Permit Y M
CITY TIGARD MECHANICAL PERMIT
*it DEVELOPMENT SERVICES PERMIT #: MEC2005 -00399
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13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/5/2005
PARCEL: 2S 110DD -02100
SITE ADDRESS: 10515 SW CENTURY OAK DR ZONING: R -7
SUBDIVISION: SUMMERFIELD LOT: 028 JURISDICTION: TIG
Project Description: Add a/c
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: 1 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
JERRY DURGAN Description Date Amount
10515 SW CENTURY OAK DR [MECH] Permit Fee 7/5/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchaq 7/5/2005 $5.80
Phone: 503 620 - 1802 Total $78.30
Contractor:
SUPREME COMFORT HEATING
9425 SW COMMERCE CIRCLE #16 REQUIRED ITEMS AND REPORTS
WILSONVILLE, OR 97070
Phone: 503 682 - 1985
Reg #: LIC 21892
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 • - _- 001 -0100. You may obtain copies of these rules or direct question to OUNC by calling 503 - 246 -6699
or 1 -8•1- 332 -2344.
Issue. By: tap Permittee Signature: 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 project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit, Application FOR OFFICE, USE ONLY
Received
City of Tigard Date/By: Ho I Permit No.: Hee ,i d
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 iix y;r i..,'�, Date/By. Other Permit:
Inspection Line: 503.639.4175 r � l I
J � ° �' : _ -, Date Ready/By: ®See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: IM Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
El New construction 53
performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
dwelling RESIDENTIAL EQUIPMENT /.SYSTEMS FEES*
-and 2-family g ❑ Commercial /industrial 12 Accessory building
El Multi-famil For special information use checklist.
y ❑ Master builder ❑ Other:
Description I Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: 1 o5 (5 5w e44V - y o . Dr- Air conditioning or heat pump
(requires site plan showing placement) / 14.00 4 ,OD
City /State /ZIP: Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: W ( g .,C0 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
Add �� I / - `( Gas fireplace 10.00
A d k -6 • r-- k. � 1'� C _C V y&5 Flue vent for water heater or gas
rr ,, /�j fireplace 10.00
tC y Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00 ,
Chimney /liner /flue/vent 10.00
PROPERTY OWNER ❑ TENANT Other: 10.00
Name: J rr IJ ,,,,,,,ix,„.., Environmental exhaust and ventilation
Range hood/other kitchen
Address: (p6 (5 5 (,J C•2"4414,11: Oct, k- 0r equipment 10.00
City /State /ZIP: -'jr 7 . 4 7 2 Clothes dryer exhaust 10.00
r Single -duct exhaust (bathrooms,
Phone: ('50.3) G ZO .r jgd 7/ Fax: ( ) toilet compartments, utility rooms) 6.80
a APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: S u 1/4. , P ((-4 --_ Other: 10.00
1 Fuel piping
Contact name: e 4m/id, 4, $5.40 for first four; $1.00 for each additional
Address: 1, + S• al. C owt vyte e evfi 7 (( Furnace, etc.
-� Gas heat pump
City /State /ZIP: otgo.� 0 t (V_ a 7 ! v Wall/suspended/unit heater
Phone:
v to i 1 - ( p Water heater
1 �) � � 't . � � �� Fax.. (5 ; )
Fireplace
E -mail:
Range
rr
CONTRACTOR - Barbecue
Business name:
A,, ct t Q `teer/n7 ` Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) ! — 0k . SO
Plan review (25% of permit fee)
CCB lic.: 2 (% 2/ State surcharge (8% of permit fee) !) .
%/ TOTAL PERMIT FEE -- 1 / 31
Authorized signature: ` / This permit application expires if a permit is not obtaineb within 180
� days after it has been accepted as complete.
(�
Print name: ,V (° 4 Date: 7 * • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits\MEC- PennitApp.doc 12/03 4404617T(II /02/COM/WEB)
Mechanical Permit Application - City of Tigard `°
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total_ Valuation: . Perniit 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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CITY OF TIGARD R ' .' Aa
BUILDING DIVISION PERMIT #: MiEC2005 00399
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/5/2005
Phone: (503) 639 -4171 A " '1\
Inspection Requests (24 Hrs.): (503) 639 - 4175!x- 'I
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 96
u.) z . 104
SITE ADDRESS: 10515 SW CENTURY OAK DR CLASS OF WORK:
SUBDI'V,ISION: SUMMERFIELD LOT #: 028 TYPE OF USE:
PROJECT NAME: DURGAN
' DESCRIPTION: Add a/c;
OWNER: DURGAN, JERRY PHONE #: 503-620 -1802
CONTRACTOR: SUPREME COMFORT HEATING • PHONE #: 5036811986
Inspection Request Scheduled For: Date: 7/14/2005 V Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 01 503682 - -1985 N •
Corrections/Comments/Instructions:
A ? . /29 )eZ_ a �r'>.
4 /6._ u Ai ! 7 -0 . /v114
gill,
PASS 11 'A' --•AL APPROVAL ❑ CANCEL El NO ACCESS
FAIL VL FOR INSPECTION . ❑ ADDITIONAL FEES ASSESSED
Inspector. Dater /1 718-