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Permit ''CITY OF TIGARD MECHANICAL PERMIT .l DEVELOPMENT SERVICES PERMIT #: MEC2003 -00634 eh( 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/29/03 PARCEL: 25111 AD -14600 SITE ADDRESS: 14809 SW 91ST AVE SUBDIVISION: MALLARD LAKES ZONING: R -4.5 BLOCK: LOT: 012 JURISDICTION: TIG 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: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: 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: 1 Remarks: Installation of gas fireplace and gas piping. Owner: FEES SCHNEBERGER, RONALD W + Description Date Amount 480 9 SW 91ST SW AVE G 14809 [MECH] Permit Fee 10/29/03 $72.50 1 TIGARD, OR 97224 [TAX] 8% State Surchart 10/29/03 $5.80 Phone: Total $78.30 Contractor: AMERICAN CHIMNEY SWEEPS AMERICAN CHIMNEY + MASONRY INC PO BOX 13311 REQUIRED INSPECTIONS PORTLAND, OR 97213 Phone: 644 Gas Line Insp Heating Unt Insp Reg #: LIC 61354 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 requi,es- you-to_follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 Iss ed By: '' /Vol % Permittee Si natur-. . ► a gib Call 50 s 9 -4175 by 7:00 P.M. for inspections needed the next busin• s day MC -nical Permit Application . FOR OFFICE USE ONLY Received Mechanical . /�, � j � J� Date/By: /D }9 %5 Permit No.: I'f z t� G`^' (f)5 City of Tigard Planning Approval Building Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503 639 - 4171 Fax: 503 -598 -1960 Post - Review Land Use Internet: www.ci.ti ard.or.us Date /By: Case No.: Contact Juris.: 24 - hour Inspection Request: 503 V ' �I Su See Page 2 for Name /Method: Supplemental Information. ` -'. ' : ;; .'TYRE,.OFe WORK: : ".- .•:,:.' L _ .- . ',;:;r: n : ,-t COMMERCIiALFFEE *.;SCHEDUI E USE CHECKLIST_' =_' r ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement El Other: performed. Indicate the value (rounded to the nearest dollar) of all y" : :' ;' 'CATEGORY OF_' CONSTRUCTION' ° ° @= 'sibG'rR5 mechanical materials, equipment, labor, overhead and profit. ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule El ;., ; :RESIDENTIAIf•E Q T / *- ; CH; .: Accessory Building ❑ Multi- Family Q UiPMENSYSTEMS•EEE SEDULE Description Qty Fee(ea.) Total 111 Master Builder 111 Other: Heating/Cooling r"• -;-''. JOB:SITE - INFORMATION anifLOCATION: °: ' _ •: ';: 4; `. Furnace - add -on air conditioning** 14.00 Job site address: H550 c6W Q i gl- � \,q, ,c tAcil Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: (L� ~f1 S1, Ac_�r Sc � Hydronic hot water system 14.00 Residential boiler Cross street/Directions to jo'b 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 #: Repair units 12.15 Tax map /parcel #: Other Fuel Appliances Water heater 10.00 . ; r -r1 ... _ _ r .X= : DESCRIPTION:OE'W.URK .- ?a ',1 ftr.': P. :i- s Gas fireplace / 10.00 ,_ -Vst, INCX Cora: Lxhp l= ro no G Flue vent (water heater /gas fireplace) 10.00 - LA Y'1∎ t 7 1'd l ar�l0 \ 1 1 - 161rno Ghty� l "I' r) Log 1fighter (gas) 10.00 - Wood/Pellet stove 10.00 a . e s • si ' " - ,'► l'• " Wood fireplace /insert 10.00 ��. ' Q( t '_ � , Chimney /liner /flue /vent 10.00 _ OEERTYOWNER. t iriFt ®s, TENANT '-`�r`t�s' ; „; ':: Other: 10.00 Name: N.-p Ul a �, q v-‘‘ `e --.---1.9\1\ �� , Environmental Exhaust & Ventilation ' . I i e hood/other kitchen equipment 10.00 Address: 1'L45 Q 4 F-4.0 Q V� t1-e - i — n � O ct-�AQ Single es dryer exhaust 10.00 City/State/Zip: C��1 Singl duct exhaust Phone: sa Ind 4 ' ZNS:p Fax: (bathrooms, toilet compartments, 0 APPLICANT: : ; ; ;. " '1:;; ❑.CUNTACT , utility rooms) 6.80 Name: Attic /crawl space fans 10.00 Address: Other: 10.00 Fuel Piping City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Phone: Fax: Furnace, etc. ** E -mail: Gas heat pump ** �_ . . Wall /suspended/unit heater ** v 9 ' CONTRA 1 `< ` .F :�.; „7.. ;. . �, ,,,�K: •. -. � � CTOR =.. -; . � Water heater ** � 4. _ Business Name: X11 t. r . s . n Fireplace / ** Address: Range ** City /State /Zip: BBQ ** Clothes dryer (gas) ** Phone: Fax: Other: ** CCB Lic. #: Total: Authorized Mechanical Permit Fees* Signat ! C_�L ., .:- _ mate: i('j1,� q� 0 3 Subtotal: $ ` �t Minimum Permit Fee $72.50 $ 7a, 57) Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ 5 . ge TOTAL PERMIT FEE $ 7 $ , P?6 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. is \Dsts \Permit Forms\MecPermitApp.doc 01/03 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. $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. • is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc CITY OF TIGARD 24 -Hour BUILDING Inspection Line: ,(503) 639 -4175 INSPECTION DIVISION • Business Line: (503) 639 -4171 MST BUP Received c ! Date Requested / �1 ° " AM PM BUP Location ` ` g , D 9 f . /mot -v-� Suite MEC 3 - a v' Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/010 ELC Footing a [ �3 g ELC . Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: � /-r Te7 9 j �-� N SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing ( qq� /I Drywall g (r 5 t°q 5 a S - ([p/ J �VJ�! �c 7"l00 fI cr D all Nailin ` ,/ Firewall 9a vQ ✓ - e- Goa t J Fire Sprinkler - Fire Alarm Susp'd Ceiling Roof ( ¢_ GCS u� r e 5 ry "� T—e f ® — Other: e Final f vt � 6 e - O ✓! t C• C C d PASS PART FAIL PLUMBING o e � S f t ✓t Post & Beam Under Slab //'��� / // Rough -In &&t. 5 'l ve "L4_ C `e e 4 J G `4/17 c� 4 ® ' Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final - PASS PART FAIL MECHANICAL Post•& Beam Rou n • as Li C e ( vr � e Dampers • ina PASS PART 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 LI Please call for reinspection RE: 0 Unable to inspect – no access Fire Supply Line ADA r / .�' Approach /Sidewalk Date ( �® © J Inspector �" ` Ext • Other: lJ Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL