Permit 2.2-too a - -0 00`0�p
Mechanical Permit Appli4a'tilne ' .t ,� " FOR O F FICE.USE O
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- Received Permit No.: �.J r
City of Tigard Date /By: • � 4 94 DV (.lb , l ' p DD 00 ek 0
13125 SW Hall Blvd., Tigard, OR 97223 1.161‘ Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 iP 76,513 Other Permit:
r � !`.i �lA�b " i 1 ' ' lI it DatcB
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Inspection Lit e: 50,,,,__ 9.417 F ` `GV s p! Date Ready /By: Juris: ® See Page 2 for
t i • f!1IV! W
Internet: .ci.t4$dsr.US , ` 01-- w`S`v`4 Notified/Method: ./! Supplemental Information -
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k ,`. sb0' >1 v �- _ �r . 1 . COMkgi GIRL /FEE, CHEDUli E 'USE4,CHECKLIST
s �� �;, _tl �� II � �T�YPE yyOE WORK. �-
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*I New construction 1::1 Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, " overhead, and profit.
g . ', `:z CA'r it ; , ; -TV,3 r „ ll ::�.: _ „Mir - .. l. ` ` v .z ;'$c, `-'11 i,Y,r;F •:` Value: $ /0 Vo 0
•�' : " '' '''' ' : '''''' CATEGORY OF, gCONST"" - ' "" : 8, . ,• , n E - : „ ' - . Y - F :. 411.' : r�.,
h RESIDENTIAL EQUIPMEINT / SYSTEMS . FEES*
❑ 1 - and 2- family dwelling g] Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description Qty. Ea. Total
,s: .., 5•�2: T : _ ^..C"t" Y3'k _ .anfk.�:;'�Y -,F`. : *t %r .
;$ 37 "� i ;� ^ *� 3OB SI 1 i FORMATION AND LOCATION -, ,, Heating/cooling
Job Air conditioning or heat pump
ob site address:
3 sw iiL�/GLA I, p (requires site plan showing placement) 14.00
City /State /ZIP: TI 6 iA21> OR. 9 i - 7 v7-3 Furnace 100,000 BTU (ducts /vents) 14.00
t / Furnace 100,000+ BTU (ducts /vents) 17.90
' Suite/bldg. /apt. no.: Project name: O/ L /2_ Y' Q /� e_g �'3 Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
7_4 �y� Hydronic hot water system 14.00
"E- IT s . J _AiNi 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: i Lot no.: ,
Other: 10.00
Tax map /parcel no.: Other fuel appliances
"!4 , _: it f F uDESC OF) WORKt .r fiw :r ; Water heater 10.00
14 -r, +;n •r;•g e't::.z ., c..-a tr.: h�a; '.a•, -x :... v. .,;a., aB.� ,.,,r .,4: �3+. .,
Gas fireplace 10.00
T. t . i3 OIFPIC_ _ 'E31.-4;L 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 r-i., ,, . . „ ', ,<..., ; ,: z , a , , t1: r. -, Chimney /liner /flue /vent 10.00
. iti% tgtP,'R ,.,, IMI ',t, ,_ . .. ,TEANT _,.•.. ,3. « :._ _
Other: 10.00
Name: - PAT G-- 1 Liam Environmental exhaust and ventilation
Range hood /other kitchen
Address: S'/ 00 s uJ 11 +aeje.,n es. in A. S� t rE_ 2.9'0 equipment 10.00
City /State /ZIP: '7D1-1-ZAt...)N> 1 (7R.. ° I -- I 23°1 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (5b) Z2_7 - 5559 Fax: ( ) toilet compartments, utility rooms) 6.80
yrr .;. ; r,t v r k . "` >, .,, i - .. �,,; . � - Attic /crawls ace fans 10.00
,ard•z . ,. $ :i� , .` r e, ,: r y" + ®CONT zEERS ` >„ ' ?i: p
�. s> F��, . >� .,� .,�'�.�.s;..� =' ,:u� °�.,�. „ a,.. ,,t.� �...,�. ,1,-,.., � r
Other: 10.00
Business name:' b 14 F ,.....s.--- cD►- TR..x.1 - 1. b rj G (7Q., Fuel 1 in
P�P� g
Contact name: "rr».s"s 2 - 1 L- - . $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
2�{ S S f��c - p I L -1-- ZG� • Gas heat pump
City /State /ZIP: LA 0 v4 D ! (::::)., 9 -7 Da5 Wall /suspended /unit heater
Phone: (5 7S3 - 2_(,-2_ Fax: : (,sb ) 9 3 - IS3 Water heater
Fireplace
E -mail: Range
s, ); ;w ,,, ; W Barbecue
ON , . :;,` "�, ' ! ;:, COPT 7?RAGTQR ; :, ;€ AN: r. ; A , : ,,ag. :143 'v2, -
Clothes dryer (gas)
Business name: t
TI Other:
Address: r " ` l; =,0 NIECHANICALTERIVIIT.'FEES* . • City/State /ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
\ _ This permit application expires if a permit is not obtained within 180
� Allthorize d Signature: Y �� days after it has been accepted as complete.
Pr name: "*-1■,A r211 . tOA Date: 412 / °I - * Fee methodology set by Tri- County Building Industry Service Board
■ 1:\ Buj iding\Permits \MEC- PermitApp.doc 12/03 440 -4617T (I I /02 /COM/WEB)
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Mechanical Permit Application - City of Tigard
Page . 2 2 Supplemental Information
Commercial Fee Schedule:
A p,
k '; 4
$ 1 0 0 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:\BuildingTermits\MEC-PermitApp.doc 12/03 2
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: y —Q 00)- 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 7 3 0 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 - Z g 0 co Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
SS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL -- n CALL FOR INSPECTION ❑ ADDITNAL FE S ASSESSED
Ins ector: k Date: 3/Z U hone #: (503) 718- -23