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Permit a S� CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00379 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/21/2008 PARCEL: 2S102DC -00510 SITE ADDRESS: 09115 SW EDGEWOOD ST ZONING: R -4.5 SUBDIVISION: EDGEWOOD LOT: 013 JURISDICTION: TIG PROJECT: LARSEN Project Description: Installing A/C. 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: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: FURN > =100K BTU: <= 10000 cfm: > 10000 cfm: GAS OUTLETS: Owner: FEES PAUL & LORI LARSEN Description Date Amount LORI MEG 9115 SW EDGEWOOD [MECH] Permit Fee 7/21/200€ $72.50 TIGARD, OR 97224 [TAX] 12% State Surch 7/21/200€ $8.70 Total $81.20 Phone: 503- 639 -6325 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 By: k; •ermittee Signature: Call 503.63•.• 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. Mechanical Permit Application , F OR OFFICE SE .ON� w ` . City of Tigard Received �,Q Permit No . IN ' Date/By ��I/ W ' �� I� /i� 'IT v 13125 SW Hall Blvd , Tigard, OR 9722 Phone 503 639 4171 Fax 503 5 0 \\Ii Plan Review Date/By Other Permit Tl GARD Inspection Line 503.639 4175 ^ OQ� Date Ready/By Mil ® See Page 2 for Internet. www tigard -or gov ��� (� 11• OD Notified/Method Supplemental Information TYPE OF WOR ®� ® 0 � COMMERCIAL FEE* SCHEDULE' — USE CHECKLIST � bent Mechanical permit fees* are based on the value of the work 0 New construction EVAdditionJalte`` performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: �!J\ mechanical materials, equipment, labor, overhead, and profit. CATE OF CONSTRUCTION Value $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES *_ 1 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building Multi- family ❑ Master builder ❑ Other: For special information use checklist. Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: '//� S 0 F 2- L 'b i Air conditioning s sie plan o heat P pump v (requires si ] showing placement) ( 14.00 /G� City /State /ZIP: j , � i & D R rF 5 Furnace 100,000 BTU (ducts /vents) 14.00 I J Furnace 100,000+ BTU (ducts /vents) 17 90 Suite/bldg. /apt no.: Project name: Z4 CY f• J Gas heat pump 14.00 Cross street/directions to job site. p , t72 V j _ Duct work 10 00 Hydronic hot water system 14 00 _ Residential boiler (radiator or hydronic) 14 00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc 14 00 Subdivision: Lot no.: Flue /vent for any of above 6 80 Other: 10 00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 ` 5 _�� /O 6 1 _ Gas fireplace 10 00 J I \C - - 13 t k ©✓1l Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10 00 Wood /pellet stove 10.00 Wood fireplace /insert 10 00 • OPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 10 00 Other 10.00 Name. PA o L&-( I, A->e-5 ,o 'AO Environmental exhaust and ventilation Address: /./6---- S� p 7 , r jva Range hood other kitchen s f�� !' equipment 10 00 City /State /ZIP: . / c p , / I - t 1 Q g 9 , VI Clothes dryer exhaust 10 00 Single -duct exhaust (bathrooms, Phone: (5(.5 (., 3 Q 6, Fax: ( ) toilet compartments, utility rooms) 6 80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10 00 Business name: Other. 10 00 Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc Gas heat pump City/State /ZIP: Wall /suspended/unit heater _ Phone: ( ) , Fax: : ( ) Water heater E-mail: Fireplace Range CONT OR Barbecue Business name: Clothes dryer (gas) Other Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal l Phone: ( ) Fax: ( ) Minimum permit fee ($72 50) — 2.2,S — r,,,) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) — 7 TOTAL PERMIT FEE e Authorized Signature: This p ermit application expires if a permit is not obtained within a / t, days after it has been accepted as complete. Print name. / f4 A � T � „ Y1 /I Date: / eo / * Fee methodology set by Trt- County Building Industry Service Board I \Buddding \Permits \ME.C- PermitApp doe 01/19/07 ^J Jr �° 4 -4617T (11 /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I \Buildmg\Permits\MEC- PermitApp doc 01/19/07 2 • Information Notice to Property Owners About Construction Responsibilities Statement Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. [ORS 701.055 (4)] This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. ,,, � ;•z..�.± s,?";,,.<t- ';,k.r's;�x » =,�5`" _ a., 'n;,afl -— = - ___ __ _; ;1 ";; — ..,� °y'Ya, Se... _ _ _ riate , an „ 9a ,� ;s - - � ; �'t`~: r,.� -, ;'�.•`,r: n : , s��; ".: " - x � >,' ���x; = - - I "��`� ° _ . , t�•c =V: ; - :mPleasea check: = '-th e.la ° r box > d,:.com `lete , :the f,n statement: :�.= s : �� y. 9�. >, x - - " y#i, � ai. � ` �e , BC bM ,u oll ow i .•' : ' v °A 9 . �r,� °:.S 'b.. <,'v <.'flo a..' -.- `` t.: £`>•h*h',,_ . �+„,� . _ - �'S$ - kx,'• - s'F„ r ,gx . • i J _ C ,$ .,, n. ,' "yf•<�i" t,t� , "-fv'R "..." . F`Y.: °,➢ { i E _ Vim, "W ,.s.€ < " "Y - ' , w _ _ 'A .i , � {^u w ''x F -< a ' ,. a." $° - _ . , ! "G. `rzcS"` < Ad; i - f. t" --r} . , <S ✓5 x c ry ,; x ,. .'1 56 ' v3`,: ,�.+ .. �`,',� - .;rot' >. >:' '.uv s x'r°^: -' - '''i: �;?. 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"i.: XEtXb . 3 "' `:„r s'4x .•ax °,<+n ",t� . �� ,,, . ".''" - °.1r - +y��` Y4„,x.trx1', ' C' pk . � , I haveread under th e- Information•�Notice:to3Pro er m.Owners<abou't Construct'" „ .;. , . t3' ,. - ii ' :.:a. "< . ,,� . �'�.'%'�'-``'ttiw.ia `«'�'y r,..:'o : ,. k's , � . > , - *,",� ;� z ` " r-- � `.� � k %'�s -, - '.•dr- ���` F �'''��; , ;;,.m�'��,s, '. .�+„5� -°y � -,.a%'�,��' r��." . �'.;:++.'•3'�!'Y -:.`° � _ ,'�.+ ': r x ^,.. ," " "W„ ` " Responsibilities,,contained onkthese two °pages and =I hereb „ ce r t i fy - t informat checked,.an ; to R " 3 , :� < - 'F, Y ' ; g -a ,s _ , x,-', '�S-w +�.`�" - „r' ", ^r r, xi - $t;;. - a'.h ' n, , - „..x� Fq h ^ ' µ �; y , ,,*., _ "�.w'k" - �`?,( «.y�s� .'�' zs> _ '3' #ac ,, Sy'” :; �•y” n �., xs..` ' <�;;_ "^ `�`�` _ ,. ".� ..rJ..» ,st "`:�' _a,• "er " y:r�,'.�. completed °a' Bove `is`..co ,��� =•r" = ;r�� = r -.��: t " _' �� ;,;w'•u l] t: �' - ;`'^ ::: - z�' � _ k ,x , <6ry „„## L a x w iy r9 8 � ��;�>� x .,�R.x <^- «. 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'�.d ; . _ .. � � ;,Si natur Pri e of errri't'a applicant, `�, :� fv ° „=';'^^'; Permit #: This form is supplied to building .F o permit offices by the Oregon � address: , //S n • - Construction Contractors Board N' i T �/ � 9 as required by ORS 701.055 (6) ' � � �7/ 5 Issued by: �T Date: /c This copy to issuing permit office /~� �5 r CITY ���� ��N�������� ��no m ��w mm�������� BUILDING DUNG D PERMIT #: mEc20O8,00378 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7921/200B Phone: (503) 639-4171 09 111401# Inspection Requests (24 Hrs.): (503) 639-4175 ^�/a- A �� INSPECTION WORKSHEET FOR DATE: 12/12/20O8 TIME: 7:00*M PAGE: 7 SITE ADDRESS: 091168VVFDGEW0{)D8T CLASS OF WORK: SUBDIVISION: EDGE LOT #: 013 TYPE OF USE: PROJECT NAME: LARSEN DESCRIPTION: I A/c OWNER: LARSEN, PAUL & LORI PHONE #: 503-839'$325 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 131 12/2008 ' Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 078020'01 503 N Corrections/Comments/Instructions: . ' PAS I/ PARTIAL APPROVAL 7 CANCEL 7 NO ACCESS 111 FAIL CALL FOR INSPECTION � � ADDITI L F ASSESSED - c ~~----, y�" \ /}�l |nopacto ��r Date: /c�_/ /�—~1 �^ Phone (503) 718- c--{�` / �r ■m�. � #: ` -' _~� CITY OF TIGARD BUILDING DIVISION PERMIT #: MEC200#l00379 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7121/2008 Phone: (503) 639 -4171 �u Inspection Requests (24 Hrs.): (503) 639 -4175 `_'_... INSPECTION WORKSHEET FOR DATE: 12JB/2008 TIME: :00AM PAGE: •14 SITE ADDRESS: 09115 SW EDGEWOOD ST CLASS OF WORK: SUBDIVISION: EDGEWOOD LOT #: 013 TYPE OF USE: PROJECT NAME: 1 ARSEN " DESCRIPTION: Installing NC. OWNER: LARSEN, PAUL & LORI PHONE #: 503.639 -6325 CONTRACTOR: O\ JNER PHONE #: Inspection Request Scheduled For: Date: 12002000 Pour Time: Code # Inspection Description Confirm # Contact # Mess -•e 699 Mechanical final 078855. -01 503-44,"______12_. _ le Corrections/Comments/Instructions: 1) P o v s' c''.: -inc-r / "�Z I 0R. ea . e'°P° �t . 4 C_ L f..1 iTh — u. ) �� / O f-" / ` A" / .__ (J' &1 � _ ill ( o� . / e � Ale_ z..? O .ti O ` ) 1"--- az ii .A..) C a AL ".- lit . IN. . 0 ....._ _ . 6iew al,' ,„. " _ !, PARTIAL APPROVAL ❑ CANCEL U NO ACCESS "► ' FAIL "CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: Date: _� 1 0 Phone #: (503) 718- Z-Z—W,