Permit 'CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00737
TWA DATE ISSUED: 12/18/2007
1 3125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S134CA -00105
SITE ADDRESS: 11595 SW NORTH DAKOTA ST ZONING: R -4.5
SUBDIVISION: BARTON LOT: 002 JURISDICTION: TIG
PROJECT: BRENT
Project Description: Install gas furnace, venting and gas piping.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 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:
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
SINI BRENT Description Date Amount
11595 SW NORTH DAKOTA
TIGARD, OR 97223 [MECH] Permit Fee 12/18/20C $72.50
[TAX] 8% State Surchar€ 12/18/20C $5.80
Phone: Total $78.30
Contractor:
AIR COMFORT INC
5785 NE COLUMBIA BLVD
PORTLAND, OR 97218 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 260 -7806
Reg #: LIC 58835
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 g to OU NC by
calling 503.246.6699 or 1.800.332.2344.
Issu • By: 1 6 ,/ Permittee Signature:
Call 503.639.4175 by 7:00 a.m for inspections that b /fines d. y'
This permit card shall be kept in a conspicuous place on the job site u t mpl = of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application ` �.f' } ' , y FOR �O FICE USE ONLY , ' ; ,zt ",i
lilt `C ify of Tigard Date/By: Received , /id Permit No.: / ti n 2
ii 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review v'
9 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
"= Inspection Line: 503 Date Read /B Juri
4T I G A It D Ready /By: �/ 63 See Page 2 for
Internet: www.ngard or.gov Notified/Method: f(a Supplemental Information
TYPE OF WORK . COMMERCIAL. FEE* SCHEDULE - .USE CHECKLIST
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.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES* .
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: r AA Air conditioning or heat pump
f ' J J`� (requires site plan showing placement) 14.00
City /State /ZIP: 7 1 0 � Furnace 100,000 BTU (ducts /vents) 14.00 . f lP,ai
J Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: bjJ r
l Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
j ( � , I It Hydronic hot water system 14.00
/46)1 1 J1d Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
' DESCRIPTION OF WORK Water heater 10.00
t Gas fireplace 10.00
--u ►2d) j�Q ^ - ^f-3 lira- a- 0) D A} Flue vent for water heater or gas
1 � fireplace 10.00
C- Q 1 U' /, Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: N t (q ¶" N j VS t � ) Environmental exhaust and ventilation
Address: ) J ' ` 1 Yv / T Range hood/other kitchen
equipment 10.00
City /State /ZIP: �� Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ A PPLICANT ' • ❑ 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. 1- c,
ti
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace _
E -mail: Range
CONTRACTOR Barbecue
Business name: A) � eh gy i � J G Clothes dryer (gas)
Other:
Address: r7' c N - 2_ CAW, c f2 //1/4------4t 'MECHANICAL PERMIT FEES* '
City /State /ZIP: 0 `1 } ZI 6 ,) Subtotal ( ?, -/ 0
i Minimum permit fee ($72.50) 1 j.
Phone: ( j Z 1 ) v ,7 Q _ Z Fax: ( ) Plan review (25% of permit fee)
CCB tic.: (-/ e - J- State surcharge (8% of permit fee) 540
J TOTAL PERMIT FEE 7$ .,jd
Authorized signature: �I �[ - 1' 1J ,,/ r This permit application expires if a permit is not obtai within 180 _ , / days after it has been accepted as complete.
Print name: r Date: / 2// r . * Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Permits' PermitApp.doc 01/19/07 440- 4617T( /COM/WEB)
Mechanical Permit Application - City of Tigard ,r
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.
1:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2007.00737
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/19/2007
' Phone: (503) 639- 4171 M _
Inspection Requests (24 Hrs.): (503) 639 -4175 A ' . / &. �d 7 — t O � 7
INSPECTION WORKSHEET FOR DATE: 12/1 912007 TIME: 7 : 00AM PAGE: 3
SITE ADDRESS: 11695 NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: BARTON LOT #: 002 TYPE OF USE:
PROJECT NAME: BRarr
DESCRIPTION: Install gas furnace, venting and gas piping.
OWNER: BRENT, SINI PHONE #:
CONTRACTOR: AIR COMFORT INC PHONE #:. 503-20-7806
Inspection Request Scheduled For: Date: 12/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 061860-01 503- 2 60.780 Y
Corrections/Comments/Instructions:
Co�
P' - ASS I I PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: 94 Date: /2 —0-7 . Phone #: (503) 718- �4- Kc-s-''y