Permit CITY OF TIGARD
MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00588
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/1/2004
PARCEL: 2S111 DB -07800
SITE ADDRESS: 15455 SW ALDERBROOK DR
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 372 JURISDICTION: TIG
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: 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: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas insert and gas piping.
Owner: FEES
ARTHUR KERNS Description Date Amount
15455 SW ALDERBROOK DR [MECH] Permit Fee 9/1/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 9/1/2004 $5.80
Phone: 503 - 598 - 1160 Total $78.30
Contractor:
GAS CONCEPTS & CONSTRUCTION
P.O. BOX 86232
PORTLAND, OR 97286 REQUIRED INSPECTIONS
Phone: 503 698 - 4996 Gas Line Insp
Mechanical Insp
Reg #: LIC 133149 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) 46 =669•.
Issue y: y 41 / � Permittee Signature: ' "' jj/
Call (503 639 -4175 by 7:00 P.M. for inspections need d the next business day
Mechanical Permit Application FOR O FFICE U SE ONLY O`
Cit o f Ti and Received permit No.: Q '}S ,
p E
1312 Hall Blvd., Tigard, OR 97223 Date/By: 91=811M.) �L' ii Plan
Phone: 503.639.4171 Fax: 503.598.1960 /� ;\ D ateB eview
Other Permit:
Line: 503.639.4175 . I1
Date Ready/By: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: IIM Supplemental information
' 344V110;" „ x11 a . i . - . ' x ' »i'Ca4 M. .-.4 ." u„xi: I �i::: x""c'a t r �' . S €' x �, .r -
�». .� ';�.��..r E OF':;WORK": ° '`y= .�'�:'�ox�t�R �.tF��� � :..,.�� =C..OMMEItCIALF�EE. ,.SCHEDULE -
= "= °T
Mechanical permit fees* are based on the value of the work
0 New construction
154ddition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
W 4 , "CATEORY rOF @ ONSTRUCTIO, . 1r
Value :
�. . uWa .,...� , � . >>.; ,,e .:_, ,o...s,. ,,,, ;, -... .. ° ...--11e.,... Vi i; > • ; �::,e: i .- ; �. --- . - ..
RE SIDENTIIAL EQUIPMENT =' % SYSTEM FES*
E
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
�` ',5., . 3X"„- s;'. ib4• „+.^;y1r^a.`.i.+'z`3'+vH':��•L` + .' ��v: -: w`.. ». «'wL'<'i€ �M,� , �X x.'r �,w +xs,,
.°..�n�.'�."`v�... -.. ,.;g sut:,�a�'�` 'e����aw . a'S x� r r i'J «,.: ` °�;i�'it - k =`
,,. :l ' - �,'?`t JOB SITE IN4.*ATION AN� U LOCATION "A` n z , "� Heating/cooling
Job site address: i $ y S 5 $) 1 t'e..._ Dt2 Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State /ZIP: 7 p.4 -- )
6 ,20_ ? 72 Z / Furnace 100,000 BTU (ducts /vents) 14.00
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts /vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
/) j ?-6/7- [ , t ho /; 4 u �� 'MA^ Hydronic hot water system 14.00
y j / � ((�( /� /i-" !� '0 7 '' ` Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
.B:�R„ "r. x `.5. 4' ", . i -;Fti'•. '_,. r . �. +5.i .`,�%:.�Rh.'d5:.. ?+.%, m i a�.. '3:=, c +"'n , 5
�; `t � ��,�,�� � �° ,i,�s;:'' ^��± -.�,. � Water heater 10.00
:� s: � x `.: `l1ESC Ok' WORK 4 m 'm
�. .p.,ua s"?�s��,�,�....w.� � 'sm�.a^.a. -aaa �-:> .« ._� °A r . ��ti _�,w � „9i
Gas fireplace j 10.00
74 ,Gt 5%C/1..-1 Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
>- ' r ' 'j .•; ". x Chimney/liner/flue/vent /liner /flue /vent 10.00
a3 ;,;,:. y �iF 8 ° 'etc ..„�''�`` �-'�'�°' ?� ..c ��2 ' "` ��",.c1r,' y
FR ItT1 "O NER N T" EI+IANL, s, '
��,',. v�� a •�a+'7 ..�.�. i,, . _ ''��' �cm.�>� � ? .� Other: 10.00
Name: . �Q�
/O'i. Environmental exhaust and ventilation
Address: /5Y (( SS 5 ' 1 -tf /4-1.0.6e/2-4 /ix,ei k /L Range hood /other kitchen
equipment 10.00
City/State/ZIP: 7 L) Iii "7 Z ZZ51 Clothes dryer exhaust 10.00
/ / Single -duct exhaust (bathrooms,
Phone: ( 3 5' 6 .---/iLQ Fax: ( ) toilet compartments, utility rooms) 6.80
rf4 == ,r ^, =..': ., : ° °:: i s ., :,- s:'... -'i.0 Attic /crawlsace fans 10.00
; p
" > , 7ripiLLCAN �a *" - ❑ WO1�TACe P Reca ` :X
s � '.�.�.'�� ; � a. RcL,�. *""� ., a i . .. � ��,+;e a. �4eu'��„
Other: 10.00
Business name:
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
ie ,a,y ' ``� 0• 1274C OR a ," °�" . f & Barbecue
. mac'., x ..eW ., r ..ate: ,... ss - - .9 s:�c� ,P . ....U1 , .. , a ' - lil .. :
Clothes dryer (gas)
Business name: G.y¢5 Or 14 L.971-5 Other:
Address: pa /90X �� Z gl �� ,- �y >.,,- _n. Ar,,..... s' e.- s�-v ,rs ,�:a. . .
/ Z 4 - . NIECH;p:T11GAI i'E ,.F i
City /State /ZIP: pa /1 - 0/ 9 72 - 6 Subtotal
Phone: (5d J C � g } �sO tl S Fax: ( ) Minimum permit fee ($72.50) 79..50
ff Plan review (25% of permit fee)
CCB lic.: l 7 ?i / y State surcharge (8% of permit fee) • ice `. , Ii /""' TOTAL PERMIT FEE 7g. 30
Authorized signature: f,L This permit application expires if a permit is not obtained within 130
'14 days after it has been accepted as complete.
Print name: Aq `Gk /v(i Q/l.e/z.._ Date: 9 f `l /U * Fee methodology set by Tri- County Building Industry Service Board
i:\Building \Permits \MEC- PennitApp.doc 12/03 440 -4617T (11/02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
I'otat`Va ua n "am PermitAte 4 a - V ... .'
$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
BUP
Received Date Reque ed ° AM v PM BUP `
Location / S � { -s s Suite aQ a (7 `- 6D s-ge
Contact Person Ph ( ) DCJ 5 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 1.42 A/ /. .7Z
Firewall e'sX .12 Iw
Fire Sprinkler
f
Fire Alarm I `�✓" _
Susp'd Ceiling r\ 0 1\91\
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
PASS PART FAIL
MECHANICAL t
Post & Beam ,(
Rough -In � �'��;, �J/'
mS oke Dampers
PASS 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 " 2 —
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL