Permit 71 ..: k. C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00303
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/25/2007
PARCEL: 1 S134AC -02650
SITE ADDRESS: 11080 SW COTTONWOOD LN ZONING: R -4.5
SUBDIVISION: ENGLEWOOD NO.3 LOT: 216 JURISDICTION: TIG
PROJECT: HAYNES
Project Description: Replace furnace, add AC, alter ductwork and washer exhaust.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 0
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
NAT 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: 1 AIR HANDLING UNITS CLO DRYERS: 1
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 0
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
KENNETH HAYNES Description Date Amount
11080 SW COTTONWOOD LANE
TIGARD, OR 97223 [MECH] Permit Fee 5/25/2007 $72.50
[TAX] 8% State Surcha 5/25/2007 $5.80
Total $78.30
Phone: 971 - 645 -8856
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
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 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: Permittee Signature: / .AA- -- ` i / . i
Call 503.639.4175 by 7:00 a.m. for inspections that bu mess day.
This permit card shall be kept in a conspicuous place on the job site completion of the project.
Approved plans are required on the job site at the time of each inspection.
I''
Mechanical Permit Application 'r:.'',,, 4 ' ° s FOR,OFFICE USE C NLV r' „:,,
��' Received f
City of Tigard FTC-TB y ) Permit N. Je3
�;. w 4� I ?-,, DateBy 2 *A .. L � -' dr� • 13125 SW Hall Blvd., Tigard, OR 9_ Plan Revie
Phone: 503.639.4171 Fax: 503.598.1 2 5 2007 Date/By: Other Permit:
i IyGA'RE Inspection Line: 503.639.4175 Date Ready /By • luri 0 See Page 2 for
Internet: www.tigard - or.gov CITY OF CIGARD RD Notified/Method: J Supplemental Information
BUIL®:NC' D�F
Ii
' - TYPE O F WORK - ,. COMMERCIAL FEE* • SCHEDULE — USE CHECKLIST
❑ New construction g' 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.
CATEGORY OF CONSTRUCTION . ' Value: $
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
Multi - family ❑ Master builder ❑ Other: RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION • ' • ' Heating/cooling
' / � � l Air conditioning or heat pump
Job site address:
I ( ago S ( , 1 / 1 CJ 1A) 3 C)) LAJ (requires site plan showing placement) 14 00 i
City /State /ZIP: 771, ,v14) 4 ) >•,)-.3 Fumace 100,000 BTU (ducts /vents) 14.00
Suite/bldg. /apt. no.: Project name:
Furnace 100,000+ BTU (ducts /vents) 17.90
5 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
A g� Gas fireplace 10.00
M y (`�� i ,AZ A/C,, �`nGAi Cf F01 Flue vent for water heater or gas
/ /V2 - f - tm Log lighter (gas) fireplace 10.00
!11 vv„ ' 10.00
h o y YL V& - Wood/pellet stove 10.00
Wood fireplace /insert 10.00
/ Chimney /liner /flue /vent 10.00
[� PROPERTY OWNER ❑ TENANT .
Other: 10.00
•
Name: C/ • � Environmental exhaust and ventilation
`` / y ' ) Lr) Range hood /other kitcheh
Address:
/�� �) r:� �7 U
� /T► equipment 10.00
City /State /ZIP: 1-- /6..,/}42— q 7 t 3 Clothes dryer exhaust 10.00
/ Single -duct exhaust (bathrooms.
Phone: ( '7( )1 s 4/ Q' -6 Fax: ( ) toilet compartments, utility rooms) 6 80
0 APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: O� sue Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: CriA)/v�..YZ Clothes dryer (gas)
Other:
Address: • MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee)
��_ TOTAL PERMIT FEE 7k, 30
Authorized signature: Z_ This permit application expires if a permit is not obtained within 180
/4 d ays a i t has been accepted as complete.
Print name: - — 4 y Date: S X 0.7 ' Fee methodology set by In- County Building industry Service Board
I:\Buildmg\Permits\ 4EC- PermnApp doe 04/06/06 / , ' / 440 -4617T t /02/COb'VWEB) / 4'0
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental 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
$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\Permits\MEC- PermitApp doc 12/30/05 2
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BUILDING DIVISION
' PERMIT #: �EC2OO�003O9
13125 Hall B}vd.. Tigard, ORO7223 DATE ISSUED: 512512007
Phone: (503)639'4171 �
Inspection Requests (24Hmj:(5O3)630'4175 ��-
INSPECTION WORKSHEET FOR DATE: 4K16/2008 TIME: 7:00AM PAGE: 10
SITE ADDRESS: 11080 SW COTTONWOOD LN CLASS OF WORK:
SUBDIVISION: ENGLEW0OQN0.3 LOT #: 216 TYPE OF USE:
PROJECT NAME: HAYNES
DESCRIPTION: Replace hirnace, add AC, alter ductwork and washer exhaust.
OWNER: MAYMES.KENMETH PHONE #: 971'645-0856
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/16/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
696 &4ioc,inmpedfon 088473'01 971'&1‘;.8856 Y
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Corrections/Comments/Instructions: .
Mj PASS n PARTIAL APPROVAL ri CANCEL El NO ACCESS
| I FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
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Inspector: ^,~' , Oatm� ,---���-��' �i Phone #: (503) 718-
CITY QFTEGARD �, - ^-
BUILDING DIVISION PERMIT #: MEC2007 011303
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/25/2007 I
Phone: (503) 639 -4171 /v Nl�lld`i
Inspection Requests (24 Hrs.): (503) 639 -4175 °`''_�..
INSPECTION WORKSHEET FOR DATE: 10/15/2007 TIME: 7 :01AM PAGE: 44
SITE ADDRESS: 110$0 Silt/ COTTONWOOD 1_1j CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO3 LOT #: 218 TYPE OF USE:
PROJECT NAME: HAYNES
DESCRIPTION: Replace furnace, add AC, alter ductwork and washer exhaut t.
OWNER: HAYNES, KENNETH PHONE #: 971 -81f -8816
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
899 Mechanical final 057503-02 971- 645 -0856 N
Corrections /Comments/ Instructions:
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PASS I I PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' Date: Al /J —d Phone #: (503) 718 - -- `1'`4S
--
CITY OF- TIGARD _ L ,�_�
BUILDING DIVISION PERMIT #: MEC2007 -00303
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/25/2007
Phone: (503) 6 3 9 - 4 1 7 1 J / 4 N 4 I � i i ' AI
Inspection Requests (24 Hrs.): (503) 639 -4175 jlL1 /
INSPECTION WORKSHEET FOR DATE: 7/18/2007 TIME: 7 :01AM PAGE: 25
SITE ADDRESS: 11080 SW COTTONWOOD LN CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO.3 LOT #: 216 TYPE OF USE:
PROJECT NAME: HAYNES
DESCRIPTION: Replace furnace, add AC, alter ductwork and washer exhaust.
OWNER: HAYNES, KENNETH PHONE #: 971-645-8856
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
625 Duct work 05225501 971 - 645-8856 Y
orre ons /Comm nt/Instructions: Z
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❑ PASS
k RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL 1 CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
- Inspector: . Date: ? / U e1 7 Phone #: (503) 718 -