Permit " CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: MEC2009 -00314
Date Issued: 06/30/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 110BA09200
Jurisdiction: Tigard
Site address: 14127 SW 116TH TER
Subdivision: EVERGREEN SPRINGS Lot: 17
Project: Moss
Project Description: Install air conditioner
Owner: FEES
MOSS, JAMES A & Description Date Amount
KATHLEEN L, 14127 SW 116TH TER Air Conditioning or Heat Pump 06/30/2009 $14.00
TIGARD, OR 97224 12% State Surcharge - Mechanical 06/30/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 06/30/2009 $58.50
Contractor:
TRI- COUNTY TEMP CONTROL
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503- 557 -2220
FAX: 503 - 557 -0919
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
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 !ling 503.246.6699 or 1.800.332.2344.
Issued By: 1)4°''', -3 �7 Ate( �� Permittee Signature: � .• X 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.
JUN -27 -2009 11:35A FROM: T0:5035981960 P.1
- - RECEIVED
Mechanical Permit Application JUN 2 9 2009 I (m t l I I I(I I'`NI I )\ 1 N
City of Tigard Received / hi PennitNo.: EC _p 3
Ill u 13125 SW Hall Blvd., Tigard, OR 9722 I'y OF TIGARD Plan Review
Phone: 503.639.4171 Fax: 503.598 Other Permit
Line: I nspec ti on Li 503.639.4175 pa�By.
I i t , \ I: luris:
LDING DIVISION Date Ready/By: 10 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* arc 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.
CATEGORY OF CONSTRUCTION Value: S
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
4121 evv ( ( (.h �C�� Air conditioning or heat pump
Job site address: L. tl V C 9 r kl (requires site plan showing placement) I 14.00
City/ State/ZIP: Tigard, OR '722,4 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (duets/vents) 17. 90
Suite/bldgJapt. 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
a0 1 (fir 1 } Gas fireplace 10.00
t 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
PROPERTY OWNER ❑ TENANT
Chimney /liner /flue/vent 10.00
* 1` Moos _Ether: 10.00
Name: Environmental exhaust and ventilation
n /� Range hood/other kitchen
Address:
Sw / W equipment • 10.00 _
City /State/ZIP: Clothes dryer exhaust 10.00
�/� M Single -duct exhaust (bathrooms,
Phone: (SO ZC J 4024 Fax: ( ) toilet compartments, utility rooms) 6.80
0 APPLICANT ❑ CONTACT PERSON Attic/crawispacc fans , 10.00
Other: 10.00
Business name: Same as contractor Fuel piping
Contact name: Diane Mason $5.40 for first four; $1.00 for each additional
Fumace, etc.
Address: Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) _ Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Tri County Temp Control Clothes dryer (gas)
Other.
Address: 13150 S. Clackamas River Drive MECHANICAL PERMIT FEES*
City / State/ZIP: Oregon City, 97045 Subtotal
Phone: (503) 557.2220 Fax: (503) 557.0919 Minimum permit fee ($72,50)
Plan review (25% of permit fee)
CCB 1ic.: 72623 - , ` 1 Q State surcharge (12% of permit fee)
3 I 4 A n n e - I TOTAL PERMIT FEE 1.
Authorized signature: Kew �C his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Diane Mason I Date: 7/2./oq • Fee methodology set by Tr-County Building Industry Service Board
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CUSTOMS INFORMATION
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NAME (Up ao sC o
ADDRESS /
-T � 9 q1( / / PLEASE REPAX APPLICATION WITH SITE PLAN.
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City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14127 SW 116TH TER, TIGARD, OR, 97224 July 3, 2018 at 2:35:14 PM
Record Type: Record ID:
Residential - Mechanical MEC2009-00314
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS - NoCofO
Comments:
Mechanical final approved per inspection dated 7/6/09.
Electrical final for ac approved 7/8/09.
Violation Summary:
Inspector Contractor