Permit A , . CITY OF TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00705
p �' ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/25/2004
PARCEL: 2S1 11 AD -13000
SITE ADDRESS: 15025 SW 89TH PL
SUBDIVISION: SCHECKLA PARK ESTATES ZONING: R -4.5
BLOCK: LOT: 029 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Install free standing gas stove for heating
Owner: FEES
FURUKAWA, THOMAS T AND Description Date Amount
ESTELLE Y [MECH] Permit Fee 10/25/20( $72.50
15025 SW 89TH PLACE [TAX] 8% State Surchart 10/25/20( $5.80
TIGARD, OR 97223
Phone: 503 639 - 2283 Total $78.30
Contractor:
HOT SPOT FIREPLACE & PATIO
11525 SW CANYON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone: 503 - 626 - 4652 Final Inspection
Reg #: LIC 71782 C
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:
14—ide/ �i Permittee Signature:
Call (503) .39 -4175 by 7:00 P.M. for inspections n-eded t e next business day
RECEIVED
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Off' 1 5 2UO 2004 A
Date/By: ed� Permit No 6 . 00 -705
13125 SW Hall Blvd., Tigatid, OR 97223 - ' '
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGA Dx „ + \ Plan Re Date/By Other Permit:
Inspection Line: 503.639.4175 leg„ I ;. y
p BUILDING DIVI - _,,; , I � Date Ready/By: Juris 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental information
' a 4 ' , .i' ? - , � - ° - = 'COMMERCIA'L FEE * ':SCHEDULE -- USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction [ ' Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
?y 7 Value: $
r .' . . ' '. '' .; ,, � ;'...r... .,,. u� >.. ° . - RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
[ . 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checkli
❑ Multi - family ❑ Master builder ❑ Other: E
Description Qty. Ea. Total
u. ta ' i O: de F i ? i` -) Ors " �
� �' Heating coolin
Job site address: I 6 0 2 S 5 <' • ee 4-_ I L • Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State /ZIP: 7 G A . Ri) O (. 1 7 2 11 Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: I 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
/ Hydronic hot water system 14.00
T
I A L. e.- . , _ - . 7 L L (� Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: I Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
Q 4. ° & ' Water heater 10.00
.�' � l� ,� i. . , i � �` �" , , , ``sir= +.�_�
Gas fireplace 10.00
.17 ih z..- ' I V C c. c.4_ i ei (� � ( Flue vent for water heater or gas
A_ S S v /1 j fireplace 10.00
- {�j 1 Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
r . < !G . t 5 r g ,„erg Chimney /liner /flue /vent 10.00
, a ` _ .. . t t --r Other: 10.00
Name: L [ '�1 i IL l. S ( Pu ( 2 L , ( K t\ t ) Environmental exhaust and ventilation
Address: ! S () 2 s - s i,/ 1 4- j� i _ _ Range hood /other kitchen
equipment 10.00
City/State /ZIP: TL ` is. (Z () b (Z et 2.'2_4 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (Sp y) G ?) - 2. 2. r Fax: ( ) toilet compartments, utility rooms) 6.80
`? t r � ' � t i u ,,, 7 R . . w f , Attic /crawlspace fans 10.00
.,A. .. 10.00
Other:
Business name:
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: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail:
Range
.r <s a
N k - ,- J £ Barbecue
Clothes dryer (gas)
Business name: V _ � o _ f- c r . e 7 1
1 I / y Other
Address: t.;" S i j) t s c (ff., 21 A i F ' I HA ±TICAL EES * `
City/State /ZIP: l_.V G. - h ( ( 9 - 7 0 O Subtotal
Minimum permit fee
Phone: ( ) a 6, ii / 5 Fax: ( ) ($72.5
Plan review (25% of permit fee)
)
CCB lic.: State surcharge (8% of permit fee)
f TO TAL PERMIT FEE
Authorized signatures This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: - (4-1:AttA. T. l - 1 rz L4 14 A:.J P, Date: (v 2. 41 6Cf * Fee methodology set by Tri- County Building Industry Service Board
I
i:\ Building \Permits\MEC- PermitApp.doc 12/03 440 -461 T(11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
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
$1.35 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.
i:\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: 503) 639 - 4171 MST
BUP
Received Date Requested 1/ — AM PM BUP
Location . SO 2\5 el, Suite 0 A6ozi- ao 705
Contact Person ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner - 17Y71 ELC riv�
Footing j C / ' oZ S3 ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 5A -Trc, saw- K(ztu/ sr SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing - L Lo," VDCrAvug
Insulation 610 $,' -Q# ( u car' -41:)r) )
Drywall Nailing
Firewall
Fire Sprinkler ' " 4S L/
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART IL i
PLUMBING
Post & Beam
Under Slab
Rough-In
Water Service r
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA RT FAIL
EC AI
Post & Beam i ,
ROU Oh -fin
Smoke Dampers �_ll
3Z ART FAIL
ELECTRICAL
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 or reinspection RE: Unable to inspect — no access
Fire Supply Line
, Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection recor the job site.
PASS PART FAIL