Permit r
CTY O F TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -10033
Jl� DATE ISSUED: 3/16/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S104DD - 02700
SITE ADDRESS: 12859 SW RIDGEFIELD LN ZONING: R -4.5
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 2 LOT: 024 JURISDICTION: TIG
Project Description: Vent and gas to fireplace.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP:
WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
MANDY MOCK Description Date Amount
12859 SW RIDGEFIELD LN
TIGARD, OR 97224 [MECH] Permit Fee 4/4/2006 $72.50
[TAX] 8% State Surcha 4/4/2006 $5.80
Total $78.30
Phone: 503 -524 -3549
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.
Issued By: , L ` �/ . Permittee Signature: lip a
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
J '
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.
1V eel'iiIli dal. Permit t - - :
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Cl Of T 1 I d Dat /B d ' / Permit No.:
13125 SW Hal Tigard, OR 97223 pp Date /By. a 1 e / /)ep /36 �,k�D,cob -i pQ33
�I p I 1 6 2006 Plan Revieu4
Phone: 503.639.4171 Fax: 503.598.1960 "IH i� t „ , Date/By: Othe Permit:
Inspection Line: 503.639.4175 I �, II Date Ready/By: 1 ' -® See Page 2 for
Internet: www.ci.tigard.or.us ""
CITY OF TIGAR t Notified/Method: Supplemental Information
Burn DING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction c 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: $
•
® 1- and 2- family dwelling ID Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
e f /Q Air conditioning or heat pump
Job site address: I�ds,9 314/ (I� p / ' J(� P P �Q/ Lk (requires site plan showing placement) 14.00
To � O� ✓✓ 9 r , , 3 Furnace 100,000 BTU (ducts/vents) 14.00
1 Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no. / / Project
/_ name: /1A Gas heat pump 14.00
Cross street /directions to job site: ��u YO , ,/,lpt/i Duct work 14.00
/ o �//�� ? / f Hydronic hot water system 14.00
T 0 K•f / t? P-!B Gga�dt /o Residential boiler (radiator or
JJ hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
�* / / / / r Gas fireplace 1
I t-�f J f kte a/'J/ 1 /8.7" taw( 12a.ses Flue vent for water heater or gas
fireplace / 10.00 /0, CO
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
PROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: HQjdv Mo W t^k Environmental exhaust and ventilation
Address: /� t p j Range hood/other kitchen
p e /O PT! la Z i C equipment 10.00
City /State /ZIP: 7' a r 0( , of 9 7,) 3 C!othe-dryer exhaust bathrooms, 10.00
Phone: ( S-03) - 2 i ,J 3S f Fax: ( S03) s:2 y- 3597 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 / I. 0
E -mail:
Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES* . ',a , c0
City /State /ZIP: Subtotal "
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee) ego
TOTAL PERMIT FEE ig, 3,O
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: AIR f/ /l C Date: 3 /ls /G� • Fee methodology set by Tri- County Building Industry Service Board
B \ M
i:\ uilding \PernitsEC- PermitApp.ddc 12/03 44 4617T(II /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.
i:\ Building \Permits\MEC- PermitApp.doc 12/03
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CITY OF TIGARD
. .,
BUILDING DIVISION PERMIT #: i'ALC;201. :(:i'.7'3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ''Vf2;.la.
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: GI i!2006 TIME: 7:03AM PAGE:
SITE ADDRESS: '.: ill:•,C;: la i.) .1 CLASS OF WORK:
SUBDIVISION: MOUNT All i NO. 2 ibT #: U2 TYPE OF USE:
PROJECT NAME: INA t)C2i<
DESCRIPTION: \f-: ,:,i16 10
OWNER: ?,;(,)C.le.. i‘flANI.)Y PHONE #: : 35.1
CONTRACTOR: OWNER PHONE #:
Inspection Request. Scheduled For: Date: Ei.i'l20DG Pour Time:
Code # Inspection Description Confirm # Contact # Message
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40/8 .4. L
fita-c_
Corrections/Comments/Instructions:
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PASS fl PARTIAL APPROVAL 0 CANCEL E NO ACCESS
n FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector:
941
i____
Date: ,/6 Phone #: (503) 718-