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Permit CITY OF TIGARD MECHANICAL PERMIT ' COMMUNITY DEVELOPMENT Permit#: MEC2015-00295 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/20/2015 Parcel: 2S103AB03700 Jurisdiction: Tigard Site address: 12079 SW 113TH PL Project: HARRIS Subdivision: MEADOWGLADE Lot: 6 Project Description: NC installation. Placement of A/C unit must comply with manufacturer's clearance requirements. Contractor: OWNER Owner: HARRIS, CHADWICK STEPHEN CHAD HARRIS 12079 SW 113TH PL 12079 SW 113TH PL TIGARD, OR 97223 TIGARD,OR 97223 PHONE: 503-703-2178 PHONE: FAX: FEES Specifics: Description Date Amount Air Conditioning 05/20/2015 $46.75 Type of Use: SF 12%State Surcharge-Mechanical 05/20/2015 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 05/20/2015 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ` Permittee Signature. e.� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application III xeived City of Tigard RECEN DateBe s Xi iy Permit No.:.mi- e�ls 2q5- 13125 550 Hall Blvd.,Tigard,OR 97223 G Plan Review Phone: 503.718.2439 Fax: 503.598.1960 {� Date/By: Other Permit: 11., \t,I) Inspection Line: 503.639.4175 MAY t 0 2��5 Date Ready/By: Juris: RI See Page 2 for Internet: www.tigard-or.gov H QAbtified/Method: ter 7 Supplemental Information CITY Of T' g,ON Mechanical permit fees•✓aree based on the value of the work performed.Indic. p� TYPE OF WO ' 1.0114( V%�lv7 the nearest dollar)of all mechanical materials,equipment,labor,overhead,at ❑New construction Hi Addition/alteratio reppllacement Value:$ RESIDENTIAL EQUIPMENT NT/SNSIE FEES* ❑Demolition ❑Other: For special information use checklist CATEGORY OF CONSTRUCTION Description I Qty. I Ea. 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building ir conditioning A niti onicling: Air cng / 46.75 It&.'75- ❑Multi-family ❑Master builder ❑Other: Furnace 100,000 BTU(ducts/vents) 46.75 JOB SITE INFORMATION AND LOCATION Furnace 100,000+BTU(ducts/vents) 54.91 Job site address: 279 S u ! 312 IL D pump 61.06 Duucct t work 23.32 City/State/ZIP: -77644) QE.. 17 22-.5 Hydronic hot water system 23.32 r' 1 Residential boiler(radiator or 23.32 Suite/bldg./apt.no.: Project name: �J /`1fte �0.14 N/a�4 S hydronic) Cross street/directions to job site: Unit heaters(fuel-type,not electric), 46.75 � ,� in-wall,in-duct,suspended,etc. l/l�rT, ^ S%,///34 /L AX.4/2- (t ivzsbl /u'T Flue/vent for any of above 23.32 Other: 23.32 Other fuel appliances: Water heater 23.32 Subdivision: 1 Lot no.: Gas fireplace/insert 33.39 Flue vent for water heater or gas 23.32 Tax map/parcel no.: fireplace DESCRIPTION OF WORK Log lighter(gas) 23.32 •�1 ^ .. - Wood/pellet stove 33.39 /iVS7 L /17e - i-laX e,/t 4Q J1 1641 oe,0 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 Environmental exhaust and ventilation: Range hood/other kitchen 33.39 13 PRO)l RTY OWNER Clothes dryer 1 ❑TF.I!1ANT Clothes d exhaust 33.39 Name: 61/9/9 r44, 1s Single-duct exhaust(bathrooms, 23.32 toilet compartments,utility rooms) Address: /Ze)71 Spti //3 Attic/crawlspace fans 23.32 City/State/ZIP: 7 OIL 7Z-Z3 Other: 23.32 �q�y Fuel piping: Phone:�(/,�1 793 ZJ7 g Fax:( ) $14.15 for first four;54.03 for each additional ❑_ APPLICANT rn ❑ CONTACT PERSON Furnace,etc. Business name: `_ Gas heat pump ate/""' �.f �+�� Wall/suspended/unit heater Contact name: Water heater Address: Fireplace Range City/State/ZIP: Barbecue Phone:( ) 1 Fax: :( ) Clothes dryer(gas) Other: E-mail: PERMLT IFIBie CONTRACTOR Subtotal dC(e-'73 Business name: f^�� Minimum permit fee($90.00) fa(J[� Plan review(25%of permit fee) Address: State surcharge(12%of permit fee) to-ro City/State/ZIP: TOTAL PERMIT FEE M.,)-et This permit application expires if a permit is not obtained within 180 days after Phone:( ) 1 Fax:( ) complete. • Fee methodology set by Tri-County Building industry Service Board CCB lic.: Authorized signature: ��t Print name: ��"Z/ i,i S I Date: S /S/ I COMMERCIAL FEE*SCHEDULE-TIME I 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 per mits. 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 I will inform my general contractor that a II subcontractors who work on the structure must be licensed with the Construction Contractors Board. or i I will be performing work on property I own, a residence that I reside in, or a residence that I w ill 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 horn eowner statement is true and accurate. (//4"*D 1,4%/2-05 Print Name of Pe ifApplicant . /1 c v- c.)A--- Signature of Permit Applicant Da Permit#: 1.-5t C) ,i —CA.',j�iC'//'' ki i5-c..45-- l�� Address: i).0 7f ft-�l //321 j4L. --:�. •ok • .,,7,4,.„11 auls7(,. :y Issued by: 6- %- Date: /,�J/S— 11 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 12079 SW 113TH PL, TIGARD, OR, 97223 Residential - Mechanical 699 Mechanical ﬁnal FAIL MEC2015-00295 George Heimos 1. Provide AC Unit locking access port caps, not installed. M1411.6 2. Provide electrical ﬁnal approval. 3. Recall inspection when corrections have been completed. NOTE inspection can be made with access to residence Csharris356@gmail.com Violation Summary: Inspector Contractor 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 12079 SW 113TH PL, TIGARD, OR, 97223 Residential - Mechanical 699 Mechanical ﬁnal PASS - No C of O MEC2015-00295 George Heimos NOTE: AC Unit locking access port caps installed. ELC2015-00390 Violation Summary: Inspector Contractor