Permit CITY OF TIGARD
MECHANICAL PERMIT
I l k DEVELOPMENT SERVICES PERMIT #: MEC2004 -00008
' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/8/04
PARCEL: 2S103BB -08400
SITE ADDRESS: 12415 SW 122ND AVE
SUBDIVISION: LAKE TERRACE ZONING: R -4.5
BLOCK: LOT:011 JURISDICTION: TIG
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:
LPG 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Kitchen remodel. Water heater vent and 30' gas line for range with 1 outlet.
Owner: FEES
LEWIS, LINDA ANN Description Date Amount
12415 SW 122ND AVE
TIGARD, OR 97223 [MECH] Permit Fee 1/8/04 $72.50
[TAX] 8% State Surchart 1/8/04 $5.80
Phone: 503 - 590 - 7544 Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Gas Line lnsp
Mechanical Insp
Reg #: Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issued By: / / 40 / Permittee Signature:9( 1,0
Call (503) 639 -4175 by 7:00 P.M. for inspections neede the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
C Tigard Date/13y: ' _$ —off PemutNo.: mE Da �O�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 t mN�1M„NpiGli�Yi� � r1 Date/By:
Inspection Line: 503.639.4175 ,a.J,� >.• Dat R /B cis: ® See Page 2 for
er /
Internet: www.ci.tigard.or.us Notified/Method: / / Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Jg 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*
14 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
N Air conditioning or heat pump
Job site address:
i 5 5VJ l 22 (requires site plan showing placement) 14.00
City/State /ZIP: l th- O 0 (L at - 7 2. Furnace 100,000 BTU (ducts /vents) 14.00
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: 1 2 -i 4- iN N LIT Duct work 14.00
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. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Ce't, rt -A-e0 g - mQOeL Flue vent for water heater or gas -
fireplace 1 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
[PROPERTY OWNER ❑ TENANT Other: 10.00
Name: 1...-I •l 9 A L—,—Ill (S Environmental exhaust and ventilation
t l r7 Range hood /other kitchen
Address: �j Vv ( ZZ N equipment 10.00
-
City/State /ZIP: 'n 6- Pc?-19 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (Sc' ) S'?C 1 5 Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT ❑ CONTACT PERSON ' Attic /crawlspace fans 10.00
Other: 10.00
Business name: Fuel tin
P g
Contact name: pl, j L t e 12Ept--y.1 $5.40 for first four; $1.00 for each additional
Address: Z 41 t7 c � l ZZ N--(2 Furnace, etc.
V Gas heat pump
City/State /ZIP: (( Mil Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range jO 1 L 1 N&
; OOOKif Barbecue
Clothes dryer (gas)
Business name:
Li) N a Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Minimum permit fee ($72.50) '�,- j'U
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) /�
CCB lic.: State surcharge (8% of permit fee) 6.$5
TOTAL PERMIT FEE '7 '. (.)
�,l/� � l This permit application expires if a permit is not obtained within 180
V�
Authorized signature: 4f. / days after it has been accepted as complete.
Print name: r N ( V Q Date: 1/ * Fee methodology set by Tri- County Building Industry Service Board
i:\Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (II /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.
i:\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�J BUP
Received Date Requested / / 7 AM PM BUP p�
Location / 2.- 1 4 /.S / Z Z ✓1'd Suite MEC V-- Or) ao D
Contact Person ' 114.3e Ph ( ) 5 - ' -- L5 I /4 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
A ccess:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing ,
Insulation
Drywall Nailing rjalirffifM .
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
P ----
Roof
Other:
Final
P ASS PART FAIL (__ ..-------
PLUMBING ,Q�
Post & Beam j ; \ I _ �\ 1 , 1 v '2 '3N1 ��S S
Under Slab IP J 1
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
W i l l iiie — 1S
Smoke Dampers
Fi .��
E_\` FAIL
EL
Service
Rough -In
UG/Slab �
Low Voltage /t/d 64 C 4 ,
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA - t7 Q / l _
Approach /Sidewalk Date / Insp Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL