Permit CITY TIGARD MECHANICAL PERMIT
4 DEVELOPMENT SERVICES PERMIT #: MEC2006 - 10016
44.:6k- n DATE ISSUED: 3/8/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 134CA -02700
SITE ADDRESS: 11995 SW SUMMER CREST DR ZONING: R - 4.5
SUBDIVISION: BURLWOOD LOT: 001 JURISDICTION: TIG
Project Description: Gas piping to range.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
SHEILA TAYEFEMOHAJER Description Date Amount
11995 SW SUMMER CREST DR
TIGARD, OR 97223 [MECH] Permit Fee 4/1/2006 $72.50
[TAX] 8% State Surcha 4/1/2006 $5.80
Total $78.30
Phone: 503 - 590 -1843
Contractor:
KOEHLER CONCEPTS LLC
10772 SE HWY 212
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503- 650 -1220
PRI 503- 650 -9550
Reg #: LIC 120277
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 By: /(v),2f_e: Permittee Signature: ' <'
Call 503 - 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 project.
Approved plans are required on the job site at the time of each inspection.
CI OF .TIG D
MECHANICAL PERMIT 1
, , $e B SERVICES DIVISION
° "' I iI ?, 13125 SW Hall Blvd., Tigard, OR 97223
J:,-- . =`
503-639-4171 www.tigard - or.gov PERMIT #: V(\.6C,,,?d,6 E
DATE ISSUED: 2.-a_0 6 __ SITE ADDRESS: j / gei 5 j 5���� a' S PARCEL #:
BLDG/STE #: ZONING:
SUBDIVISION: LOT: JURISDICTION: - 1 (
This is an interim permit issued during computer system maintenance.
Construction work and inspections may proceed under this permit number.
The actual permit will be issued and mailed to the applicant within one week of the date issued above.
i_..__ _.__PROJECT DESCRIPTION; jc:LS .. � l -- t1 ._--- '�0'< 4N �e ... .------ - - - - -. _
CLASS OF WORK: jam__ FLOOR FURNACE: EVAP COOLERS:
TYPE OF USE: UNIT HEATERS: VENT FANS: _^ _
OCCUPANCY GRP: VENTS W /O APPL: VENT SYSTEMS:
STORIES: I BOILERS /COMPRESSORS V i HOODS:
0 - 3 HP: DOMES. INCIN:
{ FUEL TYPES I 3 -15 HP: _ COMML. INCIN:
MAX INPUT BTU: 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: , /50+ HP: CLOTHES DRYERS:
FURN < 100k BTU: AIR HANDLING UNITS . I OTHER UNITS:
FURN >= 100k BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
�. OWNER :: FEES -
Name: y pU Q ��v`�' ,z\ Permit Fee $
Address: I1 Plan Review Fee $
City /State /Zip: , - - -- State Surcharge (8 %) $
Phone: 5 3' d J tai 3 _ - -_ Other Fee: $ -
Other Fee: $
Total Fees: $ 3 0
_ __._... CONTRACTOR - 'i
Name: - _. \Y
Address:
City /State /Zip: \_ C- ..91 C _ -. -_
Phone: Q 3 " r i 5 _ 0 ' ` 3 �_ 511
Fax: _a0 -C Q 2 — b
CCB Lic #: I2 v., . This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies
of these rules or direct questions to OUNC by calling 503 - 246-1987 or 1- 800 - 332 -2344.
Issued yi'�;, Permittee Signature: _`u2e, �p p
1 \
Call 503 - 639 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503 - 718 -2433 for assistance.
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.
1:\ Building\ Forms\ ManualPermitForms \ManualMECpermit.doc 03/07/06
Mechanical Permit Application - . ,, :-. , ...... , :...- , , , i. , . ,., .?: . 'it...L2 . .- -, -T.f,.cof
,A-; 0 1 z _0 I I( 1.: I , s1,...( ).1,-,1:4-42, ;:
City of Tigard ECEL'VED A Rer..,,...., ,
.....y, i : , , -, . Permit No \" _ /0. -.
01
• I 3125 SW Hall Blvd., Tigard, OR 94a ___
Phut Review
Phone: 503.639.41 7 I Fax; 503.598,1960 .» Permit:
,r::: Date/By:
Inspection Line; 503,639,4175 n +4, infifi i'lt4VI'l 1 -,
Internet: www.ci,tigard.or,U5 Mikl, ( CU..... .=--...:. -...:.. D ", mo ar ifi Ready ccum /By: : lin VI See Page 2 for
Supplomontei Infonnadon
v,fi i ■r . 8 ' 99,16 6 „ i ,q ,
,i •.,1 1:, • 4 a e■ ., ( oj,:i1,0,1:11 gilit'o .. (•■ ,...1; , , ' ' j " '''SU —' :"V% , — — , ,„. ,
' '' .::( 1 ':. !'.. !: i ` ' ' ' ':1111.1'' f :?; 1 f 41i . .....iiLS ) 13I,% ' i. '1 ;%' al .; ! , rikilViiin■IIS l ' !■k., (I A il Q . " ' .**1 1 1INV P :0,00 1 00kgr4.040014**$ ' r :
,..., ; • • ' .. '''
171 New construction - 'bon/alteration/replacement
Mechanical permit fees* are based on the value of the work
US I ,
performed, indicate the value (rounded to the nearest dollar) o f all
0 Demolition El Other: mechanical materials, equIpmellt labor. overhead, and profit.
% . . ,!, :: ...i. 4 :: Nei Value'. S
. i ya,!;irILMZTMMSZEIM :„ ,:.,
eikl - and 2-family dwelling 1:1 Commercial/industrial 0 Accessory building ' ..
For special information tar checklisi.
r71 Multi-family El Master builder 0 other! Description 1 Qty. 1 Ea. i Total
i::,04.#: 'j. lleating/cooling
Job site address: \\C -.‘,...,„... ', exz Air conditioning or hear pump ei -(- (requires site plan ahowingplacement) 14.00
City/State/Z1P: ■--\.. ck-17.2..: Furnace 100,000 BTU (ducialvenis) 14,00
Furnace 100,000+ BTU (ducia/ven94 17,90
Suite/bIdgJapt. no.: 1 Project name: .
Gas heat pump 14.00
. ,
Cross street/directions to job site: Duct work
Hydronic hot water system 14 -
, 14,00
Residential boiler (radiator or
hydronic) _ 14.00
Unit heaters (firel not electric),
in-wall, in-duct, suspended, etc. 10.00
_
_
_
Flue/vent for any of above 10.00
Subdivision: Lot no.:
- Other 10,00
Tax map/parcel no.: Other fuelappliances
4 Water beater t 0,00
Gas fireplace water heater 10.00
V1/4-J■Nrstr■, w■.4. NIZirik$CLAL ,07.:• ; CA 0.-AM. ")-Aite- Flue vent for or gas
fireplace 10.00
r. ..'"'' ' (.41214vN4 t' \ - Log (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent I0:00
' ' ' ::! ;,' ' :: arillitiii16' :,:,1 other:
I 0.00
Name: '' — SNP*-4*. - -Sc.-•c••■0 \ t've....40-re Environmental exhaust and ventilation
Range hood/other kitchen
Address: \\C"c\ .....".... .-••••.yo.r..ia_sc- C_X4. -‹ equipment 10,00
City/State/ZIP: -...\Aggh,k--6, o_- c \--k-L-47- Clothes dryer exhaust Fax: 10.00
Phone: _ \
(2,.) c.i 5,.. ax: ( )
:i (b 4 6.80
:' ,.:":■';' 1 1': :11 , 4 :. ; i ..,.. , „q , ,?,),Tilly , AtticfcrewisPacc fans
10.00
Other.
Business name: Njoes„. ety--es \ 10.0 \.L. Fuel piping
Contact name: .. S5.40 for first four; $1.00 for each additional
e .
Address: \ED c...$e ,..,‘. , ‘,..Z.\""L. Furnac etc.
Gas heat pump
City/State/ZIP: C.....,\\....ve,,,,,,..... 04 4- ZC\ c'5 Wall/suspended/unkheater
Phone: z%) . _C I Fax: : (GSS ) L ... \-z2E) Water heater
Fireplace
E-mail: -- c , 6, c,, c cyNee „a b , L
Range
-' ' 1 :1' , :ii■ilii ,1 7 .:' 15,1;. I'M Ilr,iFr:‘' Barbecue _
Clothes dryer (gas)
Business name: \_(:)eV\42.4.4-• Q.Cy-\-\-C.,„ .
Other
Address: \\z-v11_,,
City/State/ZIP: 0 C)<1 Ocic..... Subtotal
Minimum permit fee ($72 rc
.50) --,so
Phone: G S & ) l . n . S ( Z ) - C \ S S S . Fax: S175) (42 6 - \7_-u, .
Plan review (25% of permit fee)
CCB lic.: V...0--crt State surcharge (0% of ponnit fcc) .450
_ ...
_
TOTAL PERMIT FEE
*
Authorized si gnature: Thle permit Application ozpiree If o permit le not obtained within 180
.---
days after it has been accepted es complete.
Print narne: \,..„... k:1/4\ Date:...1_0( • Fee methodology so by Tri-County Building industry Service Donnl
040.4612T ( 1 I /
1 \ EluildinglPermi0AMEC.PerrnitApp doc 12/03
300/001 Sid33NO3 831H30 N 0ZZL099609 XVJ 61.:VO 900Z/L0/00
zw6-/od,46
4 ,, CITY OF TIGARD RECEIPT
DEVELOPMENT SERVICES RECEIPT DATE: 3 mo -;
tan 13125 SW Hall Blvd., Tigard, OR 97223 JURISDICTION.: 5-
- -� 503- 639 -4171 www.tigard - or.gov CASHIER DATE:
CASHIER RECEIPT #:
LINE ITEMS:
Case No. Fee Description Revenue Acct. No. Amount Due
Total Due: $
LI SEE ATTACHED FEE SCHEDULE.
PAYMENTS:
Payer: - ) 0 � ti •\ 2k- C c� ��
Method Initials Cbeck No. Confirm No. . Amount Paid
I: \ Building\ FormsWlanualPermitForms \ManualReceipt.doc 03/01/063/7/2006
CITY OF TIGARD " ' oyl.-c-
BUILDING DIVISION PERMIT #:aO(1 i — loo / (o
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 'alJ
.
Inspection Requests (24 Hrs.): (503) 639 -4175 ..' ' I J.. / .01006 - /Oa/ (P
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: // 995 e (Q" v CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 - l - 0 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments / Instructions:
/C C-X-d--4- 9 /0-A._ -c .ef2_1 0 ' -D
2 A S P , , . , 5 r te . T - r - td--57" = 2.1-- .. p s , c . " - - 11d & 4,- ,
4.. -c-� ex Pow S 5 - 7 - Z. , _ , -•r S c Li7)' --,----4e
C � cl i Cr , ,e-,,,, , / -- vas c 7c (./ wJ7457 L a t.c-a ie7lc'sr 0
(111. ( it itCH
`6�
��t
l l�
P
' PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL , CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: -- 9- Phone #: (503) 718- 2-# `t