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Permit CITY TIGARD MECHANICAL PERMIT . DEVELOPMENT SERVICES PERMIT #: MEC2005 -00083 461 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/2/2005 PARCEL: 2S111 BD -03200 SITE ADDRESS: 09790 SW PEMBROOK ST SUBDIVISION: CLOUD CAP ZONING: R -3.5 BLOCK: LOT: 014 JURISDICTION: TIG 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: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Replacing water heater, adding gas fireplace w /piping, gas stove. Owner: FEES KRANZ, NEAL Description Date Amount 9790 SW PEMBROOK ' MECH Permit Fee 3/2/2005 $72.50 \I 0 TIGARD, OR 97223 [ ] [TAX] 8% State Surchar€ 3/2/2005 $5.80 Total $78.30 Phone: 503 - 598 - 1150 Contractor: AMERICAN COLD STORAGE PO BOX 621 REQUIRED ITEMS AND REPORTS WELCHES, OR 97067 Phone: 503 225 - 0775 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. Issued By: , Permittee Signature Call (503) 639 -4175 by 7:00 P.M. for inspections eeded the next business day. This permit card shall be kept in a conspicuous place on job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Inspections Required for: MEC2005 -00083 ✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By BUP - Building Permit ELC - Electrical Permit 405 Excavation 105 Underground /slab cover 410 Fill 110 Temporary electrical service 415 Grading 115 Electrical service /reconnect 205 Footing _ 120 Electrical rough -in 805 MFG - Structure grading /footing 125 Wall cover 210 Foundation walls 130 Ceiling cover 215 Footing drain 135 Low voltage 220 Slab 140 Sign installation 310 Crawl drain 145 A/C or heating unit circuit 225 Post/beam structural 150 Hot tub /spa/pool 230 Underfloor insulation 195 Misc. inspection: 235 Shear walls /anchors _ 199 Electrical final 240 Exterior sheathing 245 Firewall 250 Roof nailing ELR - Restricted Energy Permit 255 Wtr proofing basement walls 135 Low voltage 260 Tilt -up panel 195 Misc. inspection: 265 Masonry _ 199 Electrical final 270 Reinforcing steel (rebar) 275 Framing 810 MFG Structure set-up MEC - Mechanical Permit 280 Insulation 605 Post/beam mechanical 285 Drywall nailing X 610 Gas line 287 Suspended ceiling X 615 Mechanical rough -in 295 Misc. inspection: 620 Hydronic piping 899 MFG - Structure final 625 Duct work 498 Grading final 630 Fire damper 299 Final inspection 635 Smoke detector shutdown 640 Exhaust hood 695 Misc. inspection: X 699 Mechanical final BUP - Fire Protection System Permit 905 Sprinkler underfloor /slab PLM - Plumbing Permit 910 Sprinkler rough -in 305 Plumbing underslab 915 Fire alarm rough -in 310 Crawl drain 920 Suppression trip test 315 Post/beam plumbing 995 Misc. inspection: 320 Plumbing rough -in 998 Alarm final 325 RP/backflow preventer 999 Sprinkler final 330 Water service 335 Rain drain 340 Storm drain SIT - Site Work Permit 505 Sanitary sewer 405 Excavation 345 Culvert/catch basin 410 Fill 350 Septic tank 415 Grading 395 Misc. inspection: 205 Footing 399 Plumbing final 210 Foundation walls 215 Footing drain 420 Sprinkler supply lines SWR - Sewer Permit 495 Misc. inspection: 505 Sanitary sewer 498 Grading final 595 Misc. inspection: 499 Final inspection 599 Final inspection I: \Building \IVR \InspCard - AOP.doc 02/02/2005 Mechanical Permit Application FOR OFFICE U SE ONLY City of Tigard � � Received { permit No.: D ateBy:. 5 Q J \\\_,...- � 77 d ei y 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 I Other Permit: Inspection Line: 503.639.4175 V61 II DateBy: Internet: www.ci.ti ard.or.us h1A 0 .e. °' Date Ready/By: 0 See Page 2 for g Notified/Method: ) \ Supplemental Information .-Av is of 4R1t � • - 1 .`I"' -' COMMERCIAL FEE *;SCI DULE =;U CHECKLIST • ❑ New construction �L��t .- ��� a4;t. o rY � ce men l 1 ) (" Mechanical permit fees* are based on the value of the work �TTT la performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. r r.' • CATEGORY OF CONSTRUCTION Value $ :. ' RESIDENTIAL EQUIPMENT / FEES* an 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total • JOB 'SITE INFORMATION AND LOCATION . - Heating/cooling Job site address: 79e, s� ���� O Zd,� Air conditioning or heat pump _ (requires site plan showing placement) 14.00 City/State /ZIP: 1 O �/� Ql� 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 14.00 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. 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 Gas fireplace 10.00 /1/(u] ,1_5 SC /ZeiICC 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 El PROPERTY . ... Chimney/liner /flue /vent 10.00 'TENANT Other: 10.00 Name: zvCici/ L Environmental exhaust and ventilation Address: Range hood /other kitchen S' ! "< equipment 10.00 City/State/ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) 5 < c"- //5�) Fax: ( ) toilet compartments, utility rooms) 6.80 • , ❑ APPLICANT' . . . - ❑' 'CONTACT_ PERSON. . Attic /crawlspace fans 10.00 Other: 10.00 Business name: A Al/ t ' ., (ok , S /0 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 ; i CONTRACTOR Barbecue � /� . Co, �� S o z� Clothes dryer (gas) Business name: /d/ Other: Address: 7)69 g �g / : ,IVIEC HANICAL;PER M IT FEES*- `' City/State /ZIP: 't /c A ' $ ©� 9 7067 Subtotal gg Fax: ( ) Minimum permit fee ($72.50) Phone: c�4 J ,,,,7\5_6:3775 Plan review (25% of permit fee) CCB lic.: /9i 1 ?'Gj / --22 — 0 State surcharge (8% of permit fee) / TOTAL PERMIT FEE Authorized stgnatu T his permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: — l %OE „/72_,.... � Date: �� — Q 5 * Fee methodology set by Tri- County Building Industry Service Board i:\ Building \Pemtits\.V¢C- PennitApp.doc 12/03 440 -4617T (11 /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation Permit Fee f $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 2 Mar 04 05 08:42a PP 1 VJ /VJ /LVVJ LV•1J [[[A V }[[ V[ [3Vt1[W .0 vvy �x 5 - 0 3 .642. 370/ VC i°<) S % CUL) \ 10) Building Division �� r `'� j Applicant Request for Permit Action k City of Tigard d P ( \G SON G \ - 0 pG, O\ �vS TO: CITY OF TIGARD, BUILDING OFFICIAL 4v -°\ N 13125 SW Hall Blvd, Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 FROM: Applicant Name: - - /OE SZE�E ( - i6•:s4 CC"! 7 _ J Mailing Address: 38` - 7-/e-/c./.545/y' City /State/Zip: 5441CY1/ e z . 9 7c 55 V 0 0 Phone No.: 5C3 JAM 0 Fax No.: 563 - 370/ PLEASE TAKE ACTION CHECKED (✓) FOR THE FOLLOWING PERMIT: I CANCEL PERMIT APPLICATION. Al REFUND PERMIT FEES. Permit No.: leD5 — 000 83 Type of Permit: /f X15 r/ Site Address: C!`! iO 5w FPhaQ.CXJk, Subdivision: /j/t/ Z Lot No.: EXPLANATION: rcMrs& G4iev c l / /C( cab Signature: Date: 3' ‘94 Print Name: --✓O E 2� +Ec t�L i FO �FI ICE' -1_ OL 2 / .!f O .. .. lN ... Route to Admin.: Date: _ By: 11111 Permit Canceled: Date: i Refund Processed: Date: d I I I I I I MI I B : Cashier Receipt: Date: �� . , n #: Amnt: 5 ��, 30 Payment T •e: Per: g ',v h' e iv = .P, o-r) e i s1Bnilding\Form3\RegpermitActon 09- 27- 04.doc