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Permit C ITY OF TIGARD MECHANICAL PERMIT �yAr DEVELOPMENT SERVICES PERMIT #: MEC2004 -00288 �= 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/18/2004 PARCEL: 1S136CB-03600 SITE ADDRESS: 11115 SW 83RD AVE SUBDIVISION: STEVE + HUGHIE'S PLACE ZONING: R -4.5 BLOCK: LOT: 008 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF 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: 1 FURN > =100K BTU: < =10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Furnace and exterior A/C. Do not place A/C within the required setbacks Owner: FEES SKOFF, MATTHEW J Description Date Amount 11115 SW 83RD [MECH] Permit Fee 5/18/200 $72.50 TIGARD, OR 97223 [TAX] 8% State Surchar€ 5/18/200/ $5.80 Phone: 503 620 - 2295 Total $78.30 Contractor: EAGLE HEATING 25820 SE HWY. 212 BORING, OR 97009 REQUIRED INSPECTIONS Phone: 503 810 - 3019 Final Inspection Reg #: LIC 138893 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. Issued By: / �� Permittee Signature: 1 U � ' ? ' y r Call 03) 639 -4175 by 7:00 P.M. for inspections need the next business day • Mechanical Permit Applicat FOR OFFICE USE ONLY City of Tigard ECE ® Received yy��� ��y Date/By: 3 Permit No.ttt.itatD9'�2g 1312e SW Hall Blvd., Tigard, ORB— � 'I Plan Review 6 4� D f - 02 % iio Phone: 503.639.417171 Fax: 503.598.19 //mmt t ,i D ate B y: Other Permit: Inspection Line: 503.639.4175 ^ � ^ ,e( 04 6 7 Internet: www.ci.tigard.or.us a " " r Date Ready/By: Tuns: ® See Page 2 for g Notified/Method: Supplemental Information cm( OF - flak RD st ttiPPI • COMMERCIAL FEE* SCHEDULE -- USE CHECKLIST ❑ New construction 2r 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: $ ❑ 1- and 2- family dwelling ❑ Commercial/industrial C1 Accessory building xESIDENTIAL EQUIPIVIENTl,$YSTEMS FEES* For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION ,. Heating/cooling um or heat p p Job site address: \ C.tJ /4 v P Air conditionin /�G (requires site plan showing placement) / 14.00 City/State/ZIP: *' I ' o e l\ , Furnace 100,000 BTU (ducts/vents) / 14.00 / 7 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 p f. Q`� � ` D Hydronic hot water system 14.00 (' r` 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 F il ic a av / C_ A C 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 E PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 10.00 /�Q Other: 10.00 / Name: iA et c, J C K e //- Environmental exhaust and ventilation Range hood /other kitchen Address: S °"`y equipment 10.00 City/State/ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) ( O - 0-9S Fax: ( ) toilet compartments, utility rooms) 6.80 Q APPLICANT ' ❑ . CONTACT PERSON Attic /crawlspace fans 10.00 � Other: 10.00 ,(� Business name: E / % t 9 1 g 14 .ea T) ineg_ Fuel piping Contact name: fa e' 5 KQ r'a - - -' $5.40 for first four; $1.00 for each additional Address: f 0 e2 ( I L/ q 3 Furnace, etc. Gas heat pump City/State /ZIP: Wall/suspended /unit heater Phone: ( *v3) . . .t q 7 Fax: : (''o3 Water heater Fireplace E-mail: 6 yJ -gO47 G Range CONTRACTOR - Barbecue Business name: "i" 6 1 ea P jsr � - �f A- C Clothes dryer (gas) C! Other: Address: e .,„ e c X r y r 3 - . 4 _� MECHANICAL PERMIT FEES* City/ State/ZIP: E d c ., ?Id g_ p 1 ' 9 q 0 © 9 Subtotal Z es-- Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 7 2. 0 Plan review (25% of permit fee) CCB lic.: 1 3 g e ' ? State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature:/ �5 This permit application expires if a permit is not obtained within 180 d days after it has been accepted as complete. � Ye p� Print name: � — , Date: 5 — /p - a ` Fee methodology set by Tri- County Building Industry Service Board i:\ Buildineermi ts\MEC- PetmitApp.doc 12/03 440- 4617T(11 /02/COM/WEB) Mechanical Permit Application - City of Tigard Y, 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- PemvtApp.doc 12/03 2 4 • • :. ; '', I '' :''' 1 : ‘ 1 ' . • . • I E.R--,- . . frt-q__ • • • • • o . i . fro . , . • , . ( . , . . . , 01 (-0.1._. . ,, ,. . .. . . �� . . , ., .. . , . .. . . . , . . . , . . , , . . , . . . , . . . .. . . . , , . • • • r • CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received 7 Date Requested �1 / / AM PM BUP Location /MS M l S 83 4-i2 Suite MEC aka 1 06° Contact Person Ph ( ) PLM Contractor Ph ( ) SWR / BUILDING Tenant/ up 6 ? O - Z 2 [ s ELC 07� " Od . 4 ) Footing Foundation ELC Access: Ftg Drain O M 1 �l ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm • Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain _ Shower Pan Other: Final . PASS PART FAIL MECHANICAL Post& Beam Rough -In Gas Line Smoke Dampers AP' PART FAIL CTRICAL Service / J i Rough -In ` /'AV/II `� UG/Slab Low Voltage �A F : Alarm 'AS - PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE 0 Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA Date 61 OH Inspector ( Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL •