Permit IN u
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00301
TIGARD DATE ISSUED: 6/12/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S133DD -10300
SITE ADDRESS: 11830 SW 125TH CT ZONING: R - 4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT: 140 JURISDICTION: TIG
PROJECT: BROWN
Project Description: Replacing furnace.
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: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
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:
Owner: FEES
MARY BROWN Description Date Amount
11830 SW 125TH CT
TIGARD, OR 97223 [MECH] Permit Fee 6112/200E $72.50
[TAX] 12% State Surch 6/12/200€ $8.70
Phone: Total $81.20
Contractor:
APOLLO AIR, INC.
16088 SW FLAGSTONE DR.
BEAVERTON, OR 97007 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -579 -5455
Reg #: LIC 156907
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.
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Issued By: ,,,g/Ist _ - - • „...i .. ., � Permittee Signature: G�!G¢�X e" -------- -
Call 503.63 by 7:00 a.m. for inspection h t 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.
Mechanical Permit Application } " , - FOR OFFICE. USE ONLY
ipli
� .; City of Tigard Received
Plan Review , M b i/ 'PermitNo.: iiiik .. i y
13125 SW Hall Blvd., Tigard, ORg9 22
Phone: 503.639.4171 Fax: 503 "5 1960 %); 1 Date/By:
veve d Date /By: Other Permit: A " ' 0 )08 - ,,,_ U If
T I G A R D Inspection Line: 503.639.417a \v Date Ready /By: • ® See Page 2 for
Internet: www.tigard- or.gov ' � Notified/Method: Supplemental Information
TYPE OF r COMMERCIAL FEE* SCHEDULE - USE.CHECKLIST
❑ New construction Addition /altea� /r eplacement Mechanical permit fees* are based on the value of the work
Yy performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
dwelling RESIDENTIAL EQUIPMENT/ SYSTEMS FEES *.
- and 2-famil
gr
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
Multi - family El Master builder El Other: Description Qty. Ea. Total
.JOB SITE INFORMATION AND LOCATION, Heating/cooling
J
Job site address: Air conditioning or heat pump
Z S� site plan showing placement) 14.00
�� ✓� / e l (requires P gP )
City /State /ZIP: G2 �� r7 /e 722 Furnace 100,000 BTU (ducts /vents) 1 14.00 lti,
7/
l . 3 3 Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. no.: Project name: - 0//Lrt/ Gas heat pump 14.00
Cross street/directions to job site: 5[J jAvil e / _ I/ -6- 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: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
l , e (...305/^6 t_ Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER CI TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: V. __ • v v ,_ - x/Y" ,_ / Environmental exhaust and ventilation ii, / - r Range hood /other kitchen .
Address: equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON ' Attic /crawlspace fans 10.00
,, \\ Other: 10.00
Business name:
Wu c ,5' ") 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 TOR . Barbecue
• Business name: 4. -rK, 1 e � / Clothes dryer (gas)
� °(' Other:
Address: I 7� MECHANICAL PERMIT FEES*
City /State /ZIP: 4 Li - .J1 a F' - ' 700 2 Subtotal
t Minimum permit fee ($72.50) - 7;),1�
Phone:) 3 (is,- egg Fax: ( ) Plan review (25% of permit fee)
CCB lie.: / S6, -, 7 State surcharge (12% of permit fee) R ,rk
TOTAL PERMIT FEE 8 i r,l
Authorized si ature:� /_ This permit application expires if a permit is not obtained within 180
j 2°24 p� days after it has been accepted as complete.
Print name: �� � ct e S' Date: V - ` 0 0 * Fee methodology set by Tri -County Building Industry Service Board
�' v /` 6
1. \ Building \ Permits \MEC - PermitApp.doc 01/19/07 440 -46t7T (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
$ I00,000.00.
$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 01/19/07 2
CITY OF TIGARD .
- ,..
,
. ,((
BUILDING DIVISION
PERMIT #: MEC2000-00301
V
13125 SW Hall Blvd., Tigard, OR 97223 AE ISSUED: 6/12/2008
Phone: (503) 639-4171 ,.,: amliti lit
gir, 1
Inspection Requests (24 Hrs.): (503) 639-4175 • 1
INSPECTION WORKSHEET FOR DATE: 6/13/2008 TIME: 7:01AM PAGE: 18
SITE ADDRESS: 11830 SW 125TH CT CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT #: 140 TYPE OF USE:
PROJECT NAME: BROWN
DESCRIPTION: Replacing furnace.
OWNER: BROWN, MARY PHONE #:
CONTRACTOR: APOLLO AIR, INC. PHONE #: 503-579-5455
1 11 ) 4
Inspection Request Scheduled For: Date: 6113/2008 4\l Pour Time:
Code # Inspection Description Confirm # Contact # Mes - ge
699 Mechanical final • 071364-01 503-348-8554 Y
Corrections/Comments/Instructions:
"SS — PARTIAL APPROVAL 0 CANCEL NO ACCESS
_
0 FAIL El CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
,
Inspector: Date: IPA r Phone #: (503) 718-
2 ' L l
_ _