Permit r /' I
CI TY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00731
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/26/03
PARCEL: 2S111AD -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: 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: 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 with 35ft. gas line and outlet.
Owner: FEES
FURUKAWA, THOMAS T AND Description Date Amount
ESTELLE Y
15025 SW 89TH PLACE [MECH] Permit Fee 12/26/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 12/26/03 $5.80
Phone: Total $78.30
Contractor:
HOT SPOT FIREPLACE & PATIO
1 1525 SW CANYON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone: 503 626 - 4652 Gas Line Insp
Mechanical Insp
Reg #: LIC 71782 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: 4 - Pecs Permittee Signature,'/ v---�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed t e next business day
Mechanical Permit Application FOR OFFICE USE ONLY
�--. '� Received /
City of Tigard ' Date/By: �f /�� / O Permit No.: &C), 3 — 007 8/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /
Phone: 503.639.4171 Fax: 503.598.1960 .."' iii \ Date/By: Other Permit:
Inspection Line: 503.639.417511 _i��
Date Read /B y y: g
®
Internet: www.ci.tigard.or.us Notified/Method: I / i t...\ Supplemental See Pa e 2 Infor formation
TYPE OF WORK COMMERCIAL 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.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
kr-cnd 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total
JOB SEE INFORMATION AND LOCATION Heating/cooling
�� / Air conditioning or heat pump
Job site address: ' 1j () 2 S S W 1+-6 P 1 � C Q, (requires site plan showing placement) 14.00
City/ State/ZW: t� v c 0 �� c 7 2 2 Furnace 100,000 BTU (ducts /vents) 14.00
/ Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: 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
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
( Gas fireplace 10.00
t' 1-, STr~ C� S -1,: r¢ I a LL l j-1 S ¢ , 4--e> Flue vent for water heater or gas
J r � J fireplace 10.00
I Ys L IL r LA PI r% ` I" ' j l� 1 1 ` X . 3 T Q e __ Log lighter (gas) 10.00
O� d A-$ H ( Wood /pellet stove 10.00
J Wood fireplace/insert 10.00
, Chimney /liner /flue /vent 10.00
g . st t -0 a ¢ k n F S N P
=� 1 I � Ax At- i r om Other:�gg 1'� INS 10.00
Name: T in O m A. S P UL. r if.— 4. l.✓ ex Environmental exhaust and ventilation
_ Range hood /other kitchen
Address: I �j U Z5 S W _i, j a equipment 10.00
City/ State/ZIP: � 7 4-h C) (� 1 . 7 2- 2 Clothes dryer exhaust 10.00
l Single -duct exhaust (bathrooms,
Phone: (g 6 Y _ Z z s 3 Fax: ( ) toilet compartments, utility rooms) 6.80
PLICANT ❑ CONTACT PERSON ' ; ., Attic /crawlspace fans 10.00
Other: 10.00
Business name: Fuel piping
Contact name: S c—m e? („ S L V v L $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City/ State/ZIP: Wall /suspended /unit heater
Phone: ( ) Fax :: ( ) Water heater
Fireplace 35 / G L t IV( . /
E -mail: Range
CONTRACTOR , Barbecue
Z
Business name: )4 64- S (� ../..._ - F c r e0 1) I ct < Clothes dryer (gas)
r o l ' Other:
Address: ((C Z S S C �H O \ MECHANICAL PERMIT FEES*
City/State/ZIP: lie 0.J� _-. (
U I-�, �(� /R `i e j - 2 0 Gj Subtotal
Minimum permit fee ($72.50)
(�V ) � 2-4 44.5.2, (tj p � 2.../.. � Lj � ..7,_ , s-7) Phone: 3 Fax: Plan review (25% of permit fee)
CCB lic.: L,
ci State surcharge (8% of permit fee) ti�(J
TOTAL PERMIT FEE --- 7<, 36
Authorized sign T his permit a pplication expires if a permit is not obtained within 180
gn e ff j-� days after it has been accepted as complete.
Print name: ( u h S, r r L (L(.. G6.�,,,,+ —* Date: 1 I r ,D....4 / 6, 3 ` Fee methodology set by Tri- County Building Industry Service Board
i:\ BuildingTermits \ M pp.doc 12/03 4404617T (I 1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard -
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$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