Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00565
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/16/03
PARCEL: 1S134DA-00800
SITE ADDRESS: 11030 SW 106TH AVE
SUBDIVISION: NORTHERN PINE ZONING: R -4.5
BLOCK: LOT: 008 JURISDICTION: TIG
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:
LPG 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: 3
Remarks: Convert furnace and water heater to gas, add gas piping for future range.
Owner: FEES
RICHARDS, JOHN A + JULIE A Description Date Amount
11030 SW 106TH AVE [MECH] Permit Fee 9/16/03 $72.70
TIGARD, OR 97223 [TAX] 8% StateTax 9/16/03 $5.80
Phone: Total $78.50
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Gas Line lnsp
Heating Unt lnsp
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 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 set forth in OAR 952 - 001 -00
sued By: _' -,! ; ' ; / %/J� Permittee Signature:
Call (5 639 -4175 by 7:00 P.M. for inspections needed the next business day
_Mechanical Permit Application FOR OFFICE l SE: ONLY
Received / Mechanical /
Date/By: "r /V O J PermitNo.: MCC 3 -oo 54'
City City of Tigard Planning Approval Building
DateBy Permit No.:
13125 SW Hall Blvd. Plan Re Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503- 598 -1960 � Post- Review Land Use
n�dy , s d I, A Date/By: Case No.:
Internet: www.ci.tigard.or.us I
l� 4 Contact Junes Su See Page for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: - /,a, Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder El Other:
Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 1 14.00
Job site address: < t030 5 [01 -TiG(t -(u'> t 9. 7?.. kt Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
Flue vent (water heater /gas fireplace) 10.00
C 1•1 0 0P -T SUS Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
4 PROPERTY 0 • " I 0 TENANT Other: 10.00
Name: ,�{ -,.,1 I F ( Environmental Exhaust & Ventilation
Address: ((> 3� 54.3 10LQ`t - Range hood/other kitchen equipment 10.00
City/State/Zip: 1C_A,.J Q g_ 0,-?2 ?-3 Single es dryer exhaust 10.00
{ Singl duct exhaust
Phone: WO-- ( 2--( Fax: (bathrooms, toilet compartments,
0 APPLICANT , ❑ CONTACT PERSON utility rooms) 6,80
Name: Attic /crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *(s5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc. J **
Gas heat pump **
E WalUsuspended/unit heater *4. CONTRACTOR Water heater / **
Business Name f) , Fireplace ` **
Address: ` Range (Fig ruLc'J l ** **
City /State /Zip: C dryer rY (gas) **
Phone: i Fax: Other: **
CCB Lic. #: 01 Total:
Authorized -. Mechanical Permit Fees*
Signature: „ Date: 6 111( 0 (b3 Subtotal: $
Minimum Permit Fee $72.50 $ 7,P , 50
Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ j , TO
TOTAL PERMIT FEE $ 7 t' . 3D
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
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 $23 1.50 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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and
$1.10 for each additional $100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of plans.
i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 17 AM PM BUP
Location //03/7 uJ /t6' .4v . Suite MEC 3 "do s
Contact Person (71 J Ph ( ) J� 2 Y y��� PLM 5 O L I
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain / ELR
Crawl Drain �./ /�
Slab Inspec o ' Notes: - SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
P -7.6./jf
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Othe
S PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Sm..: D ampers
PART FAIL
TRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
1 ,-). "-IL/
ADA
Approach/Sidewalk Date Inspector Est
Other:
Final DO OT REMOVE this inspection record from the job site.
PASS PART FAIL