Permit IACITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: MEC2022-00102
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/22/2022
Parcel: 2S 111 CD00600
Jurisdiction: Tigard
Site address: 15905 SW 98TH AVE
Project: Dickenson Subdivision: ALDERBROOK FARM
Lot: 21
Project Description: Install ductless mini-split
Contractor: OWNER Owner: DICKENSON,JON
KARRAKER, SARA NICOLE
15905 SW 98TH AVE
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Heat Pump 02/09/2022 $61.06
Type of Use: SF 12%State Surcharge-Mechanical 02/09/2022 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 02/09/2022 $28.94
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
Issued By: Edgard-0-Maido-o-aztcr Permittee Signature: y e,
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 Auplica bn1/4i iv � I t,u 4,11 1( 1 1 .1 u\i 1
City of Tigard FEB 31012 Ratarnid
D 2 q\- z- CAE GZtsZZ-oo\
III • 13125 S11 Halt Blvd.Twat OR 91223
� Plan liniem - ,F,,.......
Phone 503 118 21:39 Fat Std3.39r( V OF 11 t'i i L flat Hs
Inspection lute 503 639417S 1
1 1t,A RD Dare Ite44.HI VI 2 CIlr�iZZ O Srr Pat,2 hie
Itttetflet mtt«tigard.tr 3UILDING DIVISION ti`ninrd hldlxd -�1fkl 1-1 - .0 iptrmramtlafnrraauoa
T1TE Of WORA COMMERCIAL TEE* SCIILDCP E- USE CIIECIal.IST
Sit-thanrul pemtrt fees•or based on the%aloe ut the marl
! El\cv,..ii i"(l.i:iirl Z't,4ditioit'altcrinnnn1replxr ncill per1 wrncd Indrexe the taint(rounded to the nearest dollar)of ail
0 I)1.n,o'iru,in ❑viher mechanaal materials equipment IaMt,oscrhead and profit.
-•-- _ Value S �.
CATEGORY Of CONSTRUCTIONRESIDENTIAL IQUIPMENf l SI STEMS EELS*
—
XI I-arid2-1umb( du tiling 0(nnlmcrttaLmdu'irtai 0 Atceswn building tortpe,ldinf rmulonuseaweMt
❑Multt-fam*, 0\lister buildcr 0 Other f3euriptrun — I Of) i Fa Total
I JOB MT INFORMATION AND LOCATION Ileatla coohag:
Air condilanmg an TS
Jab ails address' l51O5 SSA/ 911 1N 4 JE Furnace 100,000 BTU taints snits( 46 75
(etty,NUtttZ11'. YJ(,+4,W 0k 97 Z 2 I (duals venial Sa al
State ttid V'..1 e.1(EA�.Uv heat pump I 61(ih fi 1.06
r.t no Pr name. Du.I marl 23 32
Cross arecL'direetiant comb site 5 W 93 TN (i S\4 O'KNAM iq..D ll drums hot main SS lcm , 23 32
Residential boiler(radiator or.
hsdruntel 23 32
I'nil bcatcn t fuci•t pc not victim I.
tn-iall,in-duct,suapcndcd etc 46 75
F Itic'sent for ans of ahS»c 23 32
Subdivision L r C g r Q lk FA giti tut noZ I Other 23 32
Other fuel appliance':
tat map'partel no `S 11. i. C t]jot 0 6.' K ater heater 23 32
DESMITTON OF DORI. (ias fireplace insert 33 39
f kit sent for ualrr heater to gas
r 1 N 1,
y Li." i^).d F�(bS th i" 1fi 1# }?(.i f',rrtp fireplace 23 32
I gig lighter!nisi 23 32
---- -- V.and pcikt stow 33 39
Vio od fireplace utscn 23 32
(htmnc).finer flue scm 23 32
1
PR1)PER1A OWNER , a TENANT t nhcr i 21 32
F im
mune!aul indium
and*e uitaun: t
haste 3 citki D1 CKCN SQNi Range hood other lrichen
/� equipment 3339
Address 159 OS ,S W `mil-( AZ- Clothes&N r ethaust 33 39
City/State/ZIP. -ri GArP UR °I7 Z-z - Smgtcompannerin.-duct rshatot Mthnxttnr
- looter ctitnpaMicmi,utility morns) 2)32
Phone( 4'.1) 2'2 - el06r-, Fat t 1 Attic craulspaue fans 23 32 ,
0 APPLICANT ❑CONTACT PERSON (whet _ 21 12
Fuel piping:
Hustnes,name 514.15 for Pint four:34113 for drb addntottal
(Contai:t name Ittrna.e etc
_ -(, heat pump as
Address-
_ tl all impended unit heater
Cltt State ZIP. \rot(hcatci -,-
MOM' ( 1 I I it I I i ircplac'c
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CONTRACTOR ,_c iodic.drer i$asi
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Buslncsnaln_ J�/�- f/4��'7� — — — .------ MECHANIC AL!Twin EVES'
Address Subtotal t,i .2 t,
minimum permit let IS40 WI
Ct) su[eZiP ___- Plan res ie%(2' .of pemnt ice i 2.L SSi_
Phone-4 1 l'att 4 ) State suri.hargc I I2•s of permit leer t t.;') 10
.101-1I,PER%IIT FE.F_ I2.!,
CCU lie.:
the peratit application',spire.if a per.te at est titmouse wale.aM _
date aher tat ha.bewn a.ttptid in t.upkl.
Autho iKd signature Q71.7---\___ • Fta mnMxkL,ps ii hi II,i'«aiq ti.u41u44 Imtrtn Xcgatt K.!
Pnni asmc ".ore 0 4_1(en5t),,'N Date Z,/L/22E>Z2
i unissaupsiesiiusett Pausilso aim'i4,k Mn.Mi TT i 11,14r0041119i
L N
ECEIVE
FEB 3 2022
Property Owner Statement ,,,)Y Oh- ))uHHI.)
Regarding Construction Responsibilities 'IJILDING DIUISID\
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued (ORS 701.325 (2))
This statement is required for residential building,electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropnate box
I own reside in or will reside in the completed structure and my general contractor is
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board
or
I will be performing work on property I own a residence that I reside in or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
S rr i c_Keinsc
Print Name of Permit Applicant
Sfg ure of Permit Applicant Date
Permit# 'MCC20Z2- txx031-
Address
Issued by � �Date 2`#1'
�
I t-1£
This Copy for Permit Offices