Permit •
CITY `rOF TIGARD
MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00123
�1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/27/2006
PARCEL: 1S135DC-07000
SITE ADDRESS: 11675 SW 91ST AVE ZONING: R -4.5
SUBDIVISION: CHARBEN LOT: 8 -9 JURISDICTION: TIG
Project Description: Adding gas fireplace.
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:
NAT 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: 0 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
JOHN W. DRENNAN Description Date Amount
11675 SW 91ST [MECH] Permit Fee 2/27/200€ $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 2/27/200€ $5.80
Phone: Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
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
or 1- 800 - 332 -2344. / J
Issued By: Permittee Signature: � /V 7 J , kt-n4'h •
Call 503 - 639 -4175 by 7:00 a.m. for inspections that b iness day.
This permit card shall be kept in a conspicuous place on the job site ntil completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Mechanical Permit A .j � \I ED FOR OFFICE USE ONLY
C Received
s City of Tigard "�r Daze /B -7 66 -• Permit No.' 7 , . , .7
13125 SW Hall Blvd., Tigard, OR 97223 1 � Y
2 ( Plan Review
Phone: n
Inspection Lie: 503,639.417503.598.1960 � � Rid : (•rl\ Date /By Other Permit:
r i ' I Date Ready/By: Eli ® See Page 2 for
Internet: www.ci.tigard.or.us WI pF D� oN Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
El New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
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*
IN 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
1=1 y El builder For special information use checklist.
Multi famil 0 Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: //6 7 S S , (,v q / s r Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: 7/ G A pe D q 7 2.2 3 Furnace 100,000 BTU (ducts/vents) 14.00 ,
J / 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: A/. w Cp/QN/5.4 Pr. Gl / sr Duct work 14.00
Hydronic hot water system 14.00
4I c /v (/4F ,.D , 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 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
, ;l \q r 't Gas fireplace 10.00
A i) /A/ 4 GA' r� /A/ / Az Flue vent for water heater or gas
fireplace 10.00
EXiSr/ WOo 41J2ii /Ai I-'1/21= ,04_4 -C
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
PROPERTY OWNER ❑ TENANT Other: 10.00
Name: j—c; NN W ` J 2 M NA ti Environmental exhaust and ventilation
/ Range hood/other kitchen
Address: �� 6 5' S. Gv, GI / 5 equipment 10.00
City /State /ZIP: 77 6-42,5 Q q 722- 5 Clothes dryer exhaust 10.00
r Single -duct exhaust (bathrooms,
Phone: ( Su3) ( 3 q — 5 _ 7q 2 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
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: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: 01V&E'A COKT2/j n
Other:
Address: ` MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee)
/� �� TOTAL PERMIT FEE 'n•—.7 0
U,13
Authorized signature: AQ��Ih L This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: TO M. V 1DR EAfN A Ai Date: 2- 1 _0 C * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits\MEC- PermitApp.doc 12/03 440- 4617T(I1 /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.
s
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i:\ Buildin \Permits\MEC- PermitApp.doc 12/03 2
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tl
CITY Of TIGARD ,- - h'1,e
BUILDING DIVISION ! ° " PERMIT #:�DC `" e t ' �'�'' 3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
AI Np�t tilt
Inspection Requests (24 Hrs.): (503) 639-4175 .
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: // 9/ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR:
A/ its PHONE #:
i
Inspection Request Scheduled For: Date: 3 --/0 O Pour Time: 4 /fri
I //'
Code # Inspection ` scription Confirm # Contact # Message
6 ? -,,,,,,.)k
(a3/ 5 - 7
Corrections /Comments/ Instructions:
1 ASS 1 I PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: r Date: Y --- � O Phone #: (503) 718-
(- Nizivyt 12s212-9 - No ro--I I~ 06k ED 4-v �. _
CITY OF- TIGARD ..l q / -- _ /Y)
BUILDING DIVISION :- '-,. PERMIT #:2_006,— 00 / °�3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 enmuilpu � I t
Inspection Requests (24 Hrs.): (503) 639 -4175 %! I.. v v
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / / 4 75 / .,Q CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: q PHONE #:
CONTRACTOR: tit) V 7/ t /I al /I PHONE #:
Inspection Request Scheduled For: Date: . 3 — g — O Pour Time:
Code # Inspection Description r onfirm # Contact # Message
v, �I- -e: •
k--.: ../` -Y■ a djill. -57 9 )---
Corrections /Comments/ Instructions:
-- ta. -/ 0 76,6
11flL/?e4( ct PS/ 6 6 G (4/ 1.4.ZO
G !v r Apppo(1oCQ
6 IA --, iapi 0 Adifoel
Cdr 64 A_& ° , AM/(1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL fI NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
/7"-J, •� l Z 1 / 6
Inspector /� Date: 3 o'4 Phone #: (503) 718 -