Permit CITY TIGARD MECHANICAL PERMIT
{ DEVELOPMENT SERVICES PERMIT #: MEC2004 -00471
I DATE ISSUED: 7/19/2004
13125 SW Hal Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 115AD -03700
SITE ADDRESS: 10878 SW DOVER CT
SUBDIVISION: DOVER LANDING ZONING: R -2
BLOCK: LOT: 018 JURISDICTION: TIG
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: 0
STORIES: BOILERS /COMPRESSORS HOODS: 1
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas piping and hood venting.
Owner: FEES
WHITE, DAVID R AND RENEE J Description Date Amount
10878 SW DOVER CT [MECH] Permit Fee 7/19/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 7/19/2004 $5.80
Phone: 503 624 - 2720 Total $78.30
Contractor:
GARY THOMAS ENTERPRISES
PO BOX 880
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone: 503 Gas Line lnsp
Mechanical lnsp
Reg #: LIC 88093 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 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)2 : -6699.
Issue. By: p, , /10 , I ' Permittee Signature: y j(4M44.1.—t_
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nex business day
Ill_feclia_ni.cal Permit Application . . ...
. .... , FOR OFFICE USE ON
Received
City of Tigard Date/By 7 /5 Q /1111A Permit No -
i� B OO ` /
'
13125 SW Hall Blvd., Tigard, OR 97223 '
Plan Review
Phone' 503.639 4171 Fax 503 598.1960 AgtoRk. t I i Date/By EMIIIMIIINI
Inspection Line 503 639 4175 $•III Date Ready /By M .... 0 See Page 2 for r jar
Internet: www.ci.ti ardor us
g Notified/Method Supplemental Information
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�. - =' � - TXPE ,OP` WO RK. ; ., , / ` , : ,- wo + C O M NI E RGIAL °':FI7E SCHED E °' - ^USE GHECKL` [S T'
a..�' -�. m»:.��':.�. � : � f � ° ?:'r ^nk:'e`�s" �*:a �r .;�: -' � , ��_.,.., . �'a,: � . " _�:l..,?: ,-, -:-/:',) ..� _,.... _ _ ,h
❑ New construction 4 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
1 ', f . .. , -;; ,�.., F; - - �..�:�s , , .,,�,.E. Value $
•;��,u? =; ='ik , `:�� � , GOI�STRUG^ IONM'; {r�,a,:.•n' ,, s.,�`s``^
1- and 2 family dwelling 111 Commercial/industrial ❑Accessory building ``•> . 14 SIDEN.TIA,L EQUIPMENTJrSYSTEMSTEES*
For special information use checklist
❑ Multi - family ❑ Master builder ❑ Other Description Qty Ea Total
{i-OirsITE INF A ^D 3 L ' " = OCI V " , = �i:: '7' . ' _. ' a' Heating/cooling
r ;= ;x z ''^ : - .:, t' .,,,,,, . �., ...,,.,- t.,..x. ...sr .,-;; i ' -. . ATIO .a ∎ ∎ ;., : . : -,, ,, , - i,
Air conditioning
Job site address: i0 2 g ft✓tJacJQ Cock . T . (requires site plan showing heat pump
owing placement) 14 00
City/State /ZIP: r/ s4i _ � Furnace 100,000 BTU (ducts /vents) 14.00
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: /Cc/ X 561003 u 6o v 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
a` r mss- °" _�:'^. Water heater 10 00
,g �, � : , ''t • ;,� DESCtLIPT'IQN OF WOR ��,: r , ,Y^:; ..,
�s"� . �';"�:�' , ' a.r -'r =.. s� .z.� �.�.�;"�- `''y` ='� ",.tee �' � ,+�.�;, v ��e•.,,. >k����� -' `:`r "s= �. � �. ...r. :A� � °. � '" ..
6 R p)f) t06 /' /joDd Gas fireplace 1000
VC:/V] /i'�� 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
Y -,_- Chimney/liner/flue/vent 10 00
.9 ; PROPERTY O ,, ���p t = { i fl,,TEN Pu; T;•,,
� ., � ' �� � � � � � 4 ', Other. 10 00
Name: 1✓4131-D `V / ) /6e E kV rf.... Environmental exhaust and ventilation
Range hood /other kitchen
Address:
/Oi 1 >9 5u) 00 Goc>vt' equipment ` 10 00
City/State /ZIP: '7`e/ � Clothes dryer exhaust 10 00
(O Single -duct exhaust (bathrooms,
Phone. (5( (4)24 - e9.7 i') Fax: ( ) toilet compartments, utility rooms) 6 80
_,. fir4 f , ''``iy m ° ^``,' r` l : � µ >_ IS tic /crawlspace 1000
v,',,,,,:4-,_ ,' .. APPLICANi,'t i .. CO NTACT " P, ER S®N " '. ° , t At
y . 3 'vc^sLfix,�.. � ;.,..:1,;' a ^ sr k� � `�,'..k s.,. Ana, aT� . �� „ , �'e° �..aw
Other: 10 00
Business name: 6 R- /OftittS E4/7heP2t S E5 piping
i
P g
Contact name: 6, ra y ' j { i i A $ $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: PQ 8c x gi /^� Gas heat pump
City/State /ZIP' ,u , 6, 0`c 9 ? 732 Wall /suspended /unit heater
Phone: (5`03) g ii/- 6333 Fax: : (503) s3 7_ 3 ,, re ( Water heater
Fireplace
E-mail: Range j
. .� 1m, � � �a, sue,,;.= -,f. . �s r• -� ;�> +� .^.ts, , ., ,,, � ,. .. � ,, , . ,`,� -y . - . t +f � �. = t ;w .��
. 'i1, ri .`a,s ,yi zxTi, ' `g C -RA ` ` ';', -, i ' -1 - i r i..,;, ; 4 '; Barbecue
I, ,'v, : < _ :. ; "'+al .. .,. - ^mss, .,`',., , ,, 4 : :,V. :„ ,_ .; -,��, ; ' , , . '3 ggao '. ;
Clothes dryer (gas)
Business name
T �41.0...3 �" g 4-1- Other
Address- PQ 00 x Or° of 1 ; vs> : ., - , ...,, x.. < ^. _,-. ,. ;;
, y „ iV1^ EG °FIA1V'ICAP;=PEMIT�yEE'ES *''' -
City/State /ZIP: �?GLu�3 6 Qa .. Subtotal
Minimum
Phone: Fax. �' Minimum permit fee ($72 50) W. ✓V
c�n3) BQ�f - (3 33 (s j) 53 7'- 3v Plan review (25% of permit fee)
CCB he.: $S'479 V e/ �� State surcharge (8% of permit fee) 6: 6 C3
Y TOTAL PERMIT FEE 75 , 3A
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: 6/1 r l ri_biN /9't Date. 7 -4 ) * Fee methodology set by Tn- County Building Industry Service Board
i \Buildmg\Permits \MEC- PernutApp dot 12/03 ' 440 -4617T (l 1 /02 /COM/WEB)
.Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information '
Commercial Fee Schedule:
aT °ot °alsValuatio rvu 4 -5 ' `
$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.
•
i \Buildtn PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: , 43) 639 - 4175
INSPECTION DIVISION Busine: Line: 503) 639 - 4171 MST
BUP
Received Date Re ested �� .w J AM PM BUP
Location • • i i I Suite MEC •OG 9 7/
Contact Person /_- _ Ph ( ) c?Q - (033 ' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: Duf`/F l )007
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
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
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain r
Shower Pan
Other:
Final
PASS PART FAIL
`MECHANICAL _
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
CTRICAL
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 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk D a t ® 72 -/ - 0,.0 Insp ec t or Ext
MOP! Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection 'Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
7/ 7 /� �' BUP
Received � Date Reque d AM PM BUP
p
Location 0 0 751 S-1,3 Suite D o l-9 4L'1 7 f
Contact Person Ph ( ) 3 33 PLM
Contractor
Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain s " ELR
Crawl Drain
Slab Inspection Note SIT
Post & Beam
Shear Anchors /
Ext Sheath/Shear A , ,
Int Sheath /Shear 1 / 1 �t /' 1 , / JZvv)' [ t , Z Framing � l'J�C� T l
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm ,vim ; SP• �,� ).S / Pj ¢ a� & 1,
Susp'd Ceiling 1
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
CHANIC
Post am
oug In „ � -
s rn �1'"'
Smoke Dampers
Final
PART FAIL
ELECTRICAL
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date 7 o I - 0 L/ Inspector 4,e3.40%.,e Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL