Permit t -
e
CITY TIGARD MECHANICAL PERMIT
A T , DEVELOPMENT SERVICES PERMIT #: MEC2004 -00457
°•I ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/12/2004
PARCEL: 1S136AB-01700
SITE ADDRESS: 10230 SW 72ND AVE
SUBDIVISION: METZGER ACRE TRACTS ZONING: R -4.5
BLOCK: LOT: 004 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:
LPG 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: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace existing gas furnace with same.
Owner: FEES
MCBRIDE, ALBERT N Description Date Amount
VIRGINIAA [MECH] Permit Fee 7/12/200 $72.50
10230 SW 72ND [TAX] 8% State Surchar€ 7/12/2002 $5.80
PORTLAND, OR 97223
Phone: Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Heating Unt lnsp
Final Inspection
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)2 69'. /
Issued y: L J 1, I jL � 1 , ,/A 4 4 Permittee Signature: k ��%�L'PPAgt e- Az ik
Call (503 639 -4175 by 7:00 P.M. for inspections needed the next business day
M Permit A9plicatiolr ,1P FOR OFFICE USE ONLY
C 1 of Ti and 'w" U Received //
Ty g Date/By: 7 / .. Q ` Pemut No.: ge yy, � i 00 y57
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review vw
Phone: 503.639.4171 Fax: 503.598.146V OF l IGAcli � � Date/By:
p Other Permit:
Inspection Line: 503.639.4175 C.�1G OI VI � 10N ■ � t\ Date Read /B Juris: ® See Page 2 for
www.ci.tigard.or.us ww.Ci.tigard.or.us , (,.� Ready /By:
Notified/Method: Supplemental lnformation
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - 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 - Value: $
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
Air conditioning or heat pump
Job site address: /B L O 0 5 &Li 7a` � A.(fe... . (requires site plan showing placement) 14.00
City/ State/ZIP: - iE,e_.,,j LI✓L q y2.3 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
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
/e ' a av (57 A( 4 A1,4- T'.rOe-A.e_ (j Flue vent for water heater or gas
fireplace 10.00
-- - �UtQ/1f�cE Log lighter (gas) 10.00
• Wood /pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
❑ PROPERTY OWNER I 0 TENANT Other: 10.00
Name: 4,/ . 67/Z-7- 7 (/. / / q/(/4 Z -0464 (Pe Environmental exhaust and ventilation
Range hood/other kitchen
Address: /a Z ?7 d .5 -7 4,140. equipment 10.00
City/ State/ZIP: n .1� . d ? 7y 2� Clothes dryer exhaust 10.00
i 1 / Single-duct exhaust haunt (bathrooms,
athrooms,
Phone: (.,503)6. —73 7 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Fuel tin
PP g
Contact name: $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City/ State/ZIP: Wall /suspended /unit heater _
•
Water heater
Fax ::
Phone:( ) ( )
Fireplace
E -mail: Range
CONTRACTOR Barbecue _
Clothes dryer (gas)
Business name:
Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Minimum permit fee ($72.50) 2 .5
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) ll
CCB Iic.: . State surcharge (8% of permit fee) 5, p � 8v
��� 7 �� jj��,�,, TOTAL PERMIT FEE 'Jp. 32
Authorized signature:
� 'e 'a�' �AC(C. This permit application expires if a permit is not obtained within 180
days after it t has been accepted as complete.
Print name ,g Al. Ac.. 64..L E Date: 7/i ., /vv_ • Fee methodology set by Tri County Building Industry Service Board
i:lBuilding \Permits \MEC- PermitApp.dtu 12/03 440- 4617T(II /02/COM/WEB)
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 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received kb, Date Requested / / AM PM BUP
Location 2�' �"i / Suite _ EC ao - &0/!
Contact Person Ph (_) 116. 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Not s: SIT
Post & Beam 4
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation f )
Drywall Nailing �`�~
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
ICOMBI G
Pos Beam
Under Slab 0
Rough -In
Water Service `/■ ! - --
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other
i
- PART FAIL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
RICAL
Service
•
Rough -In
UG/Sfab
Low Voltage
Fire Alarm
Final fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date f ?/ i/ L - Inspector
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL