Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00185
T I cn K 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/14/2008
PARCEL: 1 S133DA -00500
SITE ADDRESS: 11040 SW SUMMER LAKE DR ZONING: R - 7
SUBDIVISION: AMART SUMMERLAKE LOT: 027 JURISDICTION: TIG
PROJECT: GERARDS
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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
HUBERT GERARDS Description Date Amount
11040 SW SUMMER LAKE DR
TIGARD, OR 97223 [MECH] Permit Fee 4/14/200E $72.50
[TAX] 12% State Surch 4/14/200E $8.70
Phone:
Total $81.20
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -557 -2220
FAX 503 -557 -0919
Reg #: LIC 72623
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: .410 Permittee Signature: 7,4
Call 50 .639.4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
APR -10 -2008 04:03P FROM: TO:5035981960 P.1
Mechanical Permit Application 4 .3 4 "A `$ '`.4.4 � y
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.matt City Of Tigard 5 Receiv ,, 7�-
g � `J g 6 �� .. D ateBy R f u ' Permit No.: 25C � ; -- (X.) ;
13125 SW Hall Blvd., Tigard,0'
=`' ■ 4 '1 Plan Revtcw
Phone: 503,639.4171 Fax fill. '!" ". ! ,: Date/By: Permit:
1 Ins ection Line: 503.639.4175 C \ Date Ready/By t Al I p �O� Eons ED See Page 2for
r.•, 1 --_ -: Internet: www.tlgard- or 1 1 S Notified/Method:
Fed O Supplemental Information
TYPE OF W/ pF D N \0 COMMERCIAL FEE* SCHEDULE - USE CHECKLrST
❑ New construction Additionlalte tt2!etnOent Mechanical permit fees' are based on the value of the work
� performed. indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1- and 2-family dwelling ❑ Commercial/industrial lde ❑ Accessory building
Multi - family For special information use checklist.
y ❑Master builder ❑Other: RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
Description I Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job Site address: 1 Y Y I ' Wl{�., (br1
1 ra
`040 6w p- for tpp conditioning Air conditionin or heat pump
V V (requires site plan showing placemeni) 1 14.00
City /State /ZIP: 1ilall U 4 2n Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000 + BTU (ducts /vents) 17.90
Suite /bldg. /apt. no.: Project name: '
Gas heat pump 14.00
Cross street/directions to job site: 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
air ^_y�� O l ney- Gas fireplace 10.00
0 j 1 I JFJf l { I { Y llJt 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
'f'l PROPERTY O ❑ TENANT Chimney/liner/flue/vent 10.00
�� �WyNERR d/ Other 10.00
Name: Q �ma Environmental exhaust and ventilation
`� `^ Range hood /other kitchen
Address: 6a equipment 10,00
City /Stale /ZIP: Clothes dryer exhaust 10.00
��//�� Single -duct exhaust (bathrooms,
Phone:
(e(z) �4.�') Fax: ( ) toilet compartments, utility rooms) 6.80
IAAPPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name:
Other: 10.00
/' Fuel piping
.SJ IW
Contact name: , 1W001/1 S5.40 for first four; 51.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended/unit heater
Phone: ( ) F x :: ( ) Water heater
E -mail: - Fireplace
Range
CONTRACTOR Barbecue
Business name:pri antrti Clothes dryer (gas)
Address:
Imo 6. WHIM V va V V Othe MECHANICAL PERMIT FEES*
City/State /ZIP: Qr' O� 0N ®1F-, l7 Subtotal
Phone: ( °
5 "J [ Fax: ( • ! I �� j "� + 867 aQ I/j Minimum permit fee ($72.50) - 7) - ,,) - ,,) 4
Plan review (25% of permit fee)
CCB lie. /21/2 State surcharge (12% of permit fee) crt J
TOTAL PERMIT FEE o l t)
r , This permit application expires if a permit is not obtained within 180
Authorized signature; .14/11/1 wA �����^'�- ��- -'- `� I • days after it has been accepted as complete.
Print name: b 1 a L [ J NI a5vii Date: 4j 0 "� ' Fee methodology set by Tri- County Building Industry Service Board
B
1.1wldin9/Permus\MEC -Perris App. doe 01/19/07 440 - 446/77(11/02/COM/WEH)
APR -10 -2008 04:04P FROM: TO: 5035981960 P.2
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2008.00185
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4114/2008
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 �
INSPECTION WORKSHEET FOR DATE: 4/2212008 TIME: 7:00AM PAGE: 16
SITE ADDRESS: 11040 SW SUMMER LAKE DR CLASS OF WORK:
SUBDIVISION: AMART �itIMMERL.AKE LOT #: 027 TYPE OF USE:
PROJECT NAME: GERARD s
DESCRIPTION: lrulallinq NC.
OWNER: PHONE #:
CONTRACTOR: TRI COUNTY 'TEMP CONTROL PHONE #: 503-557-2220
Inspection Request Scheduled For: Date: 4/22/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 068726:01 503.667 -4220 Y
Corrections /Comments / Instructions:
6Lc(, /. A4vI ...'o• 44404-- _ r — -
PASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
FAIL n CALL FOR INSPECTION U ADDITIONAL FEES ASSESSED
Inspector: Date: 4 -2 z- 6 Phone #: (503) 718-.