Permit CITY OF TIGARD'
MECHANICAL PERMIT
N "- 1 4 * DEVELOPMENT SERVICES PERMIT #: MEC2003 -00717
.61
- �' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/16/03
PARCEL: 2S1 11 AA -02300
SITE ADDRESS: 14415 SW 86TH AVE
SUBDIVISION: GREENSWARD PARK ZONING: R -4.5
BLOCK: LOT: 015 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: 1
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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install gas fireplace insert, gas piping & flu vent.
Owner: FEES
DEHN, STEPHEN L Description Date Amount
14415 SW 86TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 12/16/03 $72.50
[TAX] 8% State Surcharl 12/16/03 $5.80
Phone: Total $78.30
Contractor:
FIRST CALL HEATING & COOLING
1650 NE LOMBARD
PORTLAND, OR 97211 -4798 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 102030 Final Inspection
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 -00
Issued By: (MOP' Permittee Signature: zlh/ ff -/° /2L / ('} icrr\/
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
++ 1Cat10II FOR OFF CE USE ONLY
• MeC a►�l><ea}. �� - Date Received � echanic ./ %/
DatBy:�;� / /�� % 7 Permit No./ 16t, Z aL3 � ' �Q
/ ,, Planning Apf ova Building
City of Tigard !U Date/By: No.:
13125 SW Hall Blvd. DEC 41 2003 Plan Review Other
Tigard, Oregon 97223 . . Date/By: Permit No.:
• . Post - Review Land Use
'
Phone: 503 - 639 -417 m ? di , ���: �A Date/
By: �c i � � f •- FP _ � • All, M I I Y Case No.:
Internet: www.ci.tig .' . . .4 e .� I Contact Juris.: ® See Page 2 for
-
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK , : -' g TCOMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
NI Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
laki & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule
DO Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS' FEE* SCHEDULE
Description I Qty Fee(ea.) Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION' and LOCATION Furnace - add -on air conditioning ** 14.00
r -
Job site address: /1/1/4,5" pf (,t> gb* 7live' Gas heat pump _ 14.00
-- - - - - -- - -�
Suite #: Bldg.iApt. #: Duct work __ 14.00
Project Name: Hydronic hot water system 14.00
J Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Repair units 12.15
Subdivision: Lot #: Other Fuel Appliances
Tax map /parcel #: _ Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 1 10.00 10 , On
__L P7 5 / Q 1/ / � c � Flue vent (water heater /gas fireplace) , 10.00 ,co . O T Log lighter (gas) 10.00
f I7✓5'.Ge e itt.5
a •sim_e_ -rf u- ./L-- Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
(PROPERTY , I ❑ TENANT Other: 10.00
Environmental Exhaust & Ventilation
Name: ,5 G � /J Range hood/other kitchen equipment 10.00
Address: / yy /S 7 6 -"./7 Clothes dryer exhaust 10.00
City /State /Zip: % ��oe HOC ! O 4�'r ?7' Single duct exhaust
Phon O. 4, 39 ie. /,--- Fax: (bathrooms, toilet compartments,
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name:
Attic /crawl space fans 10.00
Other: 1 0.00
_
Address: Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Phone: Fax: Gas heat pump **
E-mail: Wall /suspended /unit heater **
CONTRACTOR , Water heater **
Business Name:Frs -f (,,,i/ li ^ t 6vidm75 Fireplace 1 ** 5.
Addresdf ,t/cLo,7+ Range **
BBQ **
City /State /Zi ) 4-14w of epe 9 71'/ Clothes dryer (gas) **
Phone;5O24#72caS F'ax 3 256 S/ 9y Other: **
Total:
CCB L ic. #: /0„)...,:76., Mechanical Permit Fees
Authorized Subtotal: _$
Signature: i 4. ,,h0:8 Date: Z -//-1(23 - Minimum Permit Fee $72.50 $ 72.50
1-1.(404- 5F/be-S. Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ ; 130
TOTAL. PERMIT FEE $ a
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
is \Dsts\Permit Forms\MecPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503)'639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
11 - 7 �/ BUP
Received ! 3 l / Date Requested PM BUP
Location / J ,� L Suite e -3 __. 717
Contact Person Ph ( ) PLM
Contractor Ph _5 3 9 /2. SWR ��
BUILDING Tena owner _! ` �.■ ELC
Footing
Foundation Access: ELC
Ftg Drain 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 J
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 *ART FAIL
M �, r NI'AL
P . eam � t
Rough-In
s *
Gas Line
ampers
Fi na_
RT FAIL
EL ICAL
Service
Rough -In
Low olt
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 ,
Approach /Sidewalk Date Arr Inspect ' Ext
Other:
Final DO NOT • EMOVE this inspection record from the Job site.
PASS PART FAIL