Permit CITY TIGARD MECHANICAL PERMIT •
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00498
141 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/12/2005
PARCEL: 25111 AC -01400
SITE ADDRESS: 14560 SW 92ND AVE ZONING: R -4.5
SUBDIVISION: PINEBROOK TERRACE LOT: 055 JURISDICTION: TIG
Project Description: Gas piping & furnace, A/C & duct work.
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: 1 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: 1 AIR HANDLING UNITS CLO DRYERS:
•
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfm: .
Owner: FEES
GRAHAM, KRISTIE Description Date Amount
14560 SW 92ND
TIGARD, OR 97223 [MECH] Permit Fee 8/12/200E $72.50
[TAX] 8% State Surcha 8/12/200E $5.80
Total $78.30
Phone: 503- 620 -9944
Contractor:
WILLAMETTE HEATING & AIR CONDITIONI
4370 NE HALSY ST
PORTLAND, OR 97213 -1566 REQUIRED ITEMS AND REPORTS
Phone: 503- 284 -3740
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Reg #: LIC 154438
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.
Issued By: Permittee Signature: pr " !I.
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
• Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application - - FOR OI I ICE U
r. '
City of Tigard , n (� Daz y ed -II Permit No.: -C. W 2/1A -` -- 9
13125 SW Hall Blvd., Tigard, OR 97223 �J 1� ;
Plan
0�
Phone: 503.639.4171 Fax: 54598:19V / Onr, I Sll ,.., i.,4 Date /By. ew Other Permit: •
Inspection Line: 503.639.4175 \ QO� :i i I
Date Ready/By: See Page for
Internet: www.ci.tigard.or.us 1 Notified/Meted/Met Supplemental Supplemental l Information
�� 1 � Ago
' TYPE O WORK\O‘ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction yA
replace ment M echanical p ermit fees* are based on the value of the work
,,,.)\' performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
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Job site address: e- 0 Air conditioning or heat pump
/�'1 () ��lrJ
r (requires site plan showing placement) / 14.00
City /State /ZIP: 97,0 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: ' A 15 j4 o /I K Duct work 14.00
V 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
1 [ A d a f A/I-as 4,-...-......_ Flue vent for water heater or gas
g ir f - fireplace 10.00
° J Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER l ❑ TENANT Chimney /liner /flue/vent 10.00 • Other: _ 10.00
Name: Cr-A"--\--P3-----j y/ ` Y N. J- t.) Environmental exhaust and ventilation
t r Range hood/other kitchen
Address: equipment 10.00 '
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT • ' 0. CONTACT PERSON Attic/crawlspace fans 10.00
Business name: Other:• 10.00
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
I Phone: ( ) Fax: : ( ) Water heater
Fireplace
. E -mail:
. Range
CONT CTOR Barbecue
Business name:
Clothes dryer (gas)
/` �� ^� Other:
Address: � O J� `-' �(r_- � � MECHANICAL PERMIT FEES*
City /State /ZIP: 0 %i. 0 J--r---Q Subtotal
°--� r °� p� Minimum permit fee ($72.50)
• 2 <
Phone: ( ) e. d Fax:( )
Plan review (25% of permit fee)
CCB lic.: / '' G 4/ -5 State surcharge (8% of permit fee)
e TOTAL PERMIT FEE 7y Q
Authorized signature: / This permit application expires if a permit is not obtained within 180
_ days after it has been accepted as complete.
Print name: �� — �` �_ Date: f7' • Fee methodology set by Tri- County Building Industry Service Board
•►
i: \ Building \Permits\MEC- PermitApp.doc 12/03 440 -4617T (I I /02/COM/WEB)
i
• 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.
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i:\ Building \Permits\MEC- PermitApp.doc 12/03 2
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CITY OF TIGAR .....
BUILDING DIVISION PERMIT #: MEC2005- 00498
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/12/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 - 4175
INSPECTION WORKSHEET FOR DATE: 8/16/2005 TIME: 7:05AM PAGE: 68
SITE ADDRESS: 11560 SW 92ND AVE CLASS OF WORK:
SUBDIVISION: PINEBROOK TERRACE LOT #: ass TYPE OF USE:
PROJECT NAME: GRAHAM
DESCRIPTION: Gas piping & furnace, A/C & duct work.
OWNER: GRAHAM, KRISTIE, PHONE #: 503. 620 -9944
CONTRACTOR: WILLAMETTE HEATING & AIR CONDITION! PHONE #: 503-284
Inspection Request Scheduled For: Date: 8/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 013666.01 503- 803 -7074 N
Corrections/Comments/Instructions:
_ /
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ki PASS /1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL , 6ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/
Inspector: /_ Date: 6 v � Phone #: (503) 718-