Permit C ITY OF TIGARD MECHANICAL PERMIT
jetl DEVELOPMENT SERVICES PERMIT #: MEC2006 - 00152
A II DATE ISSUED: 4/14/2006
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2S 101 AD -01400
SITE ADDRESS: 12700 SW 68TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 033 JURISDICTION: TIG
Project Description: TI Duct work, relocate hood, 3 registers. Value: $700.00
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B 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: REPAIR UNITS:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
OREGON KI SOCIETY Description Date Amount
12700 SW 68TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 4/14/200E $72.50
[TAX] 8% State Surcha 4/14/200E $5.80
Total $78.30
Phone:
Contractor:
TOM MILLER REMODELING
3636 SE GLENWOOD
PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 318 -6632
Reg #: LIC 106900
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: ,,Z�fj Permittee Signature: `/1.�/!/j/i/ / ../11
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 t e project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Per> iftaca Lion FOR cirri <.I: usl: (�,� L.�
City of Tigard V ED Ak , " y. m U ! 6 Permit N. u 6 b _op
,
13125 SW Hall Blvd., Tigard, OR 97223
Plan Re' i w
Phone: 503.639.4171 03.
Pho03.639.4171 Fax: 55 6 ,i,.,.1 Other Permit:
ap Ai 1 4 2006 J,l � �eRY
Inspection Line: 503.639.4175 _ _ / _ I Date Ready/By: lwis El See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD J Notified/Method Supplemental Information
SUILIOIMpOnghE
COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
emolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ 70O
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 2,.....700 5 'ill ) &?-- `/ .' Air conditioning or heat pump
(requires site plan showing placement) 14.00
City / State/ZIP: 776 0 Q 7223 Furnace 100,000 BTU (ducts/vents) 14.00
` /� Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: /7
Gas heat pump 14.00
Cross street/directions to job site: Duct work f 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
74/7D1 770 / A '� a. ki Gas fireplace 10.00
V Flue vent for water heater or gas
Du ? • , . /.� -_ I n an 5 fireplace 10.00
,/ (,( $ - f� J'U! ` 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: (9(0•67-69 / S: y Environmental exhaust and ventilation
Address: Range hood/other kitchen
r�� equipment / 10.00
City /State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
.APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: - 704.4 /��G� / ��G -1� ( 4f/ Other: 10.00 _
Fuel piping
Contact name: 70714 /l,L $5.40 for first four; $1.00 for each a dditional
X36 /1, Furnace, etc.
Address: �[ %J 5� Gas heat pump
City /State/ZIP: f'17/V') ,O,g_ g720 Z Wall/suspended/unit heater
Phone: ( }) --- ‘063 7 I Fax:: (5j) 777 -Q 2 Water heater
��/C ( CO'AA � Fang
E -mail i "�" ( Range
/
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State/ZIP: Subtotal 7 , 5
Phone: ( ) ( ) Minimum permit fee ($72.50)
Fax:
Plan review (25% of permit fee)
CCB lic.: /0C4 J /a ` 0 -07 State surcharge (8% of permit fee) lco
TOTAL PERMIT FEE 1 ,;0
!...,/ This permit application expires if a permit is not obtaine wit hin 180
Authorized signatur / : / / days after it has been accepted as complete.
Print name: 7 A,/, I Date: - 4i4 1 • Fee methodology set by Ili-County Building Industry Service Board
1:\ Building \PennitAMEC- PamitApp.doc 12/03 440- 4617T(11 /02/COM/WFB)
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 2
CIT6f6OF TIGARD _�
BUILDING DIVISION ( Z4 j PERMIT #: MEC2006-00152
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14120()6
Phone: (503) 639 -4171 �AIII
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/10/2006 TIME: 7:04AM PAGE: 4
SITE ADDRESS: 12700 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 033 TYPE OF USE:
PROJECT NAME: OREGON KI SOCIETY
DESCRIPTION: TI Duct work, relocate hood, 3 registers. Value: $700.00
OWNER: OREGON KI SOCIETY, PHONE #:
CONTRACTOR: TOM MILLER REMODELING PHONE #: 503 - 318 -6632
Inspection Request Scheduled For: Date: 8/10/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 034746 -02 503-318-6632 Y
Corrections /Comments /Instructions: ( f 00 -- ( '. CC)
11, _ ►
in _ �_.
. I - —
P ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CA FOR I PECTION ❑ ADDITI NAL EES ASSESSED
- r
lJ
Inspector: I - Date: t v� Phone #: (503) 718 -
CITY. OF TIGARD
BUILDING DIVISION PERMIT #: MEC2006-00152
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/200G
Phone: (503) 639 -4171W ii ll
Inspection Requests (24 Hrs.): (503) 639 - 4175 4-
INSPECTION WORKSHEET FOR DATE:
6/22/2006 TIME: 7:01AM PAGE:. a
SITE ADDRESS: 12700 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 033 TYPE OF USE:
PROJECT NAME: OREGON KI SOCIETY
DESCRIPTION: I Duct work relocate hood, 3 registers. Value: $700 00
OWNER: OREGON KI SOCIETY, PHONE #:
CONTRACTOR: TOM MILLER REMODELING PHONE #: 503. 318.6632
Inspection Request Scheduled For: Date: 6/22/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 032179 -03 503. 318 -6632 N
Corrections /Comments/ Instructions:
C4S - htrctAZT- N9 c--v 2 -6.715 .
&)c,..1 /&>,.. 4, A,,o.ct 1V-k-v< ?S fee:L/1 v -----
•
Oiyulyzej--- III _! , - 1Tj
L i�.. ■ O - —
z c .' A sLe , /s a s,�,ds ,i2
7--- / . Z e.-(tJ ' : 1 d
l J , ^ .[ S cam„ _ . ,e,l ,
(-o
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: l0 / / Phone #: (503) 718- 2 7 1
CITY .. F TIGARD •
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14 (ri,
Phone: (503) 639 -4171 At�q i
Inspection Requests (24 Hrs.): (503) 639 -4175 11-
INSPECTION WORKSHEET FOR DATE: 61'l /2C"3f; TIME: 7 O3 M PAGE: 31
SITE ADDRESS: 1 ?NO S\ t ; ('H AVE CLASS OF WORK:
SUBDIVISION:: ?> 1' PORTLAND FI •I GH l - S LOT #: ()_ + =; TYPE OF USE:
PROJECT NAME: ORION ;_G KI SOCIETY
ETi`
DESCRIPTION: 1f , ^ ..r l t ! f ' 3 s k rs.
��I GL " "a. baQ�,., i . C:C:;y .1C1�+a fEl...t' V;¢I;4•: . r` �v.
OWNER: lai - ?i ' +;%1 ?±) SOC FrY, PHONE #:
CONTRACTOR: TOM Ia.LaC PHONE #: 30a -3 F;--€6::12
Inspection Request Scheduled For: Date: €Ar.1 /,r vo,, Pour Time:
Code # Inspection Description Confirm # Contact # Message
�:_. '.• r.'UULI wl< 030926.03 503 ' I l.. ( 32 si
Corrections /Comments/ Instructions:
•
• IL _ _/11
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FO INSPECTION ❑ ADDITIONAL FEES ASSESSED
W EI Inspector: / Date: 1Q ( IJP Phone #: (503) 718.--24
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4; 1 .4f
Phone: (503) 639 -4171 Az,u yl
Inspection Requests (24 Hrs.): (503) 639 -4175 _!�±J' `__..
INSPECTION WORKSHEET FOR DATE: (V1/2008 TIME: 7:03 A M PAGE: : {2
SITE ADDRESS: 12700 i?W f:t ;'I I : AVE CLASS OF WORK:
SUBDIVISION: VvFS T PO;fl'L.f i''1[) E'161(ar"i i S LOT #: 03 TYPE OF USE:
PROJECT NAME: CF EGON i <.`; SO:.ii..
DESCRIPTION: i'I 6:iuc.1 Farr!.:, ukAocai.. ;: hood, 3 regi:: :iv; J;:lue $700.00
OWNER: ORD: 0i PHONE #:
CONTRACTOR: TOM WEER Ri.:l.1ODi::1.6:'''r PHONE #: ?503- 31ts.9 :32
Inspection Request Scheduled For: Date: 6,1 Pour Time:
Code # Inspection Description Confirm # Contact # Message
03092e. ! 3 is !' � 3 , .r
.. . +l,I:ti� � li, .��i,.
•
Corrections /Comments/ Instructions:
: IL . 4111. AginliWnw‘igr
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
A&) Inspector: Date: 1 o`' Phone #: (503) 718k
CITY Of TIGARD
BUILDING DIVISION PERMIT #: Or.
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4j142;
Phone: (503) 639 -4171 11
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR • DATE: (1'1/2003 TIME: 7 :')'WM PAGE:
SITE ADDRESS: . 12/0() SW E:s)Ti - AVE: CLASS OF WORK:
SUBDIVISION: v■irt.S1 RC V<1 LANt) ! �: . li ti) l� LOT #: 63s TYPE OF USE:
PROJECT NAME: OPI s; 'J i:: SOCIETY
DESCRIPTION: 11 !: v0i. i' re!=;caie 3 ret}it;:ters. fi7i GO
OWNER: OREGON K.! SOC:AE :. 1` PHONE #:
•
CONTRACTOR: T(4,41 MILL s . RE1 [l J1'.!G PHONE #:
Inspection Request Scheduled For: Date: 611/200;; ; Pour Time:
Code # Inspection Description Confirm # Contact # Message
;10 Gas lire 030.92t.:;-.01
Corrections /Comments / Instructions:
7\
s
\r}1 k°
•
❑ ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` Date. ' V Phone #: (503) 718- - `
I �.
CITY CIF TIGARD _ , -
BUILDING DIVISION PERMIT #: MEC2006 -00152
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4114/2006
Phone: (503) 639 -4171 /o ,
Inspection Requests (24 Hrs.): (503) 639 -4175 :_..
INSPECTION WORKSHEET FOR DATE: 4/17/2006 TIME: 7:05AM PAGE: 26
SITE ADDRESS: 12700 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: WWE3T PORTLAND HEIGHTS LOT #: 033 TYPE OF USE:
PROJECT NAME: OREGON KI SOCIETY
DESCRIPTION: TI Duct work, relocate hood, 3 registers. Value: $700.00
OWNER: OREGON 1<I SOCIETY, PHONE #:
CONTRACTOR: TOM MILLER REMODELJWG PHONE #: 503 -318 -6632
•
Inspection Request Scheduled For: Date: 4/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 PoWbearn mechanical 028170 503 318.6632 `r
Corrections /Comments /Instructions: l
A,,
, . .
/ ..-
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALI, FOR INSPECTION ❑ ADDITIONAL FE S ASSESSED `
d e -
Inspector: MO Date: 4 l Phone #: (503) 718-