Permit CITY GI - rTIGARD MECHANICAL PERMIT
i, DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00447
' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/26/2005
PARCEL: 2S110BB - 03800
SITE ADDRESS: 12285 SW AMES LN ZONING: R - 3.5
SUBDIVISION: ARLINGTON RIDGE LOT: 015 JURISDICTION: TIG
Project Description: Reconnecting furnace.
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:
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
BASHART ZAFAR Description Date Amount
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12285 SW AMES LN [MECH] Permit Fee 7/26/200E $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 7/26/200E $5.80
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Phone: 503- 620 -8443 Total $78.30
Contractor:
PIONEER GAS FURNACE
3615 NE BROADWAY REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97232
Phone: 503 249 - 5000
Reg #: LIC 36102
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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 • ' = • -011 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1 - : 332 -2344.
Is - ued By: ._ Permittee Signatu _ �.,_4/lJ/ ;_
Call 503- 639 -4175 by 7:00 a.m. for inspections that bus •
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.
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111chipical Permit Application , MR ( 1 1 1 1 t . F . I ■I.. (,) \ 1.1
City' of 'Tigard , Received
MI Permit NoR -o i
&iv
13125 SW Hall Blvd., Tigard, OR 97223E1.11
E: ENE:* Date/By: ,A
Plan Review . • WV' .
- . Phone: 503.639.4171 Fax: 503.598,19CA _ C g, .-..•
''INI' 1 Date/Ely: Other Permit:
Inspection Line: 503.639.4175 ..4.iji, ' I Date Ready/By: Fii See Page 2 for
Internet: www.ci.tigard.or.us JUL 252ii Notified/Method: .
Supplemental Information
Mil .
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' : AllgIVZOW:i n . ‘-' ''' ' ' .TYPECISi\ii COMMERCIAL:1FEE • ScitlEDUILE. 1 30. 1 ff,FgW.FP'z
r5i itt
0 New construction Add M
I liNG DIV Mechanical permit fees* are based on the value of the work
tirtfoteration/replacement
,:. - performed. Indicate the value (rounded to the nearest dollar) of all
OT:lemolition . 0 Other: mechanical materials, equipment, labor, overhead, and profit.
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CATEGORY OF CONSTRUCTION Value: $
, „, .P.c•Ws, : ,..
RESIDENTIALtQUIPMENTI,03
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1 and 2-family dwelling El Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
4613 AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address: 1 # D. acK 5 (_.3 Pinko..0<iiv,0 (requires site plan showing placement) 14.00
Furnace 100,000 BTU (ducts/vents) 14.00 i
City/State/ZIP: ..-n, cti 1 Cni - IL 4.- 1 r. A.:-• (- 4
rn
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Pro name:
Gas heat pump 14.00
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Cross strzetidirections to job site: Diet work . 14.00
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Hydronic hot water system 14.00
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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
f C." . Ina" ..--...- _ ., - .. 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 .
:, ' ' "ItiKtiftV OWNER 1 0 TENANT ; Chimney/liner/flue/vent 10.00
• Name: 1 ) Cc."NnCi,r-l- FA (2- • Environmental exhaust and ventilation .
Range hood/other kitchen
10.
• Address: 5441AA-a-- 1104, ALOCAD - equipment 10.00
..
City/State/ZIP: Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ($0 l ab.- $14,43 Fax: (503 ) cdaci ... toilet compartments, utility rooms) 6.80
k1,1f.it:V='fiii APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: Ar1A.Q IN-, lo.a.toLo 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
9, Phone:.( ) Fax: : ( ) Water heater
• Fireplace
,E-mail: Range
• '!4 ..„- , .,
4 CONTRACTOR , Barbecue
- , i..*: :0. • .'•- - • -
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Clothes dryer (gas)
Business name: / (3,n eei ,-- s F frilac e
, . Other:
. .. Address: 5 41E - MECHANICAL:PERMIVEEES!'l ;
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' ... City/State/ZII% I,- 7 / an ol / OR q 7 2._ ii Subtotal /1
Mnmum permit fee ($72.50) - 7 a 5
'Phone: ( 53219 1 Fax: ( 5- 0 3 249 g2L0)
Plan review (25% of permit fee)
• • CCB lie.: 36 /6) State surcharge (8% of permit fee) 5 130
TOTAL PERMIT FEE _ 7 t - 5Zi
Authorized Signature: tA-A CNAGQS1"Th-ec`43-- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
D ate : L ' . I Print, name: I D I ' Fee methodology set by Tri-County Building Industry Service Board
- --aos--
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Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
To nl, Yaluadion e . ry ,• 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\PermitsWMEC- PermitApp.doc 12/03 2 •
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC200,6.00447
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7126/2005
Phone: (503) 639 -4171 nnNlyp'��
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/15/2005 TIME: 7:05AM PAGE: 57
SITE ADDRESS: 12286 SW AMES LN CLASS OF WORK:
SUBDIVISION: ARLINGTON RIDGE LOT #: 015 TYPE OF USE:
PROJECT NAME: ZAFAR
DESCRIPTION: Reconnecting furnace.
OWNER: ZAFAR, BASHART PHONE #: 503 - 620.8443
CONTRACTOR: PIONEER GAS FURNACE PHONE #: 503 - 249.5000
Inspection Request Scheduled For: Date: 8/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 013520-01 503 - 249.5000 N
Corrections /Comments /Instructions:
S lob l
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(P ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
(l FAIL ❑ CA FOR INSPECTION ❑ ADDITIONAL FEES ASSESS
Inspector: Date: Phone 503 718-
Phon ( )