Permit 1 1
Y
C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00013
m' I 'l
* • 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/10/2005
PARCEL: 2 S 102 D C -00501
SITE ADDRESS: 09085 SW EDGEWOOD ST
SUBDIVISION: EDGEWOOD ZONING: R -4.5
BLOCK: LOT: 013 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:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: 1
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Installation of wood stove in workshop.
Owner: FEES
SULLIVAN, RICHARD A + SUZANNE P Description Date Amount
9085 SW EDGEWOOD [MECH] Permit Fee 1/10/200f. $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 1/10/200f. $5.80
Total $78.30
Phone:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Woodstove Insp
Final Inspection
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 aiollow rules adopted in the Oregon Utility Notification Center. Thos- riles are set forth in OAR
952 -00 •010 throug •AR 952 - 001 -0100. You may obtain copies of these rule or • irect questions to OUNC by calling
(503)2
Issued :y: ` ", �/ ,/,l, t/ Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Applicatib` i . , .. F O R OFFICE USE ONLY "..
Y ,
r' Received
City of Tigard Date /By / /ll Q Permit No .1..t / /I • ,,a!
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639 4171 Fax. 503.598 1960 4 I i Date/By. Other Permit
Inspection Line: 503 639 4175 4 •1 I1 Date Read /B EI See Page 2 for
Internet. www.ci tigard.or us ` W Nonfied/Method. 70. Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction El Addition/alteration / replacement performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical matenals, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value. $ 1 00'0
Ni 1 - 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description Qty. Ea Total
JOB SITE INFORMATION AND - LOCATION Heating /cooling
f s ' woof) <,•— Air conditioning or heat pump
Job site address' l
L ��, �1� (, W J (requires site plan showing placement) 14.00
Ctty/State /ZIP: 4"-- C -0 0 0cc it to11 - 2 3 Furnace 100,000 BTU (ducts /vents) 14.00
Fumace 100,000+ BTU (ducts /vents) 17 90
Suite/bldg. /apt no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: (0 ill A t►` / � '-i.: 1 1-0 v .�414-fi Duct work 14.00
\ Hydronic hot water system 14.00
0 VN2tk 1`t, ii ca �}Z tnt " t c 1 , B r r I^ ra . CC 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
A S it :.1 I WO t i ` c t - t i ,J e t N LI ov' L a iA. cr p Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove i 10.00 ` li , Cl
Wood fireplace /insert •l 10.00 -
Chimney /liner /flue /vent i 10.00 lc ; $ 7 ."
ix PROPERTY OWNER ❑ TENANT
Other: 10 00
Name. 2 c k Y 5 u :z, f N N ;; ti ai f i t i A N Environmental exhaust and ventilation ,
Range hood/other kitchen
Address: Licata s_af a .. ore/ cli .j; equipment 10.00
City/State /ZIP: • f e 0 c.. Ca2,'•Ci Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (sc. 3 ) c, Z,0 i 2, i .,, 1 Fax: ( ) toilet compartments, utility rooms) 6.80
El 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.
I N.. Gas heat pump
City/State /ZIP: Wall/suspended /unit heater
Phone: ( ) Fax: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue _
Business name: 0 t "`��� --��� 1 LP- Clothes dryer (gas)
��r Other.
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal 2
Phone: ( ) Fax' ( ) Minimum permit fee ($72.50) "1"4, S
Plan review (25% of permit fee)
CCB ltc.: 7) (-- ' t) State surcharge (8% of permit fee) ,�
/� TOTAL PERMIT FEE 5 u
Authorized Signature' t(,/ This p ermit application expires if a permit is not obtained with' 1 T
�• days after it has been accepted as complete.o J
Print name: • K: c.k ,q S1A I I i -mot a n Date: /2 /30 f's i * Fee methodology set by Tn -County Building Industry Service Board
Mechanical Permit Application - City of Tigard .
Page 2 - S u pp lemental 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 T.
$ 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 .\Building \Pernuts \MEC- PermitApp doc 12/03 2
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received _ Date Requested AM PM BUP
•
Location U 4 _l� Ala . l %.0Jw! I ' Suite E . i Os" ?U • / 3
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: /d � SIT
Post & Beam Anchrs
Ext Sr Sh ea t h /SSh ear - y 61- Ext eah /h ��-'
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 •
Shower Pan
Other:
Final
PASS PART FAIL
Pos - eam J
Rough -In ` :a
Gas Line
Smoke Dampers
PART FAIL
EL _ TRICAL
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: El Unable to inspect - no access
Fire Supply Line
ADA D '/ e Inspector AO Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•