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Permit 1 C ITY OF TIGARD MECHANICAL PERMIT _lilt DEVELOPMENT SERVICES PERMIT #: MEC2005 -01001 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/17/2005 PARCEL: 1 S136AA -00301 SITE ADDRESS: 10240 SW 69TH AVE ZONING: R -4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: Install wood 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: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: WOD 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: UNITS: FIRE DAMPERS ?: 30 - 50 HP: REPAIR REPAIR UNITS: GAS PRESSURE: 50 + HP: O O DRYERS: FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1 FURN > =100K BTU: <= 10000 cfm: GAS O > 10000 cfm: Owner: FEES LESTER WEBER Description Date Amount TIGARD, DW OR 97223 223 AVE [MECH] Permit Fee 11/16120( $72.50 IGAD, OR 97 [TAX] 8% State Surchaq 11/16/20( $5.80 Phone: 503- 293 -9696 Total $78.30 Contractor: OWNER REQUIRED ITEMS AND REPORTS Phone: Reg #: This permit is issued subject to the regulations contained in the T rd Municipal pCoodi t o a iR p clan° Codes s within 180 other days applicable laws. All work will be done in accordance with approved the of issuance, or if work is suspended for more tan harelset days. rth in OAR ATTENTION: Oregon law 0010 through�OAR 952-001-0080. 1 You may obtain copies Oregon Utility Notification Center. Those rules of these r s-er-direct questions to OUNC by calling 503- 246 -198 or 1 -800- 332 -234 L .a Issu By: . - i . Pennittee Signature• . Call 503- 639 -4175 by 7:00 AM for an inspection that business 503 718 -2433 for assistance. Note: If you cannot schedule an inspection while the system is down, please This permit card shall be kept in a conspicuous on the job site at the time of each completion the project. Approved plans are required 1 Mechanical Permit Application ►FOR On lcI: Hsi.; ()Nix ;► 3'i r Date/By. Permit No.: .` //� �/(�/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 i .,r Other Permit: Inspection Line: 503.639.4175 +ice / "1 ` ` 1 Date _I_ Date adyBy: 65 See Page 2 for Internet: www.ci.tigard.or.us J Re Notified/Method: Supplemcntal Information TYPE OF WORK 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 ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1 - and 2 g ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. 1 Total JOB SITE INFORMATION AND LOCATION Heating/cooling L.J 1 6-C"-A.4.. Air conditioning or heat pump Job site address: 1 MO S , ..J (requires site plan showing placement) 14.00 City /State/ZIP: T; y c„_r a 0 R 9 7 Z,2'3 Furnace 100,000 BTU(ducts/vents) 14.00 Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17.90 J E o. IT t. 5 1 u t 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 't c : r. s *.4 • o o d 5-t: o v t 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 ❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00 Other: 10.00 Name: L. L S ttr w 4-10 tuf --3—e. Environmental exhaust and ventilation Address: 1 O 2 y 0 5_ti i 6 9 t Ac v 4. Range hood/other kitchen _equipment 10.00 City /State/ZIP: • ; it 9 ► 2.. 3 3 — Clothes dryer exhaust 10.00 5 G�.r^ 0 Single -duct exhaust (bathrooms, Phone: (5 03) 19 3 .) 6 9 6 Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 • Other: 10.00 Business name: - Fuel piping Contact name: S5.40 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 • CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* ©tO City / State/ZIP: Subtotal Minimum permit fee ($72.50) (. J` D Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB tic.: State surcharge (8 %ofpermit fee) 5. «C) �� � TOTAL PERMIT FEE ?$, ,3D Authorized signature: c79 4 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: L c.. g + Cr — W .4._10 4tr .N e D ate: \ — l 4, — c S • Fee methodology set by Tri- County Building Industry Service Board i:\ Building \Permits\MEC- PermitApp.doc 12/03 440- 4617T(1I /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 CITY OF TIGARD. BUILDING DIVISION PERMIT #: MEC2005.01001 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 111'1! /`,(:(I5 Phone: (503) 639 -4171 'N� (�� Inspection Requests (24 Hrs.): (503) 639 -4175 `'I INSPECTION WORKSHEET FOR DATE: 5/23/2006 TIME: 7:03AM PAGE: 913 SITE ADDRESS: 10240 SW 69TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: WEBER DESCRIPTION: Install wood fireplace. OWNER: WEI3ER, LESTER PHONE #: 503 - 293 - 9696 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5/23/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 695 Mi ;c. inspection 030363-01 603- 293.9696 N Corrections /Comments/ Instructions: I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: el Date: S– Z3-- o4 Phone #: (503) 718 - 244.-K—