Permit CITY TI GARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00296
A ' i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/19/2004
PARCEL: 1S135DB-10500
SITE ADDRESS: 11090 SW 95TH AVE
SUBDIVISION: ASHBROOK FARM ZONING: R -4.5
BLOCK: LOT: 022 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS: 1
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
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: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Bath and water heater vent.
Owner: FEES
COMSTOCK, JOSEPH R Description Date Amount
11090 SW 95TH AVE [MECH] Permit Fee 5/19/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 5/19/200 $5.80
Phone: Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Mechanical Insp
Phone: Duct Inspection
Reg #: 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 do - : • .ccordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspen• or more than 180 day ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification '= -r. Those r - - - orth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copi o rffil - e ut. - u= lion to OUNC by calling
(503)246 -6699. •
Issued By: Permittee Signature: I 1 1111111. _
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
M•echa>,ical Permit Application FO OFF U SE ONLY*
city' of Tigard keceived // /�� •
Date/By: lq Q Permit all ` �. _ k
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review olIr
Phone: 503.639.4171 Fax: 503.598.1960 keie4 , w $ ilk DateBy: Other Permit:
Inspection Line: 503.639.4175 r ■ - Date Ready/By: Juris' H See Page 2 for
Internet: www.ci.ti ard.or.us .
g Notified/Method: Supplemental Information
TYPE,. OE .VSO _ : t 01YI CIAL FEE ' ;' FI .'
r � .. a� ' �; •� �_ ,�� a� � �� � MER ;C.,.; LEUSE <CHECKIIST
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.
,:;i -" " -r. - - - i!•:' - - , -i:- - ..:rte.. �;.�.a:�b -� «: ; . fa r : b- - - ° �.H,s.:�k,�n2 " "'x -,a V alue: $
.,, ,; ;= : :F> "�,. ; t " I =,; a.
,�;.� -��i > >�� ' .,���' CATEGORY' �a0� .�tvONSTRTJ.CTTON�= �- N.t.b:� ,�„`.�`R «
- .z:�:.„�. �. a � .. a ' '� �t:a».�;.: �"' ,.. <...,. :.s
lti 1 - and 2 dwelling PRESIDENTIAL EQUIPMENT /SYSTEM &FEES*
y g ❑ Commercial /industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
_ Description Qty. Ea. Total
a
ro SITE INFORMWATTO'' N`LO ATION., - „. : :
,,�:^�'Ya az�ti 'r— ,�z'�ra s,ux:- vs�-��.• a..�n€ •- .('9�xr,. . -. uh„�.�:�. :." ...a,:
' O 9 S 9 . 1 L
Air conditioning or heat pump
Job site address:
1 ti-. 7 AV( (requires site plan showing placement) 14.00
City/State/ZIP: i ; ��� �� c.i .ZZ3 Fumace 100,000 BTU (ducts /vents) 14.00
Fumace 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
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
I: d :t 'tn$- R T q %�cu •4:J S' 3 '$'
., . t Z `u .: ' EIViji C a Waiik rW . @ h 4 ° 1 ' } ° Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
<,,,,; - W >,,.:a =' Chimney/liner/flue/vent 0.00
� - 1
:��' ®,�P'PERTY " "`� UUN:E�.`=�`�'; `�: - -�' "�.tY > „ ".. ..,... � �a�, ".
l ' .,.,. 0 , -. ?.111 r ®'',TENANT •_ . c
v_:;tx„ O ., rw.:.:'. °;r,r; "., = °:,. >:, s.. -., Other: 10.00
Name: C..0 1, \ CX \ , Environmental exhaust and ventilation
Range hood /other kitchen
Address: , (O S k ry $ "_ wt equipment 10.00
City/State /ZIP: - S�r"� O t q-) -L. - Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms, f
Phone: (SO") ) ( _ 0 Fax: ( ) toilet compartments, utility rooms) ` 6.80
g. m�; Z ,
� `r` ,1 AP•P�ICANT.Ni #i _ ; , V , N kCO T C PERSOI - Attic /crawlspace fans 10.00
V.4.40' 4 :a .... v.a , ,,- Yd's.4.,,. v. w•c R ' .ah�
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
=w _% . ". ' ,__`� s « GONTRA OR” 4'; z" - .v Barbecue
Business name: 0 W N --. K,_
Clothes dryer (gas)
Other:
AddIeSS: I ca a ; . .xt
lti M.EC$ANIOAI ,PERMFFEEESt
City/State /ZIP: Subtotal �j�
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)' Z
.
.
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee) .`)
TOTAL PERMIT FEE 7g 30
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: * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits \MEC- PermitApp doc 12/03 440 -4617T (I 1 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
4:44041
$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
PPM OF TIGARD r- 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business 4;1 e:;, (503) 639 -4171 MST
BUP
Received Date Requested HO AM X
PM BUP
Location /107c) () � Suite MEC2 — dO l
Contact Person d� �— Ph ( > 3) 0 / — 9 PLM 00 22- 3
Contractor t( Ph ( ) SWR
BUILDING Tenant/Owner ELC Z 60 4 — 002-9
Footing / ELC //
Foundation Access: �� l azsle/ Y t A�
Ftg Drain i/P1/ / l � '�� , ,� ` ELR
Crawl Drain �— �� �
Slab Inspection N • es: --> 'f" '
Post & Beam S7— ex)r
Shear Anchors
Ext Sheath/Shear i
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall aP/e / L - oo 3 ° e5
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
T FAIL
LUMBING
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / anhole
Storm Drain
Shower
Other:
A-TESO:9-7"&
:T FAIL
NICAL • //
asgh me /7 } /
as me i'� k
S r� - - Dampers
FAIL
L RICAL
• • gh -In I 41k EPr^ -CE/L1 T
v a.
Low Voltag `''t c -
Fi e Alar
1' �l Reinspection fee of $ required bef next ins tion. Pay at City Hall, 13125 SW Hall Blvd.
-(, PART FAIL
SI Please call for reinsp n 0 f , El Unable to inspect - no access
Fire Supply Line A
ADA Date S 2 -4 (5 Inspector &AR 1 V 06 Li Ext
Approach /Sidewalk ( I ns P
Other:
Final DO NOT REMOVE this inspection r cord from the job site.
PASS PART FAIL