Permit •
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00488
r � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/5/2005
PARCEL: 2S 114BB -06000
SITE ADDRESS: 16003 SW 104TH AVE ZONING: R -12
SUBDIVISION: SWANSONS GLEN LOT: 001 JURISDICTION: TIG
Project Description: Replacement of furnace & installation of A/C unit.
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: 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:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
EARLL, LOUIS G JR AND Description Date Amount
GERALDINE F
16003 SW 104TH AVE [MECH] Permit Fee 8/5/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcha 8/5/2005 $5.80
Phone: Total $78.30
Contractor:
OWNER
• REQUIRED ITEMS AND REPORTS
Phone:
Reg #: •
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.
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Issued By: :577 _� Permittee Signature: _die
Call 503 - 639 -4175 by 7:00 a.m. for inspection ' • 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 nical Permit Application roR OFr• icL USE ONLY
City of Tigard h ' Received c--.
W 62 Permit Noi lam' ,,2 607 t7l
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 An,?. . , f I.A. Date/By. Other Permit:
Inspection Line: 503.639.4175 - a J gilt I Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: �i Supplemental Information
. TYPE OF WORK COMMERCIAL FEE* ` SCHEDULE — USE CHECKLIST
❑ 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.
CATEGORY OF CONSTRUCTION. Value: $
El 1 -and 2 dwelling RESIDENTIAL EQUIPMENT /:SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ A ccessory building
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other:
Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: j 4 06 3 � 1 O fr t1 ,/ vc_ Air conditioning or heat ump placement) / 14.00
lJ � (requires p
uires site plan showing
City/State/ZIP. 7/ Q r 01� 7 2 9 Furnace 100,000 BTU (ducts/vents) P 14.00
V / 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
,^ h Hydronic hot water system 14.00
oG �1� 12a 1-' 1I t. 4_ 1 � * 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
DESCRIPTION OF WORK Water heater 10.00
,�
Gas fireplace 10.00
,Q Add i f /�/'
QiVACe /4 e /1/r 0 "P C e/✓ a- I / , f� fie ® / L1 - 2( eR Flue vent for water heater or gas
AA/d— T / ! fireplace 10.00
0 /1 a - r C D•I l/�flv(� /�
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
XPROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: 4 Q /4 S C r . An LL Environmental exhaust and ventilation
Address: /40 0 14 1 4 fh j/e Range hood /other kitchen
equipment 10.00
City /State /ZIP: t11 y a. roc 0 tg -9 7 2 2 44 Clothes dryer exhaust 10.00
p 3 6g- L _ ! _ Fax:
Single-duct compartments, rt e nts (bathrooms,
unlit rooms) Phone:
(JV ) 3 F ( ) toilet com artments, utili rooms ) 6.80
- -- - 7 -- -- ❑=xAPPLICANT-_..- .- - -. - -_ - -- -- - -- - --0. CONTACT- PERSON — = Attic/crawlspace fans 10.00
Other: 10.00
Business name:
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
CONTRACTOR Barbecue
, Clothes dryer (gas)
Business name: o
Other:
. Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($72.50) 7,A - . 5 0
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee) 4", O2
TOTAL PERMIT FEE `7 50
Authorized signature: .0 „... _ ,, / This permit application expires if a permit is not obtained within 180
r r days after it has been accepted as complete.
Print name: L o u.i s G. 6444 Li- Date: F._ F-_, D * Fee methodology set by Tri- County Building industry Service Board
i:\ Building \Permits'MEC- PamitApp doc 12/03 440-4617T (I I /02/COM/WEB)
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Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
• Commercial Fee Schedule:
Total'Vain ation: "', 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 sets of plans.
i:' Building \Permits\MEC- PermitApp.doc 12/03 2
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005-00.188
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/5/2005
Phone: (503) 639 -4171 /�av�l�y�
Inspection Requests (24 Hrs.): (503) 639 -4175 =�� `:_..
INSPECTION WORKSHEET FOR DATE: 9/19/2005 TIME: 7 :06AM PAGE: 26
SITE ADDRESS: 16003 SW 104TH AVE CLASS OF WORK:
SUBDIVISION: SWANSONS GLEN LOT #: 001 TYPE OF USE:
PROJECT NAME: EARLL
DESCRIPTION: Replacement of furnace & installation of A/C unit.
OWNER: EARLL, LOUIS G JR AND, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
615 Mechanical rough -in 016035 -01 503 -664 -2003 N
Corrections /Comments/ Instructions:
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- (1 1.1.111111 ... )
J I PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
l FAIL i j' LL FOR INSPECTION n ADDITIONAL FEES ASSESSED
/ Inspector: � Date: 62 3 Phone #: (503) 718 -
IMP