Permit V 4
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00238
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/9/2008
PARCEL: 2S109DD -08400
SITE ADDRESS: 12797 SW DA VINCI LN ZONING: R -7
SUBDIVISION: BELLA VISTA LOT: 014 JURISDICTION: TIG
PROJECT: BELLA VISTA
Project Description: Installing A/C.
CLASS OF WORK: ALT 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
RIVERSIDE HOMES, INC. Description Date Amount
1925 NW AMBERGLEN PKWY #200
BEAVERTON, OR 97006 [MECH] Permit Fee 5/9/2008 $72.50
[TAX] 12% State Surch 5/9/2008 $8.70
Total $81.20
Phone: 503- 645 -0986
Contractor:
RIVERSIDE HOMES, INC.
1925 NW AMBERGLEN PKWY #200
BEAVERTON, OR 97006 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 645 -0986
•
FAX 503- 690 -2942
Reg #: LIC 70065
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 ! /��: � `ermittee Signature:
Call 503.639.417 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 1 �� FOR OFFICE USE ONLY .
c'. p of Tigard ��I Received q� Q � /i— emit No.: i� C ®(4.� J v , 1� / � -
a .' Cif* y Tigard ' �� Date /By: S e
° 13125 SW Hall Blvd., Tigard, OR 977 �
Plan Review ' Phone: 503.639.4171 Fax: 503.598.1 �O Other P erm it ,� 1
411111 lIl
9 Datc /By: —i W�(j' V
TI.GARD Inspection Line: 503.639.4175 0 i s Date ReadyiBy: luris: ® See Page 2 for
Internet: www.tigard ongov 0 �, �1 0 Notified /Method: Supplemental Information
TYPE OF WOR �� 0 COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
[ few construction ❑ Addition /alteration7reeplacement 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:
1 -and 2- family dwelling Commercial /industrial g 'RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
❑ ❑ Accessory buildin
Tor special in/b,st ation rise checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: i 2 7 1/ ✓I / � Air conditioning or heat pump 5 hi i) 4 V J ✓) L. (requires site plan showing placement) I 14.00 I 4 ? )
City /State /ZIP: / j 9 � 02._ y.0 t o q" 'Z Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite /bldg. /apt. no.: Project name: 6.e )1(c, V + s f Gas heat pump 14.00
Cross street /directions to job site: Duct work 1(1.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
y
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.; J Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
�� �� /// Gas fireplace 10.00
"'Y ZSM y r� Flue vent for water heater or gas
f fireplace 10.00
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_ , v I a l e r^ s i Environmental exhaust and ventilation
1vi 1-V 1 t ) , „, I Range hood /other kitchen
Address: i e ` W 1 26�
I Z J 14 w .f (! , ►, ✓•�i j 1 Q� j equipment 10.00
City /State /ZIP: Re v Qr 4- OE 7 O (c7 Clothes dryer exhaust 10.00
l � Single -duct exhaust (bathrooms,
Phone: w W' 3) — efi e( , : , Fax: (6.3)40,70..... 21q Z toilet compartments, utility rooms) 6.8(1
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00 _
Business name: ,, S'/ , • Fuel t m
P g
Contact name: Al [ i S Uyt 114 0. j $5.40 for first four; $1.00 for each additional
Address: "J Furnace, etc.
Gas heat pump _
City /State /ZIP: Wall /suspended /unit heater
Phone: (' ) Fax: : ( ) Water heater
Fireplace
E-mail: VIG r , /.e.rriCi e h o rvte . CCm� Range
f - CONTRACTOR Barbecue
Business name: y„14," Ci H
e 4,,,, S J v C , Clothes dryer (gas)
f Other:
Address: j 2 5 .� w m 6.. 14 1 pk (,iI 7e3 MECHANICAL PERMIT FEES*
City /State /ZIP: C V� v
� l V 12.- "7 b J Subtotal
i Minimum permit Ice ($72.50) /2 - SO
O �( ,. g
Phone: � In Fax: ( ‘, — 2L>LZ_ Plan review (25% of permit fee)
5CB lie.: ps State surcharge (12% of permit fee) i 1
TOTAL PERMIT FEE /, Za
Authorized signature: This permit application expires if a permit is not obtained within 180
Al days after it has been accepted as complete.
Print name: /"� V61c Date: -� - t�� * Fee methodology set by Tri- County Building Industry Service Board
I: \ Building \Peumts \MEC -Pe \ unit App.doc 01/19107 440- 4617T(11/02 /COM(WEB)
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BELLA VISTA LOT 14 SCALE: 1" = 20}
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ENGINEERING & LAND SURVEYING /DESIGNED: /PREPARED FOR:
A RJ
402
Suite Canyon Ln. DRAWN: RIVERSIDE HOMES
Atv Yfe \ 1925 NW AMBER GLEN PKWY, SUITE 200
Portland , OR 97225
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SW BEAVERTON, OR 97006 c
CHECKED:
(503) 645-0986
RJ
DATE:
(503) 690-2942
V4iltic40 _
4 , . 4_ .4. r / 4 503) 291-9398 .... 6/20/03}
Fax) 291-1613 .} -c