Permit . CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00772
'l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/29/2004
PARCEL: 2S 111 AD -01300
SITE ADDRESS: 14625 SW 87TH AVE
SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5
BLOCK: LOT: 010 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace with like kind.
Owner: FEES
MARIE KNIGHT Description Date Amount
14625 SW 87TH AVE [TAX] 8% State Surcharl 11/29/20( $5.80
TIGARD, OR 97224 [MECH] Permit Fee 11/29/20( $72.00
Phone: 503 381 - 0239 Total $77.80
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 447
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 -6.''
Permittee Si nature ' #.'
Issued By: _ / / 9 �., :: iiT..7.� •`
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next • siness day
Mechanical Permit Applicatio G0 FOR OFFICE USE ONLY
13 S Tigard G Received Permit No.: ..64, 7 7 ?.
125 SW Hall Blvd., Tigard, OR 97 G
Phone: 503.639.4171 Fax: 503.598. 6� ;.; , .,_ ;, ( t> Plan Re ew // f3� �= I/ 4 OtherPermit:
Inspection Line: 503.639.4175 `+ 2 900 .' I ,
Internet: www.ci.tigard.or.us 0 O C j 1 Owi Date ed/Me Ready/By: Jwis: Supplemental See Page 2 for
!S P " ``' Nottfied/Method: i gay . Supplemental Information
., yw a : ,, t,ac � . -) r as t ai'° 3 E31S
:.vazit , ,
... ti.s. .,.+rte . _._..z 1���ctta.s .. TTB:I ST
Mechanical permit fees* are based on the value of the work
❑ New construction I Addition/alteration/replacement
performed. "Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
1.16" T:tlt:.IM;t 0. & as7 3 c 44,,'S N�@5 "l ;.;1 ,..
t r .+ � Value $ vii
�, r . - .1 -- g ' �4: �H' -r.� :::: ... tell _--vd 3.' , _ .. , .a. �- q “, , ._ -
� 8'` ' N6 'E J - : , a l . r t+... .'. "T F�`EE.S*
1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building m
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. Total
r. ,' a _ n k ' � �� '. u � e a w f3 . nip l' : ' Heating/cooling •
Job site address: �y Q -�- Air conditioning or heat pump
4�a � S u �3 (requires site plan showing placement) 14.00
City/State/ZIP: -i'-lG n Q 9 nZ A ' Furnace 100,000 BTU (ducts/vents) 1 14.00 1'f
Suitelbldg. /a t. uc.: Furnace 100,000+ BTU (ducts/vents) 17.90
p 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
Subdivision Lot no.: Flue/vent for any of above • j 10.00 10,c C
/ Other: 10.00
Tax map /parcel no.: 1 4� 5 5 Fro Other fuel appliances
P' 'w4 .t. �3` .,.. , f 8 5e ci0 it 4 W ; § 'xc. i . 1 +14.�..r' § s ' . g i Water heater 10.00
t ai._ . - 4*A ' '-r . �V_n _s € C'
Gas fireplace 10.00
(I H- C L L _ C A 5 Fu wd; ACC, 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
] ^1 , « ,V . ,.
�,. , < '4, Chimney/liner /flue /vent 10.00
r 4 - � � =-- ' .i Other: 10.00
Name: M t • V&INBNIMIIIIIIII Environmental exhaust and ventilation
Address: 1 4a S u') 9 7 - R u.e. , Range hood/other kitchen
V equipment 10.00
City/ State/ZIP: G Akz 0 Q�G. 9 -12.2A Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (; l) 3( • . • Fax: ( ) toilet compartments, utility rooms) 6.80
F.7.-ti. b y « �`.> ` s�.4 i. Ms,{s a 1 �t". Attic /crawlspace fans 10.00
Other: 10.00
Business name: ! ELL - ^� \ , N Y ' Fuel piping
Contact name: A( . o Y(Pt T T ¶5.40 for first four; $1.00 for each additional
Address: /,SS SO ZE PI AZZ A v�
Furnace, etc.
Gas heat pump
City/ State/ZIP: CLp cKA M A,.. 2.._ 9 - 7 o LS / Wall/suspended/unit heater
Phone: (,,c, 5 ) 65G - U E A. TFax : : (S pi ) 6 7 s l I Water heater
Fireplace
E -mail:
Range
d '•' :I f, t •r w S ,% t ti:
M: ,1 . :. . s f 4 ,4+ r . < _ - Barbecue
Business name: Clothes dryer (gas)
Other:
Address: / , 1, �,a s7 s: °rm
City/State/ZIP: ` Subtotal 2. 11,
7 I Minimum permit fee ($72.50) 72, Di,
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lic.: yy7 State surcharge (8% of permit fee) 5
i i CirsiA... T OTAL PERMIT FEE 7, et, Authorized signatu +� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: (7 . I CO S tit I Date: / * Fee methodology set by Tri County Building Industry Service Board
i.'Building\Permiss C- PermisApp.doc 12/03 440- 4617r(1l/02/COM1WBBI - -
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
r.
Commercial Fee Schedule:
$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
$1.3.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.
is\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
(_c?-� D BUP
Received Date Requested -- -� AM Ivy PM BUP
Location I I/ P t -
Pas' ? 7 / - — Suite � 0077.2_
Contact Person Ph ( ) PLM
Contractor -/ 1' Ph ( ) R9 D-g SWR t
BUILDING Ten AA ��. N im
ELC 1 N' V
Footing (D a. 7 - Co 7 7 ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam r ,
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear V� J _ S � (pQ
Framing v
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough-In
0 1114
Cifitig
Water Service )
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
RT FAIL
Pos • = = am
Rough -In
Gas Line
Smoke Dampers
dia17r
PART FAIL
E CTRICAL
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
F
Fire Supply Line
D ate t/b Ins ector " "� Ext
Approach/Sidewalk p
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL