Permit • 71 • _. q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 00033
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2013
Parcel: 1 S 134DA05600
Jurisdiction: Tigard
Site address: 11343 SW 105TH PL .
Project: Dailey Subdivision: NODAK Lot: 4
Project Description: (1) furnace replacement
Contractor: CLACKAMAS HEATING & COOLING LLC Owner: DAILEY, SONDRA L
15115 SE PENNY LEE CT. 11343 SW 105TH PL
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 658 -4808 PHONE: 503 - 522 -8284
FAX: 888 - 500 -2912
• FEES
Specifics:" Description Date Amount
Furnaces < 100K BTU 01/17/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/17/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/17/2013 $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: P ermittee Signature:
��. IL 1 \.1_ - =�. DkL iIPPuc1 io
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. ,
Jan 17 13 01:58p Clackamas Heating &Cooling 18885002912 p.1
Mechanical Permit A IppiLcItE ,.,
City of Tigard Received. i / " / 3 ‘..----- tern,;[ n E r�D03
13125 SW Hall Blvd., Tigard, OR 97223 `�
Flea Review
Phone: 503.718.2439 Fax: 503.598:19603AN 1 7 2013 Date/By: Ott,Oi'ermit
T I Ci n it I] Inspection lute: 503.639.4175 Dale Ready/By: !A= , El See Page 2 for
Internet www.tigard- or.gav
CITY OF TIGARD No 'T� Supplemental on
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_ . NtA p, ,11�
r5 .
;; 4W ik 1 : L1Y]S1ON ' _ _ ,. ... Mechanical perm tccs are based on value of the wW1
New construction X Addition /alteration replacement i performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
Demolition Other. Value: $
6A�flORY ; OF COI11tFEi1Q1+T :. ::-•':-, L FEES.: : , . ?_ '.
For special information use checklist.
1(1- and 2- family dwelling Commercial/industrial Accessory building
Description ] Qty. I Ea. I Total
Multi - family Master builder Other: Heating/cooling:
SOB SIZE° ?ORMATION, AND LOCA'R(lN Air conditioning
( e�teiressiteptaas lowictRplacernmt) 46,75
lob sire address:
f 1 4 3 5 I . ' ( / / 0 5 - 1 - 1 1 P rj Furnace 100,000 BTU (duetshrms) I 46.75 y6 )-"
City/State/ZIP: 77 d 2 9` 72 2 _3
Furnace 100.000+ BTU (m,tssrveats 54.91
/ / ( Heat pump
1 i
Suite/bldg./apt -no.: ` Project name: ,, (mates skt m
atshowincala„ent) 61.06
Duct work M.32
Cross street/directions to job site: H4dronic bat water systern 2332
Residential boiler (radiator or
hydrordc) 2132
Unit heaters (fuel -type, not electric),
in-wall, in -duct. suspended, etc. 46.75
Fine/vent for my of above 23.32
Subdivision: I Lot no.: Oder. _ 23.32 -
Oilier feel appliances
Tax map/parcel no.: Wades heater 23.32
lIEBCliOlq'Og; lNoiiK' Gas fireplacrfinsert 3339
r �c v in 0. L2. p' Ep �d. G2 / f y - Flue vent for water heater cc gas
ltroplace 23.32
Log lighter (Fat) 23.32
Wood/Pellet stove 33.39
Wood fireplacelinsen 23.32
Chfmneyllinedfluefvett 23.32
PROP IY._ o*NiEli -::' : : �I'EFLiS;L�11 :: '..` : 23.32
... . -..:: taletdnaaW and 6le
. ......:_ _::.. .:_ Eavienttmesr vet ' [ion:
Name: ,Kf Ie ` t fy� Range .hood/other kitchen
T/ tl l
/3 C/ 5C ' /0 / /'l Fl equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/23P: ``;` 2 erg. 872 2 3 Single-duct exh ents,,m�y [coma) 2332
Phone: 0 5Q', S 2. Z SL G y 3 fax 0 '- Atticicrawlspace fans 2332
, AP.PLJ '-`'-,. Other- I 2332
Business name: C /gck_-Pr4 13,5 _ , F -c t r� F piping:
�/ t►— $14.15 tar test four; $4.03 for each additional
Contact name: , r /' Y // . / 4 ." VTS Furnace, etc. I
1/1 j'
Address: i S I 1 r 5 F ' p e N / Gas heat tromp
Wall/snspendedmh heats I
City /statelZfP:
k9.. GJ� P1' /9- / b Water 9 7 t7/ S�' Wa heater
Phone: 0 50 3 is 58.P ' Qg Fax:: 0 882/7°500' 2 9 / 2 Fireplace
E -mail: GI�}Gk-09!'1'r �} `��_J /- e B ath
.., . c 'a Cron :... ::.:: ii .. - _'.' .:- . :`.. Clothes dryer (Fit)
Business name: C /�4/7mfi"s "(ea-l" ' Coq:: /.' Other: G L c °i � < A�cHkNL . Pt � 't`')P'EBSa..,.`. _ .
Address: / S// S S / ,�9/1 i C' Subtotal ' 46.7
ow/state/DP: /, 97°A-- Minim m paw fee ($90:00) 00
G A. / Platt review f25x or permit fee)
� "
Phon 0 573 4- S ! D 8 - Fax: 0 State surcharge (12% of permit fee) ) 0,8-6
CCB lie.: / 6 ,- 6 3 Co TOTAL, PERMIT FEE /0040
This t�apPl expires enalts
Ifspnotobtainedwithin180
days after it has been accepted as maplese_
Authorized signature: / • Fee methodology set by TdCoumyBuildingIndustry Service Bond
// /f9-di jY! i P_ /
Print name:
,. i ekg 7 Hate: / 71 Q/3
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