Permit M1 � CITY OF T MECHANICAL PERMIT
4.0010 I DEVELOPMENT SERVICES PERMIT #: MEC2004- 00311.
- 61 DATE ISSUED: 5/25/2004
13125 SW Ha Blvd., Tigard, OR 97223 '(503) 639 -4171 PARCEL: 1 S436CB -03200
SITE ADDRESS: 11235 SW 83RD AVE
SUBDIVISION: STEVE + HUGHIE'S PLACE . 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:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15- 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 -'50 HP:
•
' GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
' FURN > =100K BTU: <= 10000 OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install gas line and add -on for dryer
Owner: FEES
ROBERT GRIFFITHS Description Date Amount
11235 SW 83RD ' [MECH] Permit Fee 5/25/2002 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl ' 5/25/200' $5.80
Phone: 503 -381 -1697 Total $78.30
Contractor:
ALINE INC.
4221 SE 113TH
PORTLAND, OR 97266 REQUIRED INSPECTIONS
Phone: 503 - 760 - 8433 Gas Line Insp
Final Inspection
Reg #: LIC 138272 '.
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and,all 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 -OS I • •u • h OAR 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503) • 6699.
Iss ed By � / 1r /` % Permittee Signature: s.
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
%.
City of
13125 SW Hall Blv Tigatd d., Tigard, OR 97223
Date/By: " e
Plan RevievT Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 fe c2 1 919 ....
Other Permit:
/4.000 Date/By:
Inspection Line: 503.639.4175 L-.7.1.4. ■ 1# 112. Date Ready/By: ei See Page 2 for
___
Internet: www.ci.tigard.or.us Notified/Method: r r -. 0,.. Supplemental Information
TYPE OF - WORK :,,:„,-._.'„ ' ,-, •;,: :; •: i.„\-;,.`,...:-, ; ,..„. , ..,_, : ,COMMERCIAL EE'YSCIftEii.JLE
0 New construction 0 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
0 Demolition ErOther: Gq 5 Lo4-- A 0O 0 ^-) mechanical materials, equipment, labor, overhead, and profit.
.. ,
CATEGORY„ OF CONSTRUCTION Value $ Y" 1 11'.43:;-2,N.;
4 ..
Err and 2 dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION :'' ::::Nb: Heating/cooling
rd
Job site address: a I , 3 S S up 0 "2 0 ...., - Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: o 1 . Furnace 100,000 BTU (ducts/vents)
14.00
- Tilo o rd2 7.P..a 3
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
-- . r.: . .-; ' ,, DESCRIPTION 'OF WORK -: , - .. . :1' -, ,,,.., Water heater 10.00
k ' - • '
" . ,.,
Gas fireplace 10.00
GAS L1 ft -,- A 0 n 0 A) 'RI( niter 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
",- .., Chimney/liner/flue/vent 10.00
. . . IP' OWNER' .,.-.' ', ,:. ,., -r, : _ 0 TENANT :-:'
. . . .. . ... .. , . , . _ , _ _ ..... , , . Other: 10.00
Name: R 0 10 e Ge : f-F, 1.-4. S Environmental exhaust and ventilation
Range hood/other kitchen
Address: / / . 35 s (A) 8 . 3
equipment 10.00
City/State/ZIP: 77 Q , c p 0,e. 9 7,AP. 3 Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( 5e'3) 31 1 l 7 Fax: ( ) toilet compartments, utility rooms) 6.80
,-,-. i :, '. •:. , 11 APPLICANT :.-': '- ' - ' : ; , , : "E''.CONTACT, PERSON :4=';,',4.,, Attic/crawlspace fans _ 10.00
Other: 10.00
Business name:
Fuel piping
_
Contact name: . i . 0 ke f +- r r- f el% S' $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
5 cit...% -.1---__ Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail: Range
. . CONTRACTOR' '_--, - • '-' -- . - • . -,' Barbecue
.
.
• Clothes dryer (gas) I 5.14 i; Llo
Business name: L L 4 , ,. c .
Other:
Address: L i c: I S.E // 3 : :.-, - . ' •-•-; MECHANICAL PERMIT FEES • . • • '-
City/State/ZIP: )20C 7 -- 0 2 . ? 7a4‘ Subtotal
Minimum permit fee ($72.50) '7 sb
Phone: (5 ) 3 /7_ g 4./ 3 Fax' ( 503) 74 0 -* ?* 3 3 Plan review (25% of permit fee)
CCB lic.: /3 4 5) ,2 72_ State surcharge (8% of permit fee) ..'. 50
TOTAL PERMIT FEE 7S; 39
Authorized signature:
This permit application after it expires if a permit is not obtained complete. within 180
p a€ 4 9-t&A,k_i cAie4A:e
- days has been accepted as
,
Print name: .7- o
4 ecO S. A-Lre.ri /4 r Date: 5 --,25-... 0 y . Fee methodology set by Tri-County Building Industry Service Board
i: \Building Werrnits \MEC-PerrnitApp.doc 12/03 440-46I7T (I I/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 fast $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 Lind: (503) 639 -4175
INSPECTION DIVISION Business Line:.. (503) 639 -4171 MST
f BUP
Received /.' � Date Requested J - 2 7 461 / � v PM B
Location //Z,3 roc Suite 'A (D- //
Contact Person 4 , "! Ph cD 3) 3'/ / ( 9 7 PLM
Contractor 0-4 P ( 5 ?) PZ53 SWR
BUILDING Tenant/Owner _ � �'� . � � _ ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: /� SIT
Post & Beam / ' --+'�
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear r• � 0 2.i t
Framing
D on i --t 1c( 2060 I l
Drywall Nailing ll 1 ` Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
_ f
Water Service
• Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: -
Final -
PASSiP&RT FAIL
M A C
Po m
Rou• h -In
S o e lP ampers
F : •
� `• PART FAIL
RICAL
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 Please call for reinspection RE: JJ Unable to inspect — no access
Fire Supply Line
ADA rr g
Approach/Sidewalk Date Inspector V(--: Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL