Permit CITY TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2004 -00711
ca I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/27/2004
PARCEL: 1S125DB-03703
SITE ADDRESS: 09510 SW 74TH AVE
SUBDIVISION: BOULEVARD HEIGHTS ZONING: R -4.5
BLOCK: LOT: 023 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Add gas insert. Gas piping installed and inspected under MST2004 00037.
Owner: FEES
MINETTO, STEVEN L + JAN V Description Date Amount
9510 SW 74TH AVE [MECH] Permit Fee 10/27/20( $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 10/27/20( $5.80
Phone: 503 245 - 1555 Total $78.30
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503
Final Inspection
Reg #: LIC 126881
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 0.0 -1-0_ rough OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503 46 -6699.
/ i Iss ed By: 1 ,_e� � -� /f,____, Pe rmittee Signature: bm
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application , ' FOR OFFICE USE O NLY
City of Tigard Permit No.: Date/By:
�0��/�,; J�` ,
IG ,, -z o 7/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4.0 m� 1 Date /By: Other Permit:
Inspection Line: 503.639.4175 —Air W I i Date Ready /By: .--7,0 Juris: Ed See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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 Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: q '5 m 5.. I / q( ( v, Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State /ZIP: r 3 ' � 6 K 2. 3 Furnace 100,000 BTU (ducts /vents) 14.00
5 t v Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: 11 �216�..t_ I i Se .rfi Gas heat pump 14.00
Cross street/directions to job site: I 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
`� Y\ 5,2 -F l ' /L (� Vee � f-f' , Flue vent for water heater or gas
1 I fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
` PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: 5P 11<- 4 T� n Y ,nek D Environmental exhaust and ventilation
Range hood /other kitchen
G
Address: - i 6 0 � .... („) qL'-1'`' A , equipment 10.00
City/State /ZIP: O K ° � 3 Clothes dryer exhaust 10.00
� ' ��� Single -duct exhaust (bathrooms,
Phone: t5 G ° ) :,iti l (5 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Fuel t to
P g
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
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: I,� j c"le�� Clothes dryer (gas)
V \ +Yl YJ lit (U� ` ` fl O Other:
Address: • / ` MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal
Minimum permit fee ($72.50) 7f„ ,V
Phone: ( ) Fax:( )
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee) S $d
TOTAL PERMIT FEE 7g, 33
� � This permit application expires if a permit is not obtained within 180
Authorized signature: I V Ul,Cl�U days after it has been accepted as complete.
Print name: - t' ^ ML r� Date: (0 ) - — (ft y * 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 24 -Hour
BUILDING Inspection Line: (5'-; 639 -4175
INSPECTION DIVISION Business Line: -(5 Ii.:) 639 -4171 MST
BUP
Received Date Requested t! AM PM BU
Location ' / tb )61-- 1 - Suite M E C 46)
Contact Person Ph (_ ) PLM
Contractor Ph ) SWR
BUILDING Tenant/Owner •/ ■1 — 15 ELC t 6V-
Footing
ELC
Foundation
Ftg Drain Access: g - <� , o
ELR
Crawl Drain
Slab Inspection Notes ;i1a SIT
Post & Beam _ 0. ®,.cirmr.G.,—�:w
Shear Anchors " - e " —' ``
Ext Sheath/Shear v
Int Sheath /Shear �Framing
Insulation j416 Al&B� 4' LI G /NS :
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING f
Post & Beam _ i■
Under Slab '"
Rough -In f 0 .
Water Service C- 1
Sanitary Sewer '4
Rain Drains
Catch Basin / Manhole i _ `
Storm Drain
Shower Pan
Other:
Final
PAST FAIL
VItCHANIOL
Post •& Beam ( r. A-
Rough -In i , '
Gas Line
Smoke Dampers
' PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL -
SITE 0 Please call for reinspection R • / E Unable to inspect — no access
Fire Supply Line
ADA / / 6 ,
Approach /Sidewalk Date / r Inspector Ext
Other: `
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL