Permit C ITY OF TIGARD MECHANICAL PERMIT
A /1 DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00091
,� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/3/04
PARCEL: 2S111 DD -08600
SITE ADDRESS: 15795 SW 87TH AVE
SUBDIVISION: CHESSMAN DOWNS ZONING: R -
BLOCK: LOT: 012 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:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace gas furnace
Owner: FEES
BRENDA PURCELL Description Date Amount
15795 SW AVE
TIGARD, OR R 9 7224 [MECH] Permit Fee 3/3/04 $72.50
97224
[TAX] 8% State Surchaq 3/3/04 $5.80
Phone: 503- 620 -2181 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Phone: 503 - 557 -2220 Gas Line Insp
Final Inspection
Reg #: LIC 72623
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: _
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mar 02 04 01:46p p.3
Me chanic alAbeGall Afflicatio n Received FOR OFFICE USE ONLY
,� __L Mechani
DateBv: (�'Y�ji Permit N h y- a o y i
City of Tigard MAR 2 2004 Planning Approval Building
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGARD Date/By: Permit No.:
Phone: 503- 639 -4171 BotEDO9Gr:9841 N Post - Review Land Use
Internet: www.ci.tigarcLor.us p +
Contact Case No.: or.us f i I " t':
Contac Juris.:
24 - hour Inspection Request: 503 ^ --"` ® See Page 2 for
Name/Method: Supplemental Information.
TYPE OF WORK .. COMMERCIAL FEE* SCHEDULE - USE CHECKLIST"
❑ New construction ❑ Demolition Mechanical permit fees" are based on the total value of the work
; KAddition /alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
I & 2- Family dwelling ❑ Commercial/Industrial value: $ See Page 2 for Fee Schedule
• Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE . •
Description 1 Qty I Fee(ea.) 1 Total
❑ Master Builder IL Other:
Ueating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00 i
Job site address: 15 '79' 1/,j r S 7 -t4 Avk , Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: ?0,_(--Q .0 _1 Hydronic hot water syste 14.00
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
Subdivision: Lot i s Repair units • 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00 i
DESCRIPTION OF WORK Gas fireplace 10.00
O A— 40 {^ ( .t h I\0L4$_ „ Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove I0.00
Wood fireplace/insert 10.00
Chimney /liner /flue /vent 10.00
ROPERTY OWNER 1 ❑TENANT Other: 10.00
Name: P)r-� �� Q /� Environmental Exhaust & Ventilation
Address:
1 �� 9 S i � J Range hood/other kitchen equipment 1 0.00
� Clothes dryer exhaust 10.00
City /State /Zip: n, �� a Single duct exhaust
a.0
Phone: ( j Fax:
(bathrooms, toilet compartments,
0 APPLICANT . I 0 CONTACT PERSON utility rooms) 6.80
Name: TRI COUNTY TEMP CONTROL Attic /crawl space fans 10.00
Address: 1:3150 S. CLACKAMAS RNER_DR. Other. 10,00
Fuel Piping
City /State /Zip: OREGON CITY, OR 97045 * *(s5.40 for first 4. SI.00 each additional)
Phone: PHONE: kgF18W :557 -2220 Furnace, etc. **
E -mail: FAY- tcrril t;G-,..nga ^ Gas heat pump **
Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name: Tri County Temp Control Fireplace **
Address: •13150 S. Clackamas River Drive Mt **
City /State /Zip: Oregon City, OR. 97045 CBQ **
lothes dryer (gas)
Phone: 503 -557 -2220 Fax: 503 -557 -0919 Other: **
-
CCB Lic. : , 72623 Total:
Authorized Mechanical Permit Fees*
_
Si Date: 3'� � Subtotal: 5
Minimum Permit Fee 572.50 5 '73 - SO
°,� .°° cU r,c. ^� c,rti
`�� `� ' 1s ' �P � " �\., Plan Review Fee (25% of Permit Fee) S
(Please print name) State Surcharge (8% of Permit Fee) S 6
TOTAL PERMIT FEE 5 - 7S ,
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.
i:\Dsu\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
/ BUP
Received 0_,) Date Requested S -- 04/ AM (P 3 � BUP
Location I 7 7 Suite //--,� I /l
Contact Person C�G I c 1 c 'cz Ph ( ) 2 � �' 2 2 2-�PLM
Contractor Ph ( ) SWR
BUILDING Tenant/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 ., 2
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 . 7--
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
mpers
Agir PART FAIL
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
Fire Supply Line
ADA yoy Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL