Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 -00351
Date Issued: 06/26/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S102DB03000
Jurisdiction: Tigard
Site address: 13404 SW CHELSEA LP
Project: Luebke Subdivision: CHELSEA HILL Lot: 7
Project Description: Install a /c. Placement of a/c must comply with manufacturer's clearance requirements.
Contractor: EFFICIENCY HEATING & COOLING LLC Owner: LUEBKE, JONATHAN R & AMBER M
10117 SE SUNNYSIDE RD STE F #19 13404 SW CHELSEA LOOP
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 698 -5588 PHONE
FAX. 503 - 698 -9378
FEES
Specifics: Description Date Amount
Air Conditioning 06/26/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/26/2013 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 06/26/2013 $43 25
Occupancy Grp:
Stories:
Fuel
Fuel Types.
Gas Pressure
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct • - ions to . NC • ailing 503.232 1987 or 1.800.332.2344.
Issue. By: , / , Permittee Signa re: / �
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application - .
. FOR OFFICE l,r:, ONLY RECE
IN . City of Tigard I V I � R 3 14 � Permit No.- iyi�ia.,003s/
IN . . 13125 S W Hall Blvd , Tigard, OR 9722
m - Phone, 503 71$.2439 Fax: 503.598.1960 let' Review
T 1 G .1 it r
Inspection Line. 503 639.417 DazeBy: Other Permit,
e
Internet: wwtv.trga 3 or.gov JUN 2 6 2013 Date Ready/By: rWis: 63 See Page x for
Notified/Method Supplemental Information
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LL4 ,�t7,LRiWi� l 11 h� dd �' 1 �Y { 1 41 . �R l • E JY x}411 L.l�, L nn "-; L; 1r . Ili r ill IIN I!`- - t ,
, �- i.1:a 1 '`.fF.I%i1,3F1�in +.l�. ?, +, "L ')�r C. ,1i.411,1411'-116'7111(IL'll .,. ..al ,t. ri� _ ���, Sl :.:l'J.:: ^;Sc���'u':r,�u��:(�fG t ii':1`Itt�;,,ttl 1�a A �_i
❑ New construction Mechanical permit fees" are based on the value of the work
® Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
Demolition ❑ Other: mechanical materials Ili ment, labor. overhead and rofit.
l�lk i#s fi ilutsAmI(t a n `,' ' t�if �1� il{lUllt Value: $
1 11. -9-1 1 _ ii�6 14`4-`''''' 1L ,�r?i�Rsjjsl ltrla ,,. li ; : .. , ,, n stn -� -
II ''.- I I �;✓n g J f ., `..•. F 4 t r ti up1 .JP, j li'i'
tLbti,,l t.ac,te,. n.ln �t �n. lr„�>Jrt:rl���:�,lrl�tlt�>.•,,t t� ��:; It, .. ,Hl� , _,
® 1- and 2- faintly dwelling ❑ Commercial /industrial ❑ Accessory building For specialfnfortnalion use checklist.
❑ Multi family ❑ Master builder ❑ Other Description
�� l' 1.�,�, ,'. q� � � � �, ' Qty. Ea. Total
M l rkiil °,'� i 7, i n1 o a �`t 1 ° W ffai it l lif ��# ct `i Heating /cooling • 3
Job site address: 13404 SW Chelsea Loop Air conditioning 1 46.75
Furnace 100,000 ETU (ducts/vents) 46.75
City / State/ZIP: Tigard OR 97223 Furnace 100,000+ BTU (ducts/vents) 54 91
Suite/b1dg. /apt. no : project name: Luebke Heat p _ 6106
Duct work 23.32
Cross street/directions to job Site: Hydronlc hot water system _ 2.3 32
Residential boiler (radiator or
_hydronic) 23 32
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
Other fuel appliances:
Tax map /parcel no
�t� N Water heater 23 32
M I ISIt tL llii I 9 '1.1 Hill Ilsmt a, er, a. 33.39
. ve - ,n { .:in ` ifii G t ,) vl . N t i ! , � �� ' t Gas fireplace/insert
t � rrr�ll�x1lasi�,<1�luw , , , i8lfif{� 1;tii4 �I Flue vent for water heater or gas
install air conditioning
_fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33 39
Wood fireplace/insert 23.32
Chimney /liner /flue /vent 23 32
RIP Idll1. ,,, I s , n il� r Ie 1 ,rose, k hl? ) ti „ry � , °�t;. � �
�_l�in _ I m • 'G . ,, 4rl<. -- . ui1T i ..e„Mi i i{lltlitaii )kl , ,:att 23.32
° "'' "" 1°'1" r` Other "" Environmental exhaust and ventilation:
Range hood/other kitchen ,
Address: equipment 33.39
Clothes dryer exhaust 33.39
City / State/ZIP: Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23 32
Phone: ( ) Fax /crawlspace fans 23.32
k ��tY+ `���1`,�ttin r 'Hg) Attic
¢ ,H11 " ny J:. x er. 23.32
11P 1 3,.;- ! iu• rr ,.. �.n t L111 9 tis.%niemh In "-�iSi1111H�1� Oth -
,Business name: Fuel piping:
$14.15 for first four; $4.03 for each additional
Contact name:
Furnace, CIC.
Address: Gas heat . um.
City/State/ZIP: Wail /suspended/unit heater
Water heater
Phone: ( ) Fax: : ( ) Fireplace
E-mail: Range
i� 41�=, . t. r .. �� '..,w,n P,{'. ,:J, R .. J +.. , Barbecue
t'iJ:l i:i�t1 `E iii �t : � �llt -E n{ �1 'r''laa, -'' • v IN R 11 ° 57.41:' !•1:�..-�;r Clothes dryer (Ras)
Business name: Efficiency Heating & Cooling W Other.
Address: 10117 SE Suanyside Rd Suite F19 �I.i �"' • n�..,� �'� .• °'� 1 'n� i lfnw�Sb irgi `" .° r';
)ugh Ithir 1 e „
Subtotal _
City/State/ZIP: Clackamas OR 97015 Minimum permit fee ($90 00) �Q °�
Phone (503) 698.5588 Fax: (503) 698.9378 Plan review (25% of permit fee) -
State surcharge (l2 %ofpermit fee) /D• gU
G
CC13 lie.: 07 S3 TOTAL PERMIT FEE QQ • feO
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signet • Fee methodology set by Tin-County Budding Industry Service Board
Print name: Matt Rob man Date: 6.25.2013
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