,., f r -, Y.:. '-' 'T.e.' .... '' . . .
..., -
Business name: CLACKAMAS HEATING & COOLING LLC Clothes. - !
Other.
Address: 15115 SE PENNY LEE CT
City/State/ZIP: CLACKAMAS, OR 97015 Subtotal 46.75
Minimum permit tee ($90.00) 90.00
Phone: (503) 6584808 Fax: (888)5902912 —
Plan review (25% of permit fee)
CCB lic.: 165630 Stale .autharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80 -
This permit application expires ifs permit is not obtained within 180 .
AuthDrined signature: dila after it has been accepted m complete.
[Print name: v wflMffi MIKHATS I Date: 05.23.12 I • Yea methodology set by Tri-Caucly Building industry Service Maid
ODuildinpBerreitsWEC-ParmizApp.duc MVO I/09 440.4417T (11/)1/COlvl/WES)