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Permit • t 'r' C ITY OF TIGARD 0 MECHANICAL PERMIT AAA DEVELOPMENT SERVICES PERMIT #: MEC2005 -00237 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/13/2005 PARCEL: 2S111 BA -00807 SITE ADDRESS: 14270 SW 100TH AVE ZONING: R -3.5 SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 025 JURISDICTION: TIG Project Description: Replace gas furnace. 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: 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: > 10000 cfm: GAS OUTLETS: Owner: FEES SMITH, SHELLEY ANN Description Date Amount 14270 SW 100TH AVE TIGARD, OR 97224 [MECH] Permit Fee 5/13/200E $72.50 [TAX] 8% State Surcha 5/13/200E $5.80 Total $78.30 Phone: 503- 670 -7825 Contractor: BEN'S HEATING & AC PO BOX 80607 PORTLAND, OR 97280 REQUIRED ITEMS AND REPORTS Phone: 503- 233 -1779 Reg #: LIC 64597 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 • )2- 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: 0 Permittee Signature: Call 503 - 639 -4175 by 7:00 a.m. for inspections that b siness 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 OFFICE'USEONLY ; 7 , ,'.,e'''' City of Tigard f keceived Permit 13125 SW Hall Blvd., Tigard, OR 97223 E IV LF, Date/By: ,/ �� t- / mr C ��i / '' �� Plan Review Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 Ge�r � DateBy: Inspection Line: 503.639.4175 67 Internet: www.ci.figard.or.us M A Y 1 3 21 j -* -I Date Ready/By: 1111 0 S See Page 2 for MAY 1 Notified/Method: Sup plemen[al Information ,E ..:z; , �» *. ,�_ °� oaf ' :- x ,'�7r :k;x, ;.a+ ��. ...�a� e; >ai � w ; , �. ;a,� :�...�•,a } : .vc::��*r�. >���.sr,,:, �a,.x. re >.�.a; „' .' 4 . T YPE S , i . , . . i� COV11�T ' .. *SC HEDULE CJSE CHECKLIS � a �.� � ,...._. �.,.z.�- � .m. �a ��� � .. � m.r^ � .,. s,�ss+..^ „ tan .ins .. - . ❑ New construction f t 1 f1 r�l PPIent 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. . `' i3 ' •�" -;�r� �',• � };, », �. rem s :; «s•�- �- i�;,"•.. ^ =:; �.r. srfM;�r�;?Ks�.os�"3:#�+ - - - '' `" -; :;'�aa � xi�y- � ®l�/ N T . _,' „, .,,�� GATE,GORY' ®F CONSTRTI wo *r m t ' 3 : Value: $ _ -c. .Y.?... �°� » :.. -t _ ........... > t.. ��� Y.. 'i^ 2+� °ea'c"k. .*.e'�:a,•��:'.r.�"K:»�i�*'fiv -^ at, -a„a R3.�: ^ -� �?::'t ��ta...<..^nwx... �..- .�. -_�. fig,..,,.? % ;a" . ..� :.,.. . e..sr.:. sacra•. .,;, - .A..�>=.;z:At...;... , ... ,.t ,, ..a sx RESTDE1VTr EQUIPME1 Ti / S,TySTEMs iF.EES. 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ' " For special information use checklist. Multi family ❑ Master builder III Other: Description Qty. Ea. Total • `� JOB, SITi INTQRII�IATIO AND I OCATION .- x� Heating/cooling .� d`� . w �- � �"a%a.- �� uAs+�. Frv`: � t.., zn taT .:s�c..,.o-> o �.87y�' .4' .;. .�.. §,e...� a Job site address: e Air conditioning or heat pump �(��/ ,1 " t `� t� (requires site plan showing placement) 14.00 City/State /ZIP: T q 9 -)) it 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: Duct work 14.00 M L Hydronic hot water system 14.00 n, `1'V� 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 0 R ...°r..., ' .` : nta ,: . , � . P 01V F ®R: K � ...:.ai � � ` Water heater 10.00 ..;�r. z < .,, �(^ �AA' 614°S /1 , Gas fireplace 10.00 �-'Y 1 1 L f IN 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 _ a , � < .: ,< .. xe :` ' .r „ a r4. ,, ,Mi, '_ , .m: - Chimney /liner /flue /vent 10.00 A , N�ER, ` , ,,. '_ 1 . 1 ?, �'NANT = - 'i,.x 4 � �� ,e2 A4 Other: 10.00 Name: tY S6„N i Environmental exhaust and ventilation / Address: a 7 t 0 ,c C4) /0714 Range hood /other kitchen equipment 10.00 City /State /ZIR: - T; t 4 ev. T-7144 Clothes dryer exhaust 10.00 V Single -duct exhaust (bathrooms, Phone: (g) e a - /gas Fax: ( ) toilet compartments, utility rooms) 6.80 +; .` a,.,t• =..';v..�,.: `*::','� '�,CS•�3'- �" % `" aa.;�tt: *.;,y:a:.�', n5i., -i :*s. Attic/crawlspace fans . 10.00 �� AB0 01 TAG PERSON ��za p t� ,� _ -.� •�., .. ..e .... _ .� „'�,��,�,. .. , .; �-.. «. � F awe -:�. i�.:n t�a'ms »�zs .. `�Y,:�. >.. �.� +�- »c�?.'r��aa.,.«�... , a��s;S.i^, Other: 10.00 Business name: J� Fuel pip Contact name: Citt tie- eye" $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: , Wall /suspended/unit heater Phone: e 3 ) , �'�f I /Fax:: ( ) Water heater s S� V Fireplace E -mail: Range < ar s `"v tee' ,�+ ,.. +. -.»�« �. - GO ( - _ ' Barbecue Business name: �/ Other: Clothes dryer (gas) / �� � �►) Address" / C3 lr7 ll " y.; .r" y , _ 'r:'t s» :r:, t .... ;+ ,r.,..v ±z..,,,t,, .,:r - , �(, r© �/f l l MECHAICAL7PERIVII'r SEES* 3c���«.r�ax�.r�.ae "4..^XR' �s:4§ ,.x� v�A� t N,•7.�,ts City/State /ZIP: par-f 6 r q "ago Subtotal ,�,1 Phone: (S0 j) 233 .- )'77 Fax: (0 6 J V g� Minimum permit fee ($72.50) 7��> " Plan review (25% of permit fee) CCB lie.: 6 i ! 7 State surcharge (8% of permit fee) • / TOTAL PERMIT FEE / d ,.Y a Authorized signature: , � F „ - Thi perm app expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: C fgAi, gctr-� .. . 7 Date: 4.5"--- * Fee methodology set by Tri- County Building Industry Service Board i:\ Building \Permits \MEC- Pennit 12/03 440 -4617T (I l /02 /COM /WEB) N' Mechanical Permit Application - City of Tig4rd Page 2 - Supplemental Information Commercial Fee Schedule: 1?otal�Valua ion ; .. erMt Fee ., wn p t $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 CITY OF TIGARD BUILDING DIVISION - PERMIT #: MEC2005 -00237 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2005 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 J» INSPECTION WORKSHEET FOR DATE: 518/2005 TIME: 7 :34AM PAGE: 116 p1,b SITE ADDRESS: 14270 SW 100TH AVE CLASS OF WORK: SUBDIVISION: TIGARDVIL EL HEIGHTS LOT #: 025 TYPE OF USE: PROJECT NAME: SMITH DESCRIPTION: Replace gas furnace. OWNER: SMITH, SHELLEY ANN, PHONE #: 503.670 - 7825 CONTRACTOR: BEN'S HEATING & AC PHONE #: 503 -233 -1779 Inspection Request Scheduled For: Date: 5/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message" 699 Mechanical final 007077 -01 503 - 233 -1779 N Corrections /Comments / Instructions: MTINgtqfk L IZi ° � III PASS t� APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: �- Date: `, I Phone #: (503) 718-