Permit I w
, �11
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00732
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/29/03
PARCEL: 25111 AC -02100
SITE ADDRESS: 14695 SW 92ND AVE
SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5
BLOCK: LOT: 062 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:
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 4
Remarks: Replace furnace and water heater. A plumbing & electrical is required
Owner: FEES
WALKER, DAVID R AND JUDY K Description Date Amount
14695 SW 92ND
TIGARD, OR 97224 [MECH] Permit Fee 12/29/03 $72.50
[TAX] 8% State Surcharl 12/29/03 $5.80
Phone: Total $78.30
Contractor:
REQUIRED INSPECTIONS
Phone: Gas Line Insp
Duct Inspection
Reg #: LIC 151042 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Or oon law
requires you to follow rules adopted in the Oregon Utility Notification Ce, er. ose rules are set fi ,cth in j 0 £ R 952 - 011 -00
Issued By: Permittee Signature: >•< ! , jam'®
•
Call ( 3) 639 -4175 by 7:00 P.M. for inspections needed the next business � I/
k
Mebhanital Permit Application FOR OFFICE USE ONLY
City of Tigard Date /By: ! �/ v3 4, / G2dD3 M 73
Pemut No.' -�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / 111 d° ti Date/By: Other Permit:
Inspection Line: 503.639.4175 _ , 0' �Il Ready/By: Jur is. ® See Page 2 for
p tt• Date R eady /By: (;
Internet: www.ci.tigard.or.us W
Notified/Method; Supplemental Information
a ,�.,*a,.w--, ,:ttx :,ix€:ui.,, r:�.' �' ^mss: = " 'w;.ik "i.n, �.:.i a„ ,,..,,i.. ,°c.•., - s,,�cr - - - -iza�- -
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,, , ; C ° d' i ` a T x , t - . T,YPE .O$k�WORK < -,t e, 4p' t 1 a 0°r �' ;1,a tCQMMERCIAL' F J p SC ,, , . .., , .. _
. tam" � � ��a, �s�a�- a_ 3r�v5n .>��n� =. �K�.rl`�.� �a- a.��t ��u�"�- . rx..' sis6 :. . . - ,..,�:� ,.4 :, :.,. - - F .. ., -.
❑ 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.
t" ;"i Sr' ig.i':" =bib n' s
.�)§nt?*:'.- ;s# . .,�. , , lred ,> i r.�o "•�:.,,cxc*.�--, .-f f. .�....txRil4i a' es �d5.�;^'p=�i' `_ '.i:lif Value: $ 0®
�',� - �* ��� ' � ,��CA EGORY CONST?RUCTION� � � � _ - �
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'.I2ESIDENTIAI;�EQUIPMENT /SYSTEMS FEES*
- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
;i.' ° = " pis tn. �,{,a•�,« ,;7t ._c =
, ..a� a.,: :e,±rss „: - =f;z „'i >"' � ,'�s�. .., •s`, ;
;., ;I ` " t+ t # ,, JOB, SITE INR tiknANDr, „ " ;1 H eati n g/ co oli ng
1 105 Air conditioning or heat pump A
Job site address: 5 Z ~� l i (requires site plan showing placement) .�- 14.00
City/State /ZIP: T ` �v ck ) 0a. i Z Z Li Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 1 17.90
' Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work. 14.00
c w � I A ` - Hydronic hot water system 14.00
2 [ . S a' p i /V 1 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
? " 5 ; ;°" `. �-.Y n• ¢ a °' , x " �s " =' z,'. ; t a, Water heater 10.00
if € A , � DESRIITI®N O F r;:W ORK- : i `'s ' „, li .... . .:
. ?r, CIS -,... Y�:z#� �x ,. J: x€x a.,,��: s C awn «.°. '. -•s. .�..�.a*zm tee, ^,�. : r .ro ,
Gas fireplace 10.00
-T�5i� c s \ ) p �) d- y ', p / 6, f i ‘ 1 c �i D,,T„ Flue vent for water heater or gas
v A fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
•; x„ y a '''' "'' " ' " it �. ,,,,,, :,,n v ,_,.... Chimney /liner /flue /vent 10.00
.; w � PROPERTY �OWNER ® , T t V 1
� „w ?,� ,, �:� ":,, ...;te „k .d ._..k� _ ..,.'.,- .. -_� tea - . Other: 10.00
Name: 0 a-�`-C ( Q ij e , / Environmental exhaust and ventilation
"� " Range hood /other kitchen
Address: equipment 10.00
City/State/ZIP: , dryer exhaust 10.00
�) �� Single -duct exhaust (bathrooms,
Phone: ( 0 Fax: ( ) • toilet compartments, utility rooms) 6.80
;.,. . .,t,z;p, 10.00
i'i±,t" ' s':y: "' rr t
tr ,. , . .n ,`.lt '''gi: " "' ° > ,r t t'i „' Attic /crawlspace fans
".;" z� >�; APPLICANT , .. 3 ® g CONrT:ACT % PERS . ON � n ,, , ' ;°F*
fk,..,ao .._z,.� "43 a <. .. ._
'" `�� / � � �� Other: 10.00
Business name: L ktti St/ CO tn.&�') LL C. Fuel piping
Contact name: 1,'- �ct 1r Lvl 1nCks d' Do.-- $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: 5 70 0 ,S w 182 t.inititli A/1.4 (/'t I.( N , C 1 - Gas heat pump
City/State/ZIP: 1 Ctivt� � b (j`7 , 22 4 Wall /suspended /unit heater
% t
Phone: 6 v3) 94 -(p 3 -24 Fax:: (5 ) &B. y - O C{ "7 Z Water heater I
Fireplace
E -mail: Range f
. - �,�; ..i:a': e s'y:tF"`s+;:"' =.'SRP;," ;. =,::i' a�":.; ,:F.;w7 4,C;-_ ?�i; ; , x ^:' : °s"�'i'3'`k,;'', .- .ily.,. ^�
�a
."� ', .. 2171 t ,7 -s CONTRACTOR 11 •' i, tits l:s`t ,,, Barbecue
Clothes dryer ( gas )
Business name:
Z.V. thfB'A+ GI t.� LC Other:
Address: Cj 0 0 5 M& v ` K G t , , s;;' ,41E, MECH AN ICAL PE * -
City/State/ZIP: 1 C 44 c' o 2-2 Subtotal
Minimum permit fee ($72.50) 7� r 5 0
Phone: J Fax: (513) ( SL I - 0/.4 � Z
�� ) T �l.l 9 (,) 3 � � J Plan review (25% of permit fee) ll
CCB lie.: } 5 1 0 4 Z State surcharge (8% of permit fee) S, 1U
TOTAL PERMIT FEE ig a 0
Authorized signature: This permit application expires if a permit is not obtain 6d within 180
gn �� days after it has been accepted as complete.
Print name: �� o (r 4 l 6..,L Date: V2,- _ - * Fee methodology set by Tri- County Building Industry Service Board
b \Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (I I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard.
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuati
$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 I $1,396.50 for the first $100,000.00 and
14140-for-each-additional-$100.00-or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
•
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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 �2 7 2 i 1 C" Date Requested /— g7 —0 CAM PM BUP
Location l � � l� tJ Suite
(NE
E $ —� - 73 a
Contact Person f tri_ ‘zL c uA Ph (5 � — • - 2 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation n(4.
Drywall Nailing 5
Firewall I /
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
RT FAIL
Post & Beam
Under Slab
Rough -In /
Water Service
Sanitary Sewer
'
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
`` Other:
• ma
A PART FAIL
MECHANICA
Post& Beam •
Rough -In
Gas Line
Smoke Dampers
.urt�
-$ PART FAIL
CT ^IC;'
e
UG /Slab
Low Voltage 1 + r
Fire Alarm
'4 !ASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date ` 9 Inspecto 1 1 �''^� Ext
Other:
\
Final DO NOT REMOVE this inspection record fr , m the j b site.
PASS PART FAIL