Permit q CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: MEC2014-00338
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/07/2014
Parcel: 1 S 134CCO2900
Jurisdiction: Tigard
Site address: 11945 SW 122ND CT
Project: Kruger-Brouwer Subdivision: YE-OLDE WINDMILL Lot: 15
Project Description: Install new heat pump and vents. Placement of heat pump must meet manufacturerer's clearance requirements.
Contractor: OWNER Owner: NATALIE KRUGER BROUWER
NATALIE KRUGER BROUWER 11945 SW 122ND CT
11945 SW 122ND CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 925-580-5963 PHONE: 925-580-5963
FAX:
FEES
Specifics: Description Date Amount
Heat Pump 07/07/2014 $61.06
Type of Use: SF Duct Work 07/07/2014 $23.32
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 07/07/2014 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 07/07/2014 $5.62
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or ct questions • •UNC b ailing 503.232.1987 or 1.800.332.2344.
sued By: � Permittee Signatur �/ ,„/��/
Call 503.639.4175 by 7:00 a.m.for the next available inspecti.4 date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application I Ol t11 11t 1 I �1 11\1 1
City of Tigard may: 7 7 AShir . fi Permit No.: Ar f ex' 31
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
_ Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
TI C;A R D Inspection Line: 503.639.4175 Date RcadyBy: Loris' 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ I O 00 0
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
[r1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For spedal information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
�J Air conditioning 46.75
Job site address:
17 /.115 7 1 22 rid (2 Gl.(r '''- .x.' Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: C 17 A 3 Furnace 100,000+BTU(ducts/vents) 54.91
� l Uri ��/r7 '/
Suite/bldg./apt.no.: `J Project name: x Heat pump / 61.06
Duct work 1 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Ka-di h e r i( it 9' A I `S 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: yc_C�De 610 fu D iti I L.L Lot no.: Other 23.32
Other fuel appliances:
Tax map/parcel no.: I 51 3 4 et, O 2 Cf 00 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
f ri rra 1,( tJ )e Heal- pct nlp vQ)7 1 l 5 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
[3t'PROPERTY OWNER 1 ❑ TENANT Other: 23.32
_ Environmental exhaust and ventilation:
Name: /V/`r f a!,C 1-Cri� C.r odou top Range hood/other kitchen
��ll + v equipment 33.39
Address: l i q q 5 I 2 Z t di-- Clothes dryer exhaust 33.39
City/State/ZIP:i(n a rd 0 R. Cf 1Z1)- Single duct exhaust(bathrooms,
L] toilet compartments,utility rooms) 23.32
Phone:(q'6) !l.5q63 Fax:((4Q 0 A(17.•Sf r7 t j(f Attic/crawlspace fans 23.32
FE4PPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four,$4.03 for each additional
Contact name: Furnace,etc.
Address:
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: nj bl-LU uJerG wn1c o_51.. nc F Barbecue
(i CONTRACTOR Clothes dryer(gas)
Business name: 0 t N Other: -
MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) 90.0e'
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee) /p. $tJ
CCB lic.: TOTAL PERMIT FEE /CO,W
fn a This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized sigma /RI . .,/ A. A /1 I / • Fee methodology set by Tri-County Building Industry Service Board
Print name: i Date:
I\Building\Permits\MEC_PermitApp_0401I3.doc 440-4617f(11/02/COM/WEB)
Property Owner Statement
Regarding Construction Responsibilities
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 appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
L l
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
( i or
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
A 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.
Atf . illP # _
/ Print Name of Permit Applica t
dii / L / / / .1
-
/ Sig It re of Permit Applicant Date
Permit#: a EC o/4 - o 234
OF •
Address: Ii 419‘-
/ l�� e r
Issue by: ate: 7/7/V /4. •
This Copy for Permit Offices
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11945 SW 122ND CT, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2014-00338
David Young
Insulate ductwork to code in unconditioned space.
Violation Summary:
Inspector Contractor