Permit CITY TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00564
TI GA[l 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/13/2008
PARCEL: 1 S133AD -12600
SITE ADDRESS: 11312 SW SUMMER LAKE DR ZONING: R - 7
SUBDIVISION: SUMMER LAKE LOT: 007 JURISDICTION: TIG
PROJECT: BEASLEY
Project Description: Replacing furnace and installing venting and gas piping for furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
ROBERT & ANN BEASLEY Description Date Amount
11312 SW SUMMERLAKE DR
TIGARD, OR 97223 [MECH] Permit Fee 11/13/20C $72.50
[TAX] 12% State Surch 11/13/20C $8.70
Total $81.20
Phone: 503 -524 -4650
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued = % . - ,! � Permittee Signature: Cini oeCab_L
C I .639.4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the pro ect.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City
Rece ived
of Tigard Permit No.:
g Date By: �i , y�� , . ESL
13125 SW Hall Blvd., Tigard. OR 97223 Plan Review l (
'. Phone: 503.639.4171 Fax: 503.5 • .15, Date By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready'By: 0 See Paget for
Internet: www.tigard- or.gov 1 Ct 6E` 1 Notified•Method: �` Supplemental Information
NO �7
TYPE OF WO ' Y Of I ��+" Al COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition /alterat /r erix ? , - Mechanical pennit fees* are based on the value of the work
` 6 performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment. labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: 8
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
4 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
ID ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site addr (31 Z S_� 5�� m r 1 heat pump
t (requires site plan showing placement) 14.00
City /State /ZIP: - Ti jars( o ,� 9 7 d-^v -3 Fumace 100,000 BTU (ducts /vents) I 14.00 i C
Fumace 100.000+ BTU (ducts /vents) 17.90
Suite /bldg. /apt. no.: Project name: S Gas heat pump 14.00
Cross street /directions to job site: S (* 1 o I 1 S 1 L Q l' -r /Void-in Duct work 10.00
D Kota Hydronic hot water system 14.00
a Kota - Ti - K 6 rst r lki L Oil +0 Residential boiler(radiatoror
5priAT w00C, ` o t- hydronic) 14.00
�r t I I le n I m m P G(t cep �l \GJ{ Unit heaters (fuel -type, not electric),
bI\ -v 5(,1 mme r (a ke Nr, in - wall, in - duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue /vent for any of above 1 6.80 (.4 0
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
O Gas fireplace 10.00
4 I ■ 'hvi RCA --1,( Y 1 ne -� W t Flue vent for water heater or gas
q n % / f . t) (� �(�, r � - - - fireplace 10.00
rt Log iichter (gas) i 0.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: 1/1 r\ n �,(r� � 5 , I L / Environmental exhaust and ventilation
t� • " ' Li 7 Range hood/other kitchen
Address:
13 1 a SLO Sum mek la e, e br ' equipment 10.00
City /State /ZIP: I t • d I of _ 9J a�-� Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (5O3) _ (,it o C® Fax: ( ) toilet compartments, utility rooms) 6.80
A APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
1 Other: 10.00
Business name: See - 1rincHci Iy1S u- ( Fuel piping
Contact name: 1 55.40 for first four; $1.00 for each additional
Address: Fumace, etc. -I _5 J-1
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: SCII m e as al') ()v e... • Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal v - 4Sa
Minimum permit fee ($72.50
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of pennit fee) I. - 7c)
TOTAL PERMIT FEE ~/ t , )p
Authorized signature: ' 4 J' This permit application expires if a permit is not obtai within 180
llllll.�XX��� 111 days after it has been accepted as complete.
Print name ( ( A ' 3 / t * Fee methodology set by Tri- County Building Industry Service Board
I - , Building \Pennits`MEC- PennitApp.doc 01/19,07 440 -4 17T(II -COMWEB)
fr - Z � — &o SI ' V
Information Notice to Property Owners About
Construction Responsibilities Statement
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 701.055 (4)]
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 appropriate box and complete the following statement:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
r7f 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 contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked and
completed above is correct and accurate.
& A44 r \ 13e . L.1_ ! .L.-:...A
Print name of permit applicant Signature of permit applicant I
Date
O'
Permit #:/ 9 O I CZ��Z�'�y
This form is supplied to building // -3/01 ��� � � n
permit offices by the Oregon Fk* Address: ,. /�Y
Construction Contractors Board . :* * 6.4:,:;
as required by ORS 701.055 (6) ••��•' 7 ard c,YZ q7aidy
/3/.3 ,-
Issued by Date:
This copy to issuing permit office
CITY OF TIGARD _
BUILDING DIVISION ,r ATE ISSUED: # ` ' CGZO B '
13125 SW Hall Blvd., Tigard, OR 97223
Phone: (503) 639 -4171 ��4pu�ii��1� ►,
Inspection Requests (24 Hrs.): (503) 639 -4175 ov! ' :_.. bie
r
INSPECTION WORKSHEET FOR DATE: V1 .O U TIME: PAGE:
SITE ADDRESS: II )/Z /z f Or1/7dLC- 4/iCC= 0/ P CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE: '
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: Sg 7 / 4.3
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Coded Inspection Description Confirm # Contact # Message
GC? /`1c -c6 F,A
Corrections /Comme is /Instru ions: (..,e. i d i .. ru )
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' ] P S 1 1 PARTIAL APPROVAL — CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ✓ -- Date: t I r 6 Phone #: (503) 718- �YZy