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Permit
a L.fLQ.(rncr JJju • o CITY OF TIGARD MECHANICAL PERMIT a ` COMMUNITY DEVELOPMENT Permit #: MEC2008 -00281 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/05/2008 Parcel: 1 S133AD15300 Jurisdiction: TIG Site address: 11143 SW SUMMER LAKE DR Subdivision: Lot: Project: MCNEILL Project Description: Relocating air conditioner to previous position and installing gas line.6/22/09 UPDATED scope of work, not installing gas line. Owner: FEES RANDY MCNEILL Description Date Amount 11143 SW SUMMER LAKE DR TIGARD, OR 97223 [MECH] Permit Fee 06/05/2008 $72.50 [TAX] 12% State Surcharge 06/05/2008 $8.70 PHONE: 503 - 317 -9555 Contractor: PHONE: FAX: • Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: R3 Stories: Fuel Fuel Types: Gas Pressue: Total $81.20 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By. . /1 �I(� Q l (� /� Permittee Signature: � Q cis) r l ' n l V Q Aff2 Call 503.639.4175 by 7:00 a.m. for an inspection 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. • a CITY OF TIGARD MECHANICAL PERMIT i . = ; COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00281 � TIGA 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/5/2008 PARCEL: 1 S133AD -15300 SITE ADDRESS: 11143 SW SUMMER LAKE DR ZONING: R - 7 SUBDIVISION: SUMMER LAKE LOT: 034 JURISDICTION: TIG PROJECT: MCNEILL Project Description: Relocating air conditioner to previous position and installing gas line. 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: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: C ODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS LO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: 1 Owner: FEES RANDY MCNEILL Description Date Amount 11143 SW SUMMER LAKE DR TIGARD, OR 97223 [MECH] Permit Fee 6/5/2008 $72.50 [TAX] 12% State Surch 6/5/2008 $8.70 Total $81.20 Phone: 503- 317 -9555 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. / S� ;Y Issued By: � ,— _ � �� ' rmittee Signature: r� ' • Call 503.6 . 'y 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 - '� , 'FOR ov I61 ill S ',0N L ., e � , < u r = v e - . s a cs »..v.a:i64 .si v::-.e .v ..3i'ai e *, ;-. =S"' ..«tid �` l �C:ety of Tigard 0) DateBy� - ermit No.: `. • a '► a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ", g C - Phone: 503.639.4171 Fax: 503.598.19 Date/By. ther Permit: "-; Inspection Line: 503.639.4175 y � l I G A R D Ins p .1 OQ� Date Ready/By: luris Si See Page 2 for :� -+ Internet: www.tigard- or.gov Notified/Method: 000000000y000000or CI N TYPE OF WORK 1 0 � .�` • COMMERCIAL FEE* SCHEDULE - USE CHECKLIST 4 Mechanical permit fees* are based on the value of the work ❑ New construction Other: n/alteratio w ent performed. Indicate the value (rounded to the nearest dollar) of all ID Demolition Other: VP mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION • Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES .. 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: I ( I (..i 3 SW Sinn ry er - L a lo2 of t i/ Air conditioning or heat pump (requires site plan showing placement) ( 14.00 1 % W City /State /ZIP: - - j f c., R-IL, OP. q - 7 2_2_ 3 Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Aciu,2 r' Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 K {-i©Ll� C, Hydronic hot water system 14.00 ir 6 Residential boiler r (radiator or J� NB- P4r01 hydronic) 14.00 t `a 1 v / T 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 .l wt Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 4� 20 P A ( 1 2 C01-e -Prtl b vJ 5 f E T Flue vent for water heater or gas TO Z,OU ID i_ l ELF fireplace 10.00 (-� U �J _ Log lighter (gas) 10.00 aiu,p G i = �,�'�"�T�IiZ r Wood/pellet stove 10.00 '` — N 5 /_ " Iii /�� I. S• 6'-riAvtil Wood fireplace /insert 10.00 PROPERTY OWNER ✓'•s/ TENANT W-a� C /flue /vent 10.00 Other: 10.00 Name: R■ NZ rill L E-' U.— Environmental exhaust and ventilation L S�I\I s 0-44 _-G . Range hood /other kitchen Address: 11 equipment 10.00 City/State /ZIP: �," r� �� 7 Z 23 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms. Phone: (503) 3 L7 ct 5 S....5 Fax: ( 3) 624, 2. ZS — I toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; 51.00 for each a dditional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall/suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range . CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: r Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Minimum permit fee ($72.50) 9) Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB tic.: State surcharge (12% of permit fee) 7 TOTAL PERMIT FEE ( - p.) Authorized Signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. I/ I 6%//hg AA ' ( ;0�vv2 ( 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. P lease .c the appropria box. a compl the following statement: I own, reside in, or will reside in the c ompleted structure and. my general contractor is Name CCB# Expiration Date I wi11 instruct my,general contractor that all subcontractors who work on the structure must be .. ' licensed: with the Construction Contractors Board. or 1 wil be performing work on property I own, residence that 1 reside in or a residence that 1 will reside M. If I hire subcontractors, I will hire Only subcontractors licensed with the Construction Board. If I change my mind and hire a general contractor, •I will contract with a . contractor who is licensed with the CCB and will immediately notify the office issuing this building errnit of the name of the contractor: , I have read and understand the Information Notice to Property Owners. about construction ' Responsibilities contained on these -two pages and I hereby certify that at the information checked and completed above is correct and,, accurate.. doe pro ijy . / 1 U1 ' Print, name. of permit applicant �' Signature of permit oplicant j Date Permit 4t: /' JCi = Oc? 51 p2 8 oc This form is supplied to building of , /J permit offices by the Oregon -' ' Address: /('y3 �.cam; � n Ge. e ' er : ; Construction Contractors Board � N' ►, 'ig �, as required by ORS 701.055 (6) .• '? r ` -/ �, t d 2 y-,�3 Issued by: !•7> Date: ------ This copy to issuing permit office