Permit CITY TIGARD MECHANICAL PERMIT
,�; DEVELOPMENT SERVICES
PERMIT #: MEC2005 -00402
r�lJ 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/6/2005
PARCEL: 2S1 01 AD -02800
SITE ADDRESS: 12665 SW 69TH AVE 100 ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 031 JURISDICTION: TIG
Project Description: Grilles in T - bar ceiling. Value: $4000
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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:
Owner: FEES
CEDAR ENTERPRISES Description Date Amount
12665 SW 69 AVENUE [MECH] Permit Fee 7/6/2005 $118.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 7/6/2005 $9.49
Phone: 503 636 - 6657 Total $127.99
Contractor:
BELL HEATING
15550 SE PIAZZA AVE • REQUIRED ITEMS AND REPORTS
CLACKAMAS, OR 97015
Phone: 503 656 - 1184
Reg #: LIC 447
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: �./ f Permittee Signature: —
Call 503 - 6394175 by 7:00 a.m. for inspections that busi s 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.
6��
M flan al Permit App � FOR OFFICE USE ONLY
�G ��// Received ' M - �
City of Tigard Date/By. 4yp< 66 PermitNo.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Rene •
Phone: 503.639.4171 Fax: 503.5 8. 96 Gt . hµ:, ,. 1I
,� Date/By: Other Permit:
e1 �
Inspection Line: 503.639.4175 0 6 20�� ■ eel l fun s: 121 Date Ready/By: s: See Page 2 for
www.ci.tigard.or.us Internet: www.ci.ti ��� Notified/Method:
g CITY OF TIGARD / C\ Supplemental Information
BIJILDI E ` OF WO RK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ddition/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.
CATEGO Y OF CONSTRUCTION
Value: $ 4 f 0
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 and 2 family dwelling Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. I Total
' JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: R. (o ` j 5 L ,/ `� 6� V/• Air conditioning ho or heat pump
/ �' (requires site plan showing placement) 14.00
City/State /ZIP: 1 4 OR. Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 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: C1' i i 0 / v G I Up 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
Z U /t-t (3 LC/ ( /-I(/,1 C. _ Y S/ £tit 2//L Y Flue vent for water heater or gas
fireplace 10.00
' (( / / /, / nie z 2- /A J 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: Environmental exhaust and ventilation •
Range hood/other kitchen
Address: 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
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 /ZIP: Wall/suspended/unit heater
Water heater
Fax::
Phone: ( ) ( )
Fireplace
E -mail: Range
CONTRACTOR Barbecue
p Clothes dryer (gas)
Business name: P� // IJl77iwq'jaL Other:
Address: /rS,S-V S� / /, 2 2/1 s T MECHANICAL PERMIT FEES*
City /State /ZIP: 47_4/lac- AAA 5 OX— i id f.r. Subtotal -fi ` 50
p (3 ) 6.s( L/` 5-0 Minimum permit fee ($72.50)
Phone: (
6 q F �O Fax: Plan review (25% of permit fee)
CCB lic.: yt / 7 State surcharge (8% of permit fee) q, L/
TOTAL PERMIT FEE /
This permit application expires if a permit is not obtained 8
Authorized signature: days after it has been accepted as complete.
Print name: a i (Vl (3d 2 % Date: 1 2/ 6 1e: * Fee methodology set by Tri-County Building Industry Service Board
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 #: MEC200600402
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/6/2005
Phone: (503) 639 -4171 �i4, p � �1
Inspection Requests (24 Hrs.): (503) 639 -4175 . -_'J -: .
INSPECTION WORKSHEET FOR DATE: 7/28/2005 TIME: 7:O8AM PAGE: 48
SITE ADDRESS: 12665 SW 69TH AVE 100 CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: A31 TYPE OF USE:
PROJECT NAME: CARLSON GROUP
DESCRIPTION: Grilles in T -bar ceiling. Value: $4000
OWNER: CEDAR ENTERPRISES, PHONE #: 503- 636 -6657
CONTRACTOR: BELL HEATING PHONE #: 503 - 6561184
Inspection Request Scheduled For: Date: 7/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 012303 -01 603-209-8935 N
Corrections/Comments/Instructions:
M cteut& ca, ro4ct, 1 ax c.
C C f:---
ASS ❑ Pt 'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL % iA ' OR INS' CTION 111 ADDITIONAL FEES ASSESSED
' I
- A .11
/ 1
Inspector 4 Date: ?Ole- - OS Phone #: (503) 718-