Permit i ', ,
• CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00395
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/25/2008
PARCEL: 1 S134CA - 09200
SITE ADDRESS: 11218 SW 118TH TER ZONING: R - 4.5
SUBDIVISION: FEHRENBACHER NO. 2 LOT: 011 JURISDICTION: TIG
PROJECT: HOFF
Project Description: Installation of heat pump.
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:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
MUSTAPHA HOFF Description Date Amount
11218 SW 118TH TERR
TIGARD, OR 97223 [MECH] Permit Fee 7/25/200E $72.50
[TAX] 12% State Surch 7/25/200E $8.70
Total $81.20
Phone: 503 - 579 -9215
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 624 -2704
FAX 503 -598 -0270
Reg #: LIC 76359
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.
/ I l
Issued By: Pe rm itt ee Signature: f // Call 503.639.4175 by 7:00 a.m. for inspections t . 7 ji ss day.
This permit card shall be kept in a conspicuous place on the job sit- until completion of the project.
Approved plans are required on the job site at the time of each inspection.
v
"1Vechanical Permit Application FOR OFFICE USE ONLY
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Cl of Tigard :ea:: w v / ^� � . g a c r, Q O Permit No.: TJC / y III " 13125 SW Hall Blvd., Tigard,OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI GARD Inspection Line: 503.639 Date ReadyBy: 1 ® See Page 2 for
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Internet: ww.tigard- or.gov Notified/Method: /(C(' Supplemental Information
TYPE OF WORK . COMMERCIAL_ FEE* SCHEDULE.— CHECKLIST
USE CHELIST
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: $
ID 1- and 2- family dwelling ❑ Commercial/industrial _ ' RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Ac cessory building "
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
1 �(�/ � ;� Air conditioning or heat pump
1
Job site address:
/ (/ V l l �) /� l (, (requires site plan showing placement) 14.00
City/State /ZIP: I 1 G1 p�_i j t o [ q? z Z 3 Furnace 100,000 BTU (ducts /vents) 14.00
/ rl U Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: il- Fr Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
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. 14.00
Subdivision: Flue /vent for any of above 6.80
Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK • Water heater 10.00
` - n ( Gas fireplace f for 10.00
kall ? p H � � H ' l Flue vent or water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent
Other: 10.00
�Iy /1 ) 10.00
Name: I F F Environmental exhaust and ventilation
Address: `1� j I t Range hood/other kitchen
r W , 1 1 �jR . equipment 10.00
City/State /ZIP: l i l(Lr l ! OR. . / G 2 z3 � Clothes dryer exhaust 10.00
Phone: ( ) TJ Fax: Single -duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT • ❑ CONTACT PERSON ' . Attic /crawlspace fans 10.00
Business name:
Other: 10.00
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
Business name: (� Of 1 A 4 ( (206 1 J Clothes dryer (gas)
Address: t
{ ' .• 0 ■ 2 MECHANICAL PERMIT FEES*
City /State /ZIP: , f,4 A , N; Subtotal
Minimum permit fee ($72.50) Tj
Phone: 5763) 1 ...... en -.01. Fax: ( )
Plan review (25% of permit fee) alifirr
CCB lic.: 7 • 3 1 State surcharge (12% of permit fee). . 70
TOTAL PERMIT FEE I
Authorized signature: / 4// * This permit application expires if a permit is not obtained within 180
li/rr
�� f days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
I \Building\Permits'MEC- PermitApp doc 01/19/07 440 -4617T (11 /02 /COM/WEB)
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 $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.
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I: \Building\Permits\MEC- PermitApp.doc 01/19/07 2
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MI =C2008 00185
13125 SW Hall Blvd., Tigard, OR 97223. DATE ISSUED: 7/2512008
Phone: (503) 639 -4171 / our'IVuq�Njlt�l�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 816/2008 TIME: 7:03AM PAGE: 38
SITE ADDRESS: 11218 SW 118TH TER CLASS OF WORK:
SUBDIVISION: FEHRENBACHER NO. 2 LOT #: 0 TYPE OF USE:
PROJECT NAME: HOFF
DESCRIPTION: Installation of heat pump.
OWNER: HOFF, MUSTAPHA PHONE #: 503-579-9216
CONTRACTOR: COLUMBIA HEATING & COOLING INC PHONE #: 503-624-2704
Inspection Request Scheduled For: Date: 8/6/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message A ,n
699 Mechanical final 073776-01 503 -624 -2704
Corrections /Comments /Instructions: c,
t ics/ 4 c:111C) tir' /eel( ; Cic I i % `^A I
C5e_
PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector's Date:A Phone #: (503) 718- 2103