Permit {
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CITY TIGARD MECHANICAL PERMIT
� �� DEVELOPMENT SERVICES PERMIT #: MEC2005 -00202
A ' l!� DATE ISSUED: 5/2/2005
"�--° "` 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 105DA -01300
SITE ADDRESS: 14676 SW JENSHIRE LN ZONING: R -12
SUBDIVISION: HILLSHIRE CREEK ESTATES LOT: 019 JURISDICTION: URB
Project Description: Add A/C unit.
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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
FRAZEY, JOAN Description Date Amount
14676 SW JENSHIRE LN
TIGARD, OR 97223 [UMECH] Permit Fee 5/2/2005 $72.50
[UTAX] 8% State Sure 5/2/2005 $5.80
Total $78.30
Phone: 503 -579 -1863
Contractor:
COST PLUS HEATING + AIR
7132 N FESSENDEN ST
PORTLAND, OR 97203 REQUIRED ITEMS AND REPORTS
Phone: 503- 286 -2009
Reg #: LIC 47978
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:
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.
Mechanical P &rinii A 1Wrr IVE FOR OFFICE USE , _
City of Tigard Received G
13125 SW Hall Blvd., Tigard, OR 97223 pp qq nn
Date/By: ), �Q S P/1/4L permit N ��p�
Phone: 503.639.4171 Fax: 503.598.1960 1 °iHY Plan Review
O 200 / 11, Date/By: OtherPerntt '\
Inspection Line: 503.639.4175 AI Date Ready/By: di S ee Page 2 for
Internet www.ci.tigard.or.us CITY Of: l �1liN i N otified/Method: '( �z^[j� lementallnformation
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Tr ' ,• O; 1 ' _ COMMERCIAL FEE *: DfiLE = 'USE CHECKLIST
Mechanical permit fees* are 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 -'- i. A` Value
and 2 dwelling rRES1DENTIAL E QUIPMENT /SYSTEMS FEES*
yi 1
y g ❑ Commercial /industrial ❑ Accessory building ' .
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. I Total
'JOB 'SITE INFORMATION , AND LOCATION Heating/cooling
�` j�
Job site address: / y �p 0 / r Air conditioning or heat pump
7 L(J 'K �C (5 % � "1 �� (requires site plan showing placement) 1 14.00 1 y.�
City/State /Z1P: ‘ 5 e ¢ ( 64.. 9 7 Z'ZJ 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: e i5 A r Co " .. 00 f i Z e' - 8(.110 Duct work 14.00
Hydronic hot water system 14.00
reviLL C t " I k s 4 ..re, p'. Residential boiler (radiator or
rJ - + - tA (. ZV c . s 4 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'WORKs Water heater 10.00
�a. 4- 4 = J et-/c_ Gas fireplace
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
i, .. ,r,, -- Chimney /liner /flue /vent 10.00
- PROP , OWN ER ti IN': TENANT
�� Other 10.00
Name: 04 r A - Lei Environmental exhaust and ventilation
4P `j .i a Range hood /other kitchen
Address:
`"� � C+ �a 5 � ' ti '''t equipment 10.00
City/State /ZIP: 'Tt e, S art q - z - t 3 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (SO) j 7'- /eli 3 Fax: ( ) toilet compartments, utility rooms) 6.80
C fans
i .;, : ❑• APPLICANT '` : � ? ❑ PERS �: ' crawlspace
At tic/ 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 /Z1P: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
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CONTRACTOR v . _ _ . ' h Barbecue
Business name: e 5 7 /0/� s f4Grct:'4 ZrS, Clothes dryer (gas)
7��Z � Other
Address: Fessea c e MECHANICAL PE F -
City /State/ZIP: f iv✓1-- $YL. S' 72,.c. 3 Subtotal t �'"`
Minimum permit fee ($72.50) -72
Phone: (7) ) R 81i -2.009 Fax: St>) :2-g4 ee f f - Z. Plan review (25% of permit fee)
CCB lic.: tl 7 4' 7 Y State surcharge (8% of permit fee)
TOTAL PERMIT FEE d 8
Authorized signature 1 days after it This p ermit application expires if a permit is not obtained within 180
�����JJJ f has been accepted as complete.
Print name: s$ PV ,So4YC -c1 e l Date: ... VV / o f * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits \MEC- PermitApp.doc 12/03 440- 46117T(11 /02 /COM/WEB)
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Mechanical Permit Application City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total,Valuaton , ''.r Permit Fee,' r,,.
$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 arid $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\Perrnits\MEC-PermitApp.doc 12/03 2
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