Permit 0
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00521
Ilk • 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/25/2005
PARCEL: 2S111 CB -04300
SITE ADDRESS: 10490 SW LADY MARION DR ZONING: R -3.5
SUBDIVISION: MARION ESTATES LOT: 016 JURISDICTION: TIG
Project Description: Gas line to pool heater.
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:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
RICHARD ALLISON Description Date Amount
10490 SW LADY MARION DR. [MECH] Permit Fee 8/25/200` $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar5 8/25/200E $5.80
Phone: 503 443 - 3818 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
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: Permittee Signature:
/CLLZLIZet&L
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.
08/24/05 WED 15:01 FAX 503 635 7491 OAR TREE INSURANCE 002
li llif 1Vtechanical Permit Application
City of Tigard
FOI(OFF ICE USE ONLY
Received
_� C Date/By: g .� t � L J M Permit N o.:
13125 5W Hall Blvd., Tigard, OR 97223
hone: 503.639.4171 Fax: 503.598.1960
n on Line: 503.639.4175
( � C )�i - I � � �, I y ` � � _ ;�� .rp � .
Other Plan Revie
C �'llt Date/By: �OUter PcrrniC
Internet: V7I
2_ Date Ready/By: 0 See Page 2 for
Internet: www.ci.tigard.or.trs
Notified/Method:
Supplemental information
f 1 Yif(F1 T!F }11.j �L. "�:1i:1.1 9 .l�i:':' :i::'ti';ls4 .
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:
❑ New construction Addition /alteratiOi‘'/t� C tilenf i \r i, Ie ' `•. 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
,� _ .. .......... , ;:,.,;::::; amcal materials. ,laborprofit.
labor, overhead, and p
!.i lY +i ! ; s; t , , , r,, , y � t ,,�, : {,� , �. ! � equipment, y�
•:iii. u�.it t�s!�u -Sr S._._r�: ryi d t..sF �S. ./11' i� �C� •( i, fjl S'1") C) IbJN 1' lj;ilt -,{ *N 1 nt :i eq
Value l $ dO5O
1
1 AL 3 Xj L : "7 5 > t 1 i EFW*r i i
X 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ., „ ... ..
For special information use checklist.
Multi-family
❑ ❑ Master builder ❑ Other:
... I � Description t . Q y Ea Total
tt :::.:..:... } . •._,.....•:::, , .` ., iti ;8rCF i Iti1�>F(�R11 A'rtQl� AND 1 t't nr , 1 "` Heating/cooling
/
Job site address: Io 1 1 b SO L� Air conditioning or heat pump
1 ir�t �� t V� (requires site plan showing placement) 14.00
ttY1�A b �
City /State/ZiP: sTl iM e:Py Furnace 100,000 BTU (ducts/vents) 14.00
Suite/btd /a t. no.: Furnace 100,000+ BTU (ducts /vents) 17.90
8 p Project Warne: Gas heat pump 14.00
Cross street/directions to job ��� {rn 1 O 3 UV J site: � 5yy , iA) MC ) 6tll(Id (d sl . Duct work 14.00
+ ' ES� 6Y1 C EIydronic hot water system 14.00
Residential boiler (radiator or
A.i Ili i tir hydronic) 14.00
111"""��� Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: �7q" Flue/vent for any of above 10.00
Ail Dn &7•� Lot no.: /ea Other: 10.00
Tax map /parcel no.: L '2
tr7+ Q� c ..� Other fuel appliances
; i r I'. a S i t, A �, i t rti try St 1G�4 r u 1 r 1 S o S - t
......_.... ��.'ll'1P.kly . § '�'1 § R ...:.. ! ; l : , r : ' . i o. t a i Water heater 10.00
nnn 1 ! h r f��, t Gas fireplace 10.00
L
_N 4k(f i vi y1
A 65 1 e TedYyt V14 ET` . 4`O Flue vent for water heater or gas
tA44ER. fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
4 I
{ 1F� ii++�i l ,��t Wood fireplace /insert 10.00
i;ii 1`RUP ki `�• igk ,, • il.t1... : T1IP, r0' fail 027.W w` ''°� i1�1r.1�._;.. Chimney/liner/flue/vent 10 00
C
Other: 10.00
Name: end u1 k; So h Environmental exhaust and ventilation
Address: 10q9 O S 1 o L , i m 4 t Range hood/other kitchen
""7 Asa--t equipment 10.00
City /State /ZIP: 1 i ,, o e . 9 9 a s y Clothes dryer exhaust 10.00
Phone: Q ( �3) 9/
Single -duct exhaust (bathrooms,
(SIG) �S/ 3S / Fax: � ? v �- �y toil compartments, utility p »I ty oo ) 6.80
b y /-+ ,:::;.x „�;,....:„
�:. ii L ;1_,...i......14 r
trr '.r�P>i"�'r1O .NT i!. i r' ,) s , �! '• nr } t Attic /Crawl ace fans 10.00
.;,i.,,,,,,:,..,.... ., , t • i , : , t ,. ,. {. ,. R,.I ! i i i, .,t? : ` : 4 .„ 1SI ,„,,, 1 ,I sp ms
Business name:
Other: 1 0.00
Fuel piping
V►
Contact name: R; eAQ Aq t so y\ $5.40 for first four; $1.00 for each additional
Address: SArwLE tk-S Moot9'E Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone: (cD3) 3 , 2 41._ 73' S � k Fax: : ( ) Water heater
Fireplace
E -mail: p , Rage
r �� 111 r l,rl i ' f it t } t i i
�ir1• i tt t,fi1, �.. -t lr 11 r r ,.,(�`. .. Bar
„ becue
Business name: Clothes dryer (gas)
Other: P r dife t i('14�5 1.47E / 5. S S/Q
Address: (1 j4
ii r i l >✓`CI N AT>,tl moue 1�'i.:s :
City /State /ZiP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 19.50
Plan review (25% of permit fee) 44k77"3"
CCB lic.: State surcharge (8% of permit fee) 3 D20
' 1 /� r� TOTAL PERMIT FEE
Authorized signatur W O (/l J r r This permit application expires if a permit is not obtaine wltbin 180
l days after It has been accepted as complete.
Print name: ` d 10 • Atli S IM Date: R j c i o J ` Fee methodology set by Tri- County Building Industry Service 13oard
i:\ Building \Permits \MEC- PennitApp.doc 12/03 440 -4617T (1 I /02 /COM/WEB) f -79.3°
CITY OF TIG'ARD °'
BUILDING DIVISION PERMIT #: MEC200 &00521
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1266/2005
Phone: (503) 639 -4171 AchtwitlA Inspection Requests (24 Hrs.): (503) 639 -4175 .'
.IL
INSPECTION WORKSHEET FOR DATE: 9/2/2005 TIME: 7:07AM PAGE: 23
SITE ADDRESS: 10490 SW LADY MARION DR CLASS OF WORK:
SUBDIVISION: MARION ESTATES LOT #: 016 TYPE OF USE:
PROJECT NAME: ALLISON
DESCRIPTION: G line to pool heater.
OWNER: ALLISON, RICHARD PHONE #: 503 -413 -3818
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 014892 -01 503-443-3818 Y
Corrections/Comments/Instructions:
Co
1 r ), r )
1 - 7
........,7
t
' A SS I I PARTIAL. APRROVAL - _n .CANCEL. .. _ _ __ n _NO .ACCESS
0 FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector•: Date: 9— tea 6 Phone #: (503) 718-