Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2015-00314
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/28/2015
Parcel: 25111 CA04700
Jurisdiction: Tigard
Site address: 9600 SW LAKESIDE DR
Project: Van Kleek Subdivision: SUMMERFIELD NO.12 Lot: 667
Project Description: Add gas line for range,duct work,vent fan in bath and micro/range hood.
Contractor: PYRAMID HEATING&COOLING Owner: JIM&LANORE VAN KLEEK
9409 NE COLFAX 9600 SW LAKESIDE DR
PORTLAND, OR 97220 TIGARD, OR 97224
PHONE: 503-786-9522 PHONE:
FAX: 503-786-3432
FEES
Specifics: Description Date Amount
Duct Work 05/28/2015 $23.32
Type of Use: SF Range Hood/Other Kitchen 05/28/2015 $33.39
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 05/28/2015 $23.32
Occupancy Grp: Utility Rooms)
Stories:
Fuel Piping 05/28/2015 $14.15
12%State Surcharge-Mechanical 05/28/2015 $11.30
Fuel
Fuel Types:
Gas Pressure:
Total $105.48
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 Notif - .n 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 dire• questions • •UNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: , — i/ I Permittee Signature: Y , 4cq.
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 /y, J�) n,
Date/By: /� Y/ / (�Ov/S�O�l
City of Tigard oateJBy: a� Permit C�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review J
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175
Judi: 0 See Page 2 for
Internet www.tigard-or.gov Date,�et Ready/By: SSupplene.,td Information
r
TYPE OF WORK COMM ROAL ror SCHEDULE—USE CHECKLIST
❑New construction Mechanical permit fees°are based on the value of the work
®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
CATEGORY OF CONSIRUCTION Value:S
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
®1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder El Other: Description I Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:9600 SW Lakeside Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97227 Furnace 100,000+BTU(duets/vents) 54.91
Suite/bldg./apt.no.: I Project name:Stephens CHeat pump 61.06
ction �(� Duct work 1 23.32
Cross street/directions to job site: t Hydronic hot water system , 23.32
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: I Lot no.:
Other: 23.32
, Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Add GL to Range,Duct Work,Vent Bath Fan and Micro/Hood fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
te
.._rChimney/liner/flue/vent 23.32
Other: 23.32
El PROPERTY ❑ TENANT Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 1 33.39
Address:9600 SW Lakeside Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 1 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: _ _ 23.32
Fuel piping:
Business name:Pyramid Heating&Cooling $14,15 for first roar,S4.03 for each additional
Contact name:Holly Schell Furnace.etc.
Address:9409 NE Colfax St Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Portland,OR 97220 Water heater
Phone:(503)786-9522 I Fax::(503)786-3432 , Fireplace
Range 1
E-mail:hscheil®pyramidheating.com
Barbecue
CONTRACTOR Clothes dryer(gas)
r Other:
Business name:Pyramid Heating&Cooling
MECI ANICAL PERI OT raw.
Address:9409 NE Colfax ST Subtotal
City/State/ZIP:Portland,OR 97220 Minimum permit fee($90.00)
Phone:(503)786-9522 Fax:(503)786-3432 Plan review(25%of permit fee)
State surcharge(12%of permit fee) 414
CCB lie.:59382 TOTAL PERMIT FEE dIT00-
This permit applkatloa expires If a permit is sot obtalae8 within 150
days after it has been accepted as complete.
Authorized signature:--- jai/LA. ac. n/ _ • Fee methodology set by Tri-County Building In Service Board
-I Print name:Holly Schell vC " Date:5/27/2015 ] 5",
1:tBuitaingWermiuuQ:C_PermitApp_0e0113.doc 440461Tr(I IrovcoM/WEB)
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
9600 SW LAKESIDE DR, TIGARD, OR, 97224
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00314
David Young
Violation Summary:
Inspector Contractor