Loading...
Permit i ■ = ONLY USE � e I � � � " " ° ' FOR cFOR c OFFICE 1: ONLY Mechanical Permit Applicat -.7 I ( z. - s City of Tigard Received Plan Review 1 .� '� 13125 SW Hall Blvd, Ti OR 97224 A !� N 2 6 2011 Pan Review AIM- � �� I A h. Phone: 503. 639.4171 F 503.59 &l Dete7Bv �� r Othar? ' ' , / 4 ICQ Inspection Line: 503.639.4175 Date Ready-41y: Juns: 0 See Page 2 ibr TI GARD Internet www.tigard -a -gov CITY OF TIGARD Nodtl�d hoa: . • Suppknuntal rnforn'°"on BUILDING DIVISIO?'' TYPE OF WORK COMMERCIAL FRE• SCHEDULE - USF. CIZECKLiST Mechanical penult fees* are based on the value of the work rig New construction t1 Addition/alteration/replacement performed Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead, and profit. Value: $ 7 tn.. O. CATEGORY OF CONSTRUC LION RESIDENTIAL EQUIPMENT / SYSTEMS FEES• ❑ I- and 2- family dwelling irj Commercial/industrial ❑ Accessory building For steal information urn cbnc!dkt. ❑ Multi family 9 Master builder 9 Other: Description I Qty. I Ea. I Total JOB A. ..tr.... 1 INFORMATION AND LOCATION Heatingicoo Qo , ,,, AAir conditi n )ob site address: i au Pam A a itpvy i. 576'6 5G 1 (requires site plan showing placement) 46.75 City/StatelZ.IP: Q� pp /� , Furnace 100,000 BTU (duets/Ken) 46.75 7,6_ A " r' A ! Furnace 100.040+ BTU (duetavenrs) _ 54.91 Suite/bldg. /apt no.: 1 Project name: )9 L-t lea Al Heat pump 61.06 ; Crass street/directirms to job site: Duct work 23.32 ' Hydronie hot water system 23 32 P#41 A a i(w - (5 -- 5 w I 1' �j A sr _ Residential boiler (radiator or - hydronic) 23.32 - Unit heaters (fuel -type, not electric), in- wall, in -duet, suspended etc. 46.75 Mao/vent for any of above 73.32 Subdivision: Lot no.: Other 1 23.32 Tax map /parcel no.: Other fuel appliances Water heater 23.32 DESCRIPTION OF WORK 33.39 - - - - giir i u / p Gas fireplace pl e /� I (.t 13 a ` s i 2) l6. +ate pi O C Flue vent for water heater or gas , fireplace 2332 �, V '! - t G." Igoe" Intl" c.e • L . ff t o lea Log lighter (gas) 2332 Wood/pellet stove 3339 (J F Dt.,G f tJdtt tr ,r►� 5 t n 1... Woodfsseplaoermert 23.32 • Chimncyftin. rlftuclvcnt 23.32 Other: PROPERTY OWNER ©fENAN f 23.32 Name: 4 0, Za Ay C Ce ia, Environmental exhaust and ventilation � r Range hoodlother kitchen I 4 Address: J 23 s se. T l'r FR.s .TT er equipment 33.39 Clothes dryer exhaust 33.39 eity;statZIp: ME pig z t t J Singe -duet exhaust (bathrooms, Phone: ( ) I Fax ( ) ' toilet compartments, utility rooms) - 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attickrawlspace fans 23.32 Other: 23.32 Business name: Fuel piping 514.15 fur Test four, 54.03 for each additional • Contact name: Furnace, etc. ArJdcuss: Gas heat pump _ City /State/ZIP: ; Wall/suspended'unithrater Phone: ( ) l Fax: ' ( ) Water heater Fireplace • E -mail: Range - CONTRACTOR Barbecue , Clothes dryer (gas) . Business name. Ce.34-„e y k/ i' - , n1 G j-- ,4 /c... f r✓ Clothes other MECHANICAL PERIverFEES Address: � i 6 r S e-- �� ? 4 1J t- �. Subtotal ®3 8,5.8'4 City/State/ZIP: [,Q c s N ,y+ o R 47 0 8 o Rte. � 1 :t r�. rcnnan ---c Fax; (50 S) 6a C 6 - G 7 ! y Plan review (25% of permit fee) '7(• 9 CCB lie.: $• r7 1 G Li . State surcharge (12% of permit fee) 34. 3 / TOTAL PERMIT FEE 39 .1 / 1 This permit application empires if a permit is not obtained within 180 days Authorized signature: , , I. after it bee been accepted as complete. �L '-' 1 • Foe methodology set by Tri- County Building Industry Service Bard Print name: GQ,fe. � Pt E S Date: ':\Building Permits \MEC- PertmtAppdue 10101/(9 440 - 4017r (t vovcowwsn) 1 ,'d 69L9 999 seLUIOH fuee d9Z:£O 11. 9Z uef r -44e- A REC E.P/Fn:'; Fl ,./ !-- 1 s, - _ . S w pig h 4.. 1.1.0y JAN 2 6 2011 . ' 4'0 me 910-,03 CITY OF TI A G BUILDING DIVISIr'?‘ VO ! ,......), c/i/;, ..c4-___ - . s CITY OF TIGARD ,t A `�� 1 Approved x`=s� Clk i -..-_...-t.1-_, Conditionally Approved ( ! See Letter to: Follow [ i, 4 },- 5f Attached I PermitNumber:PU 2 -" ',_I Addr -..;,„ A L. 'MCI I. " By /,�7 Date: ���t _ �` F Y 1L.'f�Q11 �' :.. 1 0 t OFFICE CCY b Aiii Nip A • \ . LI vow I ilir , 1.r A Ail _ i 4, G a F 6 4c 4Av + COMVEMEtlCE amFT Bt ELEC1R COIf�a4C'OR S11F� Et. FLAS rm AND =1BER �• ` tf y ROOFRiG AHD NSUUn9F1 OH NEGK DIQt• 1 CNR S h' �" "k �` JUAL' BOX AND CONDUIT YOURFED !Off « - C4R1 TR I P R - , �—� ��`� �- z SUPPLY X/R DIFUSER ADJUST:3 R THE raw (ROOF CUR FTlsaftEU IN!: TO PDBIt 3ff W -It OOR tor,a OURECROM. Bt R N %PRO) -- - u --- ' , _�• = = - ^ Slat JOIST 3x 3'1U 1/4. ' . l! . p- R ER tC STRUC►tRAI PANS FOR PROPER AM�ra�h MU , . 0 - « ROOF CURB U UC I LI DCTARS. lilt REFER LL _ T O RO IIrl • -''' UHT SFNKE ?:ozczoo CM 91r or FOUR AIR DUCT r moo THE Roof FIUYE OEUVIL ` -- a ► D ALA CFPC4TE HE SUPPLY la SEE YARUFACTU SPEOFlCJiTaFls• • ] A'1 1 SEkSCR ON Tri( SUOE OF RERRRN AR Dun 4 a/8' + ' -o' IETAL STRAP ,�IROVE RETURN A9iSR11r116t�A1 ,_ 4'CARRIER ROOFTOP UNI- - VIEW OF RTU �,� s,a Dc1c4 w i z 69L9 999 • seLUloH free :,- d6Z:£0 L I. 9Z uer Community Development TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd, Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: n Owner n Applicant ❑ Contractor fgr City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City /State /Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): VOID yl CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). p a /y /ir n INVOICE FOR FEES DUE (attach case fee schedule and explain below). I REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: G C 1 I Site Address or Parcel #: (� �w 1"�}C1 L Id_ ley Project Name: R U.T) Subdivision Name: r\Jj/i- Lot #: EXPLANATION: 12.AL P\LQ Pr F LI-( iT[ LJ 6 ' Signature: � A A„ \ Date: (Ai! /// �►2.�� Print Name: t 1•46( Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONI Rte to Sys Admin: Date 2 / i B • Rte to Bldg Admin: Date .z r // By . i Refund Processed: Date . / 4— By ,!�• Invoice Processed: Date By Permit Canceled: Date /y/i B ' y ' arcel Tag Added: Date By Receipt # Date Method Amount $ I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07