Permit . . iq CITY OF TIGARD MECHANICAL PERMIT
' • ''. COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00527
TIGARD_ 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/24/2008
PARCEL: 1 S134CD -06800
SITE ADDRESS: 11756 SW SUMMER CREST PL ZONING: R -4.5
SUBDIVISION: BURLWOOD NO.3 LOT: 028 JURISDICTION: TIG
PROJECT: LHOTKA
Project Description: Install wood stove.
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: DOMES. INCIN:
WOD 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES: 1
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
CRAIG LHOTKA Description Date Amount
11756 SW SUMMERCREST PL
TIGARD, OR 97223 [MECH] Permit Fee 10/24/20C $72.50
[TAX] 12% State Surch 10/24/20C $8.70
Total $81.20
Phone: 503- 0209 -9239
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 dir- - tions to OUNC by calling 503.246.6699 or 1.800.332.2344.
. Issue
, I . Permittee Signature 1 --1 at j.)(iy
Call 503.639.4175 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.
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. Mechanical Permit Application = w 4 * FOR OFFICE , :f - ' 14 ' USE ONLY „-, y �A� (I a � ,1
City of Tigard Received Q d Permit No )'/ zLi „ ,,,D6,9..
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /
'" C .I,; Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
yT I G A R `D Inspection Line: 503.639.4175 Date Ready /By: t ® See Page 2 for
-4.::.- Internet: www.tigard- or.gov Notified/Method: a Supplemental Information
' ' . TYPE O WORK .. - . COMMERCIAL FEE* SCHEDULE - -. USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction El 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. I Total
. , JOB SITE INFORMATION AND AN LOCATION Heating/cooling
. _ .
Job site address: t t'T J S(N S&eOli ' Q ii Pi Air conditioning or heat pump
l 11 (requires site plan showing placement) 14.00
City /State /ZIP: i�)a rci 0) c 7c3 Furnace 100,000 BTU (ducts /vents) 14.00
f Of Furnace 100,000+ BTU (ducts /vents) 17.90
Lk L
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
. f DESCRIPTION OF WORK . Water heater 10.00
' Gas fireplace 10.00
_ -- ' -- e-Cil_ 11 10 Ut)v ; 2I/e Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 1 10.00 _
❑ PROPERTY OWNER' ❑ TENANT Chimney /liner /flue /vent 10.00
Other 10.00
Name: CX l 1 j/L0 k G Environmental exhaust and ventilation
(�� Range hood other kitchen
Address: ( � S Q i'' pi equipment 10.00
City /State /ZIP: "1-?5,(:: SCI '::) '7 - Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( 5() 31 5 1 Ra39 Fax: ( ) 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; $1.00 for each additional
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:
Address: y )/ MECHANICAL PERMIT FEES* . ,
City /State /ZIP: ' ` Subtotal
Minimum permit fee ($72.50) - 7:450
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) --CP
CCB lic.: State surcharge (12% of permit fee) g . 70
TOTAL PERMIT FEE g 20
This permit application expires if a permit is not obtained within 180
Authorized signature. j) 00 \ days after it has been accepted as complete.
Print name: C---00._-0 CJ� ( ate: / c/ay O 7 * Fee methodology set by Tri- County Building Industry Service Board
I: \ Building \PermitsMEC- PermitApp.doc 01/19/07 440- 4617T(11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard -
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: ;. Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
CITY OF TIGARD
BUILDING DIVISION
A PERMIT #: MEC2008-00627
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/24/2008
Phone: (503) 639-4171 Avio iAlii
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1 0/27/2008 TIME: 7:00AM PAGE: 19
SITE ADDRESS: 11756 SW OliMMER CREST PL. CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.3 LOT #: 028 TYPE OF USE:
PROJECT NAME: LHOTKA
DESCRIPTION: lostali wood stove.
OWNER LHOTKA, CRAIG PHONE #: 503
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1 0/27/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 077198-01 503-209-9239 N
Corrections/Comments/Instructions:
PASS
fl PARTIAL APPROVAL 0 CANCEL • 0 NO ACCESS
n FAIL 11] CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: --C Date: AP ocrio 6 Phone #: (503) 718- 1 ••/.2 3
, ,