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Permit CITY TIGARD MECHANICAL PERMIT 7 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00812 E7 DATE ISSUED: 12/13/2004 " - ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 2S103DB -06800 SITE ADDRESS: 11180 SW EDEN CT SUBDIVISION: GENESIS NO. 3 ZONING: R - 4.5 BLOCK: LOT: 053 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: GAS PRESSURE: 50 + HP: FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Installation of gas furnace. Owner: FEES BUSHNELL, GEORGE H JR + Description Date Amount CHARLOTTE C [MECH] Permit Fee 12/13/20( $72.50 11180 SW EDEN CT [TAX] 8% State Surchart 12/13/20( $5.80 TIGARD, OR 97223 Phone: 503- 670 -8516 Total $78.30 Contractor: PIONEER GAS FURNACE 3615 NE BROADWAY PORTLAND, OR 97232 REQUIRED INSPECTIONS Heating Unt lnsp Phone: 503 Final Inspection Reg #: LIC 36102 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. Issued By:? �1�j Permittee Signature: p Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next bisiness day Mechanical Permit Application FOR OFF l( l;. I SL:() . City ATIgard Received _ Date/By .7 L Pertnn No _ G�! a y. 13125 SW Hall Blvd., Tigard, OR 972 EC • I V � � Plan Review Phone: 503.639.4171 Fax: 503.598. 9.1 e1 d i W i gi ` ! l Date/B - Other Permit Inspection Line: 503 639.4175 '4 ' y J _ � ,,ii 1 � � Date Ready/By Mill 10 See Page 2 for - Internet: www ci.tigard.or.us DEC 13 200 Notified/Method Supplemental Information ' `'' e" 'yj'" "' 1 : T ' �� kdkV�i(lAAAD COMMERCIAL FEE* SCHEDULE:= 'USETT ECKLLST 0 �:rf,.w , ice �� D" „ ._ �I Mechanical permit fees* are based on the value of the work New construction dt ton a t ra ant performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition • ❑ Other: mechanical materials, equipment, labor, overhead, and profit. 'r w4 w "34'' . x °' CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT I SYSTEMSii ES ,, i ' 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. i0 Multi - family ❑ Master builder ❑ Other: • Description I Qty. I Ea. I Total ' ;r, ; x {{,m-• i-;:"..1011' SITE INFORMATION AND LOCATION Heating/cooling Job site address: /1 / F6 5 i l e h c't. Air conditioning or heat pump (requires site plan showing placement) 14.00 City /State/ZIP: 7/ 3 _a r d ,6 e 9 7 2- 23 Furnace 100,000 BTU (ducts/vents) / 14.00 /4 '^ Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: BIAS r rVe ` 1 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 f ;ink l 714 ; DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 ! n S -a `/ / _ga_5__ArtlaCe 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 tY f(PROPE l ❑TENANT Chimney/liner/flue/vent 10.00 Other: 10.00 Name: Cl eo e LtS,6he // Environmental exhaust and ventilation Address: ��.. /,, Range hood/other kitchen Sar e a,5' © .CJ equipment 10.00 City /State/ZIP: C Clothes dryer exhaust 10.00 r / Single -duct exhaust (bathrooms, Phone: (95j') 6 �� j � 0 Fax: ( ) toilet compartments, utility rooms) 6.80 i' ` 'f ® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10 00 Other 1000 Business name: Fuel piping - Contact name: $5.40 for first four; $1.00 for each additional Furnace, etc. Address: • . Gas heat pump City/State/ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater -------------- Fireplace E -mail: Range k- � 5 " , �' : : t ` . ' `.,' ' ' CONTRACTOR _- Barbecue Business name: /DiDn e e s �li rh e Clothes dryer (gas) // -- �1 r , ,,/ Other: Address: 3 C D s E �r -(C.l G. `"y - M ECHANICAL PERMIT: {FEES „ . City/State/ZIP: o �71 /ah01 ®te 97 , z 3Z Subtotal /4 - " ' Minimum permit fee ($72.50) 7 ,, SO Phone: ( 5 2T9 5600 Fax: (5 2 49 E26,0 J Plan review (25% of permit fee) CCB lie.: 3 /O - State surcharge (8% of permit fee) 5 . et) ( .. TOTAL PERMIT FEE - 7 g. 3t This permit application expires if a permit is not obtained within 180 Authorized signature: „. /.17 ...-- ) 01/ijr . days after it has been accepted as complete. I Print name: I D ale I ' Fee methodology set by Tn- County Building Industry Service Board Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: 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. • • , s i:\Buitding \Permits \MEC- PermitApp.doc 12/03 2 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (O3) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received l Dftste o qued 44 `� / AM PM / Location /<( O £/ 77 Suite c2 7 9 ?�c Contact Person PLM Contractor h ( ) SWR BUILDING Tenant/Owner � J ELC C 3 - 66 7 T3 Footing Foundation Access: Its' zwa 1 4-0 ° P ELC Ftg Drain �,.+Yf, 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 Shower Pan Other: Final PAS FAIL CHANICA Pos eam ,(�'�' Rough-In aLine Gas Line cc Smoke Dampers PART F CTRICAL> Service Rough -In UG /Slab Low Voltage Alarm Fina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SS ART FAIL Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line / ADA ` 0 Inspector Zl L .-� Ext Approach /Sidewalk Date (2_ Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL