Permit b • r i'
CITY TIGARD MECHANICAL PERMIT
II DEVELOPMENT SERVICES PERMIT #: MEC2003 -00706
��' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/9/04
PARCEL: 2S 102AD -01300
SITE ADDRESS: 09095 SW BURNHAM ST
SUBDIVISION: ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 4
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: 2 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 154,000 BTU 15 - 30 HP:
FIRE DAMPERS ?: N 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: L 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 1 <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Remodel portion 511,250.00
Owner: FEES
WYATT, DEWEY Description Date Amount
do WYATT, EUGENE
9095 SW BURNHAM [MECH] Permit Fee 1/9/04 $249.05
TIGARD, OR 97223 [MECPLN] Plan Rev 1/9/04 $62.26
[TAX] 8% State Surchar€ 1/9/04 $19.92
Phone: Total $331.23
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone: 503 Gas Line lnsp
Heating Unt lnsp
Reg #: LIC 14008 Cooling Unt lnsp
Duct Inspection
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 -00
Issued By: ���_� Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
/0 7rF ) k,r4v ,
r, c e iv , d > , - 12P1S PM; • ; . 6c) '-> ROTH HEATING; P age 1
cgtbrt.01 ..
' 12/10/„2003,13:35 FAX 5035981960 CITY OF TIGARD . . . !Z 001
. .
' . FOR OFFIC.E USEONLY ..
Mechanical Permit,Ap,plication Received ,,, , o fp Mechanical •
a lic:RtSlIVLCU DatrAiy: I r• , .f f . 15 Permit No.:19 — 7 ot= --- Q,,
,
City of Tigard
DEC 1 1003 411,, _. Planning Ap rovr
Date/BY: • . , Building
- Permit No.: . • --,—"
: 13125 SW Hall Blvd. . Plan RevieW : A / . Other . ..
Tigard, Oregon 97223 .
• Date/By: i 2-Ili - 1(J; 65:A Permit No.:
Post-Review Land Use . .
:': '' Phone: 503-639-4171 Fax13,110 19 .
, ,,.. 1 ,,.,-)14., i , • (-1.•;:\ .
Datrilly7 Case No.: 0
.4 ::, Internet: wvvw.cistgard.orguILDING Divistor.-4.4:'''..,:i I. Contact • . . Juris.: ® See Page 2 for
•'
24 Inspection Request: 503-639-4175 - .. . ' :. Name/Method: • • Supplemental Information.
•
(A
'1. ';-: :-:- • -,... ., , - .- . . . ., ,_ .. . . • , .. .., . .. . . . .
1,4„.1,3,-.:''•gfili.','..:'.7'..:.:':'.•,:.-,,,:::2.4.e..'':fi.•••:,2:':!•:•,.:....TYBE',OF.;IVORICa.:.;.':k2:i..;::::::'.•j7:••:fs....",,Ii::.;-•-•''.:+'• : , '77'i:44.7.:.:'COMEIVIERCEttEFEE"SC:BEDULEZ;luswancicrisr.:::::.:2,
:111i New Oonotnkfion , J Demolition • Mechanical permit fees* are based on the total value of the work
Addition/alter tion/replaceinent D Other-. performed., Indicate the value (rounded to the nearest dollar) of all
,____ . mechanical inateriaLs; equipment l, labor, overhead and profit.
:::31,1 :•,• CATEGORVOMOINISTRUCTIONU:::::i:•-•:1;...'ff:. ___-, o e
N 1 & 2-Family dwelling C Commercial/Industrial - Value:, $ . // 2 ...5 " .
• See Page 2 for Fee Schedule
III Accessory Building II Multi-Farnil . . ....'
. .. -. . Descripdon % .: • 1 Qty 1 Fee(ea.). -I - Total •
Ill Master Builder NI Other: • • .. • • - Headily/cooling • • ,
:-.........,:•:.,"v:;,40B:SITE1NFORMACTIODUailidi:LOC.A.TION'i •:•ir.:•::'::';''''.:''" • Furnace - add-on air conditioning"' 14.00
Job Site address: 9 09 .c" 5 1 ksi . 10-v". - • , Gas heat_punip ' . • - .: . . 14.00
Suite #: A./4 I Bldg./Apt.#: /1.4- . . Duct work '14.00'
- 11ydronic hot water system , 14;00 •
Project Name: LA-/j ?
a. 44 0 G . e' s e- co it e-- . Residential boiler .---
Cross street/Directiorig to job site: (for radiator or hydronic system) 14.00
•
Unit heaters (fuel, not electric)
(in wall, in-duct, suspended, etc.) .14.00
;
i, Flue/vent (for any of above) . • • 10.00.
Subdivision: Lot #: Repair units . . -- 12_15
Other Fuel Ap !lances_ : .. •
Tax map/parcel #:
Water heater 10.00
::::.''.;••:;::',:;',";;[ :';!..,;:••••••...: ;i•'77:..';:.:DESCRIPTION1i)FtWORK: Gas fireplace 10.00
ii. • 1-1-1 v4t..) One__ q fr.yrt et e_e_ €4.,,,` 44...- . Flue vent (water heater/gas fireplace) 10.00
, t- . ... -
ifk r, 6f1/1 of, '4 ,7, Ass-0cl, ‘,..,, 1..c. d Log lighter (gas) . 10.00
Wood/Pellet stove 10.00
t• dz/ ... ::* le-- ei vx ci 1 -•""r ^ :i It , . Wood fireplace/insert • 10.00
"i:14,;. 1 :.' . '... , - . :1 • Chimney/liner/flue/Vent 10.00.
:.• :!PJ!t._U___.-----.Elit,T:lr.OWtqEFe:,e::'.:;:..41 •IGENIsctilt,',kil:: Other: 10.00
.4cf:•'.' :iNartit: . ' LID tA-) ?O- -VI' -e. &.. . ... . . • • • Eavirounieittal"Exhaust &Ventilation
. : • • • • .
-,P.,'• - - ' -
Range hoodlother lntchen equipment . 10.00
-- Addiss: e 9 1 t c S 1 A T1/4.A• A.-- .----■-
.4 •- , Clothes dryer exhaust 10.00
City/State/Zip: s p: 'Tt s ---- 6, v•-
• ''..-- . Single duct exhaust
'• Phone: 9-1 9 - e2 /0 F ax: (bathrooms, toilet compartments,' . .
• lar.EiPPLICANT.: :•1•]:..:.::,:7.ii,::::;., ' utility rooms) 6.80 T
• Name: go j-1 He,. 4,' 4- tao /1 Attic/crawl space fans, . 10.00
Address: ?, 0 13o, d ("ZIA_ • - . - Other: -
. , • l0.00
Fisel.Piping • • . • : • . ,-
... . . .
1 City/State/Zip el o. „,6 OY1..- • *(55.40 for first 4, 51.00 each additional)
Phone: 20 —t24 Fax: z(0 -4-Z3 Furnace, ctc. •• ,
- Gas heat pump ' •5
II E-mail: — .
Wall/suspended/unit heater **
1 : ':::• . '''..:::.•'.." Water heater *”
Business Name: 2 ,1-1,„ ]-i''11 e e A ',Ik Fireplace • .. en
Address: Pc, s /2 _ 4 ,, c — 0 Range
BBQ • **
, . Ci /State/Zi . : it 0 (2. c k - g-c , i .." . ,
'...., Clothes dryer (gas) • ** •
* . -Phone: '2-(e (a - 12 . Fax: '2_49(0 - Li - 4- (a, Other: .,
**.
I :
!,,, .7, - • ,..CCB Lie. #: ( zi OP 49 . Total:
...7- Zk Date: 1 ..
Mechanical Permit Fees
Subtotal: $ . '
liA /03 ..
Minimum Permit Fee $72.50 S
i.:0 ". ' - ..• - ' . °A VIA 4 2- 4 k ) .
Plan Review Fee (25% of Permit Fee) $
- .
(Please pint name) State Surcharge (8% of Permit Pee) $
f ::-" . ' . ' - TOTAL PERMIT FEE $
NotiCei' permit application expires if a permit Is not obtained within Fee methodology set by Tri-County Building Industry Service Board-
Ytif::•;: _ 180 days after it has been accepted as complete. **Site plan required for exterior A/C units.
• •' •• ''. '. i:\Dits\Perrilit Forms WlecPermitApp.doc 01/03
: .
. .
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received 2 !SDateRe nested 27 G O AM PM BUP
Location go g s 1` , ��, Suite 7
Contact Person a Lk Ph ( )
Contractor s- fit.r D. - Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: �,[ SIT
Post & Beam 1 � U`4 [fit
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling
•
Roof
Other:
'Final
PASS PART • FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
( \n/
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: -
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Dampers
PART FAIL
RICAL
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 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply -Line
ADA Ta -lel- N
Approach /Sidewalk Date 2 �� q o `� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL