Permit CITY TIGARD MECHANICAL PERMIT
i °� DEVELOPMENT SERVICES PERMIT #: MEC2005-00755
. - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/14/2005
PARCEL: 1 S 134CA -08000
SITE ADDRESS: 11222 SW 117TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER LOT: 001 JURISDICTION: TIG
Project Description: AC install.
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:
ELE 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:
Owner: FEES
PAYS CUSTOM HOMES Description Date Amount
17481 SW HOODOO CT. [MECH] Permit Fee 11/14/200 $72.50
BEAVERTON, OR 97007 [TAX] 8% State Surchar€ 11/14/200 $5.80
Phone: 503 - 475 - 5041 Total $78.30
Contractor:
PAYS CUSTOM HOMES
17481 SW HOODOO CT. REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97007
Phone: 503 475 - 5041
Reg #:
Th is 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.
Issued By: . /Liee...s..4.._ , ,Z Permittee Signature: 4, /t 1 7
Call 503 - 639 -4175 by 7:00 a.m. for inspections that 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.
I '
'Mechanical PeR t r 1 otz ()IA 1( 1. t s1.ONIA
City of Tigard �/ 'Received ��6L � .
i Permit No.: 4
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 2005 Date/By. Other Permit:
Inspection Line: 503.639.4175 _�4 x 'iI i Date Ready/By: El See Page 2 for
Internet: www. ci.tigard.or.us J Notified/Method: s ;i.l Supplemental Information
CITY OF TIGARD .
t5Ui LDINC ` I `t`i1P WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
'New construction Mechanical permit fees* are based on the value of the work
❑ Addition/alterap on/replacement performed. Indicate the value (rounded to the nearest dollar) of all
Demolition [Other: / G Arm /11 //f 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 I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
�7 � `` (( p' Air conditioning or heat pump
Job site address:
I l/�� 5 l N 11 7 - k, � f/ �/k C& (requires site plan showing placement) 14.00
City /State /ZIP: -7; SCtir tA d 2 " /� Furnace 100,000 BTU (ducts/vents) 14.00
� "7 Z
1 Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: t -I- khte�rb�rihar Gas heat pump 14.00
Cross street /directions to job site: SG,j i z\ f p.1 dr -4--.4- Duct work 14.00
1 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
Flue /vent for any of above 10.00
Subdivision: (--e)(-% e / I Lotno.: t
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
14/K. U Gas firepla 10.00
� � ,�L n ('7' / 1 lj (, �( (�'L Flue vent for water heater or gas
`�/ 5 C d r \ I t 5 A 1(cL Q Log 10.00
(( Log IiRhter (gas) 10.00
`, N - pl'(fir_ r Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00
l Other: 10.00
Name: F a `3__S L U L - a^�1 '/� ! L - Environmental exhaust and ventilation
J / Range hood/other kitchen
Address: 1 '-) l j, tR ( S d\ G-b equipment 10.00
City /State /ZIP: $QAju 2 0 1 '.) 03"1 Clothes dryer exhaust 10.00
� �s - � Li 5` l 1 9 5 Single-duct exhaust (bathrooms,
Phone: ( .7 Fax: (>-' 3 J 2-1 ' '"- dJ to compartments, roo nts, utility rooms) 6.80
❑ APPLICANT ❑ 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
Furnace, etc.
Address:
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater _
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: c ,,,..,„,....„ )4 - Clothes dryer (pas)
�5S�- Other.
Address: 17 ' ' ' ` �- MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) I ( ) Minimum permit fee ($72.50)
Fax:
Plan review (25% of permit fee) (8% of permit fee)
CCB lic.: " l� l / r �� Q State surcharge TOTAL PERMIT FEE (�
Authorized si a e: 1 / This permit application expires if a permit is not obtained within 180
d ays after it has been accepted as complete.
Print name: '0 // /7 / / / /y/ 0 J-- * Fee methodology set by Tri County Building Industry Service Board
i:\ Building \Permiis\MEC- Pe+mitApp.doc 12/03 440- 4617T(II /07JCOM/WEB)
Mechanical Permit Application - City of Tigard ,
Page 2 - upplemental Information
Commercia Fee Schedule:
Total Valuat n: Permit Fee:
$1.00 to $2,000.01 Minimum fee 2.50
$2,001.00 to $5,000. 0 $72.50 forth= first $2,000.00 and $2.30
for each ad. ional $100.00 or fraction
thereof, to . d including $5,000.00.
$5,001.00 to $10,000.00 $141.50 '. r the first $5,000.00 and
$1.80 f• each additional $100.00 or
fractio thereof, to and including
0 500.00.
$10,001.00 to $50,000.00 $2 4 .50 for the first $10,000.00 and
$ .3 or each additional $100.00 or
actio ereof, to and including
$50,000.1
$50,001.00 to $100,000.00 $771.50 for .1 a first $50,000.00 and
$1.25 for each : dditional $100.00 or
fraction thereof, and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first . 00,000.00 and
$1.10 for each additional . 00.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of pla .
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
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CITY OF TIGARD -C
BUILDING DIVISION i PERMIT #:. S' — 7 Ste'
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 • /0 ' d ii� ° 'NP�4fl1'�''IP
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1 ('- 11 'ti TIME: PAGE:
I
I SITE ADDRESS: / i Z 7/2_ 510 1 (1 1 t CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: k-i D-
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Cog rte
Corrections /Comments/ Instructions:
i _
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FoR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i Date: Phone #: (503) 718-