Permit . 1 11111,
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00644
DATE ISSUED: 11/4/03
,,.��I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134CB-09100
CITE ADDRESS: 11145 SW 123RD PL
SUBDIVISION: ANTON PARK ZONING: R -7
BLOCK: LOT: 053 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: Install gas fireplace insert, gas piping, vent.
Owner: FEES
RATHKE, KAREN AN NE Description Date Amount
11145 SW 123RD PL
TIGARD, OR 97223 [MECH] Permit Fee 11/4/03 $72.50
[TAX] 8% State 11/4/03 $5.80
Phone: 503 -521 -8232 Total $78.30
Contractor:
SUBURBAN @HOME
6014 NE 112TH AVE.
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone: 503-257-5438 Gas Line Insp
Mechanical lnsp
Reg #: LIC 143335 Heating Unt lnsp
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 -0010 through OAR
952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 - 6699,,
Issued By: � iG� / Permittee Signature: v r C G� � (2� � t pe )'l
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
r
r
lie anic rmit Application Received ' � Mechanical /q/ Date/By: �G 2 Jl Permit No.: n� 7� -oa4 '/ CI of Ti and Planning ASal Building
`J g Date/By: No.: p 1
13125 SW Hall Blvd. Plan Review Other �/
Tigard, Oregon 97223
D ateB y: Permit No.: '
Phosie: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use \ \�
alou A Date/By: Case No.:
Internet: www.ci.tigard.or.us .i i i Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 -- Name/Method: lI ( 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.
0 1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule
Cl Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty 1 Fee(ea.) Total
❑ Master Builder El Other:
Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: 1 1 X15 ShI )Z) PL . Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Cross street/Directions to job site: (for orid radiator boiler
� ( 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 r 10.00 'I U --
Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 1 10.00 10 —
EPROPERTY OWNER I ❑ TENANT Other: 10.00
Name: K ARt*1 1Z AT4- K E Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: 111 LAG S J 1 a3 Q.0 i� ,. -
AC.p pia. �1 ag3 Clothes dryer exhaust 10.00
City /State /Zip: - -!
Single duct exhaust
Phone: 5,2 I- S 239 Fax: (bathrooms, toilet compartments,
0 APPLICANT 0 CONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: 1 0.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax:
Furnace, etc. **
Gas heat pump **
E -mail: WalUsuspended/unit heater **
CONTRACTOR Water heater **
Business Name: E.:Q d3"(2) Q 3 ,.\,,,e }3µi, Fireplace I ** 6. Li I)
Address: (p(` 1 Li Nr, hg-k 1A AQE . Range
C
City /State /Zip: 7 O 1_�. k.2)) C.;... C.;... Q� 99O C o tthes dryer (gas) **
Phone: c 257 -14 Fax: ( 91-sy SO Other: **
CCB Lip. #: 11-k'3"." S Total:
Authorized � ' Mechanical Permit Fees*
Signature: . Pirli . 14 1( 03
Subtotal: $
Minimum Permit Fee $72.50 $ "1Q -' t)
t Z l' S ` C -' L V �1 S Plan Review Fee (25% of Permit Fee) $
�i (Please print name) State Surcharge (8% of Permit Fee) $ G. �i'd
TOTAL PERMIT FEE $ .1S..
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 $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.
$100,001.00 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) 6n-4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 1 Date Requested r 7 AM PM BUP
Location l / / 4 "{ 5 / a 3 4 / -- Suite MEC 3 - 0 d 4
Contact Person Ph ( ) S 7 -.S c,? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection 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:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
FAIL
44 1 2 : 0 6 1 -
ECH ANICAL
Post & Beam
Rough -In
Gas Line
S u . ke Dampers
in
4. PART FAIL
ELECTRICAL
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Dat )l" 7 7 2 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL