Permit .
...., .T. - A , CITY OF TIG MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00026
- - ' 13125 SW Hall Blvd., Tigard, O 97223 (503) 639 -4171 DATE ISSUED: 1/18/2005
PARCEL: 2S1 12 B C -03200
SITE ADDRESS: 14685 SW 83RD AVE
SUBDIVISION: HAMBACH PARK ZONING: R -4.5
BLOCK: LOT: 016 JURISDICTION: TIG
CLASS OF WORK: ALT 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: Furnace replacement and 3 supply registers.
Owner: FEES
STAEGER, RALPH Description Date Amount
14685 SW 83RD AVE [MECH] Permit Fee 1/18/200f. $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 1/18/200f. $5.80
Phone: 503 -598 -0362 Total $78.30
Contractor:
THERMAL FLO
14865 SW 74TH AVE. #190
TIGARD, OR 97224 REQUIRED INSPECTIONS
Phone: 503 - 670 -8383 Mechanical Insp
Final Inspection
Reg #: LIC 151847
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:
)4"
>Z 1- ' - '—' ( ' ---A--)
' Signature: ,?-\ ��/ ' j
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 Tigard . f U
r Date /By: A -115 -05 a Permit No.: e __000a.6.
13125 SW Hall Blvd., Tigard , OR 97223 `' Plan Review
'Phone: SH3.639.4171 Fax: 503. Er Ew E®/�v Y l�'t Date/By: Other Permit:
Inspection 503.639.4175 V Date Ready /By: ins ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 774 Supplemental Information
Ag 1 a Zoos
T YPE oa 91 ti►. << RD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction 1j1 •Q ti@p/ I�et'eYnent Mechanical permit fees* are based on the value of the work
. LE�� performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ trt ier: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT !SYSTEMS FEES*
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: J '"7 e S . � r 0 Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State /ZIP: "--T—) lj, Are.' / -� L ( -� ga y y QV
Furnace 100,000 BTU (ducts /vents) / 14.00 �
`
Suite/bldg. /apt. no.: ✓ G � Project name: Furnace 100,000+ BTU (ducts /vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work / 14.00 /y W
—SC) Hydronic hot water system 14.00
OtAA-- )0 -5 5 „Z 3b-1 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
K e I D la e / ` -A D 4-e Ac J 3 6 Lr l y Flue for water heater or gas 10.00
�� �pf� / fireplace 10.00
i �� `"' 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: (kci I p ), 6 1 Pr Environmental exhaust and ventilation
` Range hood/other kitchen
Address: /..i& �S '� equipment 10.00
City/State/ZIP: , e- p i2 9 7 ? .2/4 Clothes dryer exhaust 10.00
CJ � / Single -duct exhaust (bathrooms,
Phone: 3 S ) 3 . 2 Fax: ( ) toilet compartments, utility moms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name:
Other. 10.00
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
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: i l Or L irk) Clothes dryer (gas)
l
Other:
Address: J 14 m» ' 1 7 ' D MECHANICAL PERMIT FEES*
City/State /ZIP: 1 15a lG e.2 I`_ q -7a q Subtotal e ,c) O
��-� / - ?L / Minimum permit fee ($72.50) 79 ,,,57-) Phone: ,O 70- 9 3 Fax: `7 ` 5,5 £ 7) - if
Plan review (25% of permit fee) ---
CCBlic.: /S /Fj 7 State surcharge(8%ofpennit fee) 5,�j()
TOTAL PERMIT FEE 7 fr3.,50
Authorized signature: 2 g ' 491.7---2 E This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Ma. / 1 1 h e Date: / — /3 - D,54 * Fee methodology set by Tri-County Building Industry Service Board
i BuildingTermits\MEC- PamitApp.doc 12/03 440- 4617T(11 /02/COM/WEB)
CITY OF TIGARD 24 -Hour
BUILDING ,Inspection Li • : (503) 639 -4175
INSPECTION DIVISION Business Lin : (503) 639 -4171 • MST
BUP
Received Date Requested �` ° AM PM BUP
Location L' • S c: K 3 I Suite 2 MEC , 66 Z Z
Contact Person �' , i ' ' '. ) 6 7D -830 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
. ELC
Foundation A c c e s s : • K p l u g toe, K 83
Ftg Drain 1RMt ELR
Crawl Drain
Slab Inspection Notes: SIT
Post.& Beam •
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear � 1 . `Q —/ M 17
Framing U _/ l>
Insulation
Drywall Nailing i
Firewall , F 0 �� ��� 2 , Z 5 d s < et 5
Fire Sprinkler
Fire Alarm ✓� ��
Susp'd Ceiling
Roof
Other: -
Final
PASS PART FAIL
PLUMBING •
Post & Beam _
Under Slab
Rough -In
Water Service
Sanitary Sewer • 40 10■••■""
Rain Drains -
Catch Basin / Manhole
Storm Drain ` —
Shower Pan
Other:
Final
1111Milr
- PASS PART FAIL'
114CROICAL
Post & Beam (R.
Gs
Gas Line
Smoke Dampers -
ar PART FAIL
TRICAL
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: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date v Inspector Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record om e Job site.
PASS PART FAIL •