Permit .
CITY TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00527
n'll DATE ISSUED: 8/26/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134CA-05200
SITE ADDRESS: 11775 SW BURLCREST DR ZONING: R -4.5
SUBDIVISION: BURLWOOD NO.2 LOT: 024 JURISDICTION: TIG
Project Description: Replace fireplace insert.
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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:
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GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Owner: FEES
DANIEL HOF Description Date Amount
11775 SW BURLCREST DR [MECH] Permit Fee 8/26/200° $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 8/26/200E $5.80
Phone: 503 -590 -8311 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Issued By: Permittee Signature: ,y x//7,3./X! /
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the pro]ect.
Approved plans are required on the job site at the time of each inspection. /`
Mecianical Permit Ap,p liafifin(EEIVE ' u FOR OFFICE USE ONLY
City of Tigard '� v R eceived
City Date/By 0� ) Permit No. G / --60 f
13+125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 AUG u 2 6 20� ,� Plan Review
Other Permit:
Inspection Line: 503.639.4175 /�pdiF� Date/By.
.itg. I Date Ready/By: RI See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING fMVI$tON
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction}: 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.
CATEGORY OF CONSTRUCTION • Value: $
�l - and 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
❑ Multi- family 0 Master builder For special information use checklist.
• ❑ Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling •
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Job site address: Air conditioning or heat pump
��7 / 7 J �s �� v C_' f^ S </ / (requires site plan showing placement) 14.00
City /State /ZIP: • I Furnace 100,000 BTU (ducts/vents) 14.00
i ,
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00
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. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: . • Other fuel appliances
• DESCRIPTION OF WORK Water heater 10.00
�— / Gas fireplace 10.00
T . 0 , / / 1.-- / c l ,)-7 g { 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
ROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: �� h / -e - / / /47() Environmental exhaust and ventilation
r /� Range hood/other kitchen
Address: ///' �7 7 6- 5 6,__, �� r / c v-LS „/ r equipment 10.00
City /State /ZIP: 77-.1 a_ vt7/ 5,,e Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (5o3) SCJ — ✓/ Fax: ( ) toilet compartments, utility rooms) 6.80
. ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
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
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: tit `,.) \N.—PA/
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) • Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
• days after it has been accepted as complete.
Print name: I , ` , r !7 � t Date: F.. -. -. U * Fee methodology set by Tri- County Building Industry Service Board
is \Building\Penuits\MEC - PermitApp.doc 12/03 1 440.4617T(I1/02/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
$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\Permits\MEC- PermitApp.doc 12/03 2
l .
CITY OF TIGARD .. ' -
BUILDING DIVISION PERMIT #: MEC200S -00527
13125 SW Hall Blvd:, Tigard, OR 97223 DATE ISSUED: 8/26/2005
Phone: (503) 639 -4171 u dr lAI1h
Inspection Requests (24 Hrs.): (503) 639-4175 °:_..
INSPECTION WORKSHEET FOR DATE: 9/2/2005 TIME: 7 :07AM PAGE: 70
SITE ADDRESS: 11775 SW BURLCREST DR CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.2 LOT #: 024 TYPE OF USE:
PROJECT NAME: HOF
DESCRIPTION: Replace fireplace insert.
OWNER: HOF, DANIEL PHONE #: 503.590 -8311
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 014862 -01 503-590-8311 Y
Corrections/Comments/Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
i
Inspector: , r t Date: 9 D P hone #: (503) 718-