Permit CITY OF TIGARD
MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00631
•��� ' DATE ISSUED: 9/21/2004 l Y l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133DA-05100
SITE ADDRESS: 12730 SW GLACIER LILY CIR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 073 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS: 4
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: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace (4) bath fans.
Owner: FEES
PULITO, GERALDINE K + Description Date Amount
BENNETT, EARL C [MECH] Permit Fee 9/21/200 $72.50
12730 SW GLACIER LILY CR [TAX] 8% State Surchar€ 9/21/200z $5.80
TIGARD, OR 97223
Phone: 503 - 524 - 8037 Total $78.30
Contractor:
OLSON & JONES
PO BOX 19563
PORTLAND, OR 97280 REQUIRED INSPECTIONS
Phone: 503 Misc. Inspection
Final Inspection
Reg #: LIC 54065
•
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: 17/) Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business dr419
Mechanical Permit Application . ,,,. , , FOROFFICUUSEONIN' ' . • - , , r''':
, ... .. . 2 , r • . ■
City of Migard Received
Date/By 1 - 2 --
OV I Permit No tc ci -66 f)
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone. 503 639.4171 Fax: 503 598 fraypilio Date/By Other Permit
Inspection Line: 503 639.4175 -.14 .61 I.' Date Ready/By. Ell El See Page 2 for
Internet www ci tigard or us Notified/Method Supplemental Information
' `1664AfiiEaigiiikesafiti ' Ult , =-:':IJSEdiEelkLiST
--. - - .'- ' ' -
Mechanical permit fees* are based on the value of the work
0 New construction tAddition/alteration/replacement
performed Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical matenals, equipment, labor, overhead, and profit
M' f PGrtaiidolVardo'Si§',fieefio"r:fSnl*V,':'ti,"ra$7ii Value- $
z - 47 - , ,,.., ..,,ni ,- ,,,,
- -"IttSIDEINTiArE(iti,104ENT/6SYSTEMS FEES*
5L1:- and 2-family dwelling 0 Commercial/industrial 0 Accessory building . ''' ''''' — ''" ''''' ''' - "`" ' -
For special information use checklist
0 Multi-family 0 Master builder 0 Other: _ Description Qty Ea Total
4 r lqAV6iirs - fiEiKF150GzfrC&A,Wt ' cye,a ' *dRr:V 7- A;: - : , O; '; ;i Heating/cooling
-Sl C ,^110.,•.**.W , Zik ''''': '',.,:ic : ' ,-
Air conditioning or heat pump
Job site address: t 2:7 30 5 LO G I A . cle.e . L t c.tv--- (requires site plan showing placement) 14 00
City/State/ZIP: l 1 Av .+
0 P.-, q 7 Z 2:3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17 90
Suite/bldg./apt. no.: Project name. p h 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
Flue/vent for any of above 10 00
Subdivision: Lot no :
Other: 10.00
Tax map/parcel no.: Other fuel appliances
i
4 W76Mi $7
t::';::Pa. 'lltx:5 -..n-, Water heater 10 00
.t 4.4:, 4-4 ' `i'i, :"A l':'4S
Gas fireplace _ 10.00
Re p (14-6_ 1 P al-l-k A-L 5 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
t- - v .,, ,,,,,, ,,,,, ,i, , ir.,..;.v&4,v , 1 :, , , ,,,.. Ft, , Chimney/liner/flue/vent 10 00
, .. ...;,.... ' . ' Oth 10 00
Name: p I , 1 i 1 Environmental exhaust and ventilation
Range hood/other kitchen
Address: I -2_ ? 3 0 3, (7 c. ,,,„ A 4, i IT _ equipment 10 00
City/State/ZIP: T g 4 01 6 IL 9 7 22-'3 Clothes dryer exhaust 10 00
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6 80
,, IT
, E?:•;" g); -4 „if ,, - weicr4'''L , i6;w'" ° ' - '" -- s''''' m c r 'r:' Attic/crawlspace fans 10 00
ittnag ,,,,!,,m,i,*v,Twip,,M,-: li_t=tamie, 7A, AS9i‘ .4,.‘;: P
Other 10.00
Business name: /..") /
-4 704. c: - Fuel piping
Contact name: 4 6, 1., Bilv-741.9( a 44 $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: -) , 0 g otv. , 1 q c
Gas heat pump
City/State/ZIP: Poi - 1,4_
D q72q0 Wall/suspended/unit heater
Water heater
Phone. ( S 2 _ -
Fax: ( cc 3) zi/c/....67:71, /
Fireplace
E-mail: Range
w-rrtmwm,A7'MpNk Barbecue
',
1
Busi 0 ISOA) 4.-- e7Ve '. , , • /1' & Clothes dryer (gas)
ness name:
Other
...a Address: F 0 . 1.-? / , 5 - 3 ter:viva:NI-I , ALTERNEET , FEESt
■i, City/State/ZIP: Pe10.x_, d 0 le I - 72... 0 Subtotal
Minimum permit fee ($72 50)
Y Phone (5 ) 2z... 7c/ -2 Fax: (4 ) 2, 6 79/
Plan review (25% of permit fee)
S
3.... CCB lie.. 5 6--- State surcharge (8% of permit fee)
X TOTAL PERMIT FEE 7y. .7 0
This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
Pnnt name' Date: * Fee methodology set by Tn-County Building Industry Service Board
i \BuildmePerauts \MEC-PentutApp doe 12/03 440-4617T (1 I/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
F h7Cofalt'Valua$ on ` ° _ i:t it r = h
$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\Pemuts\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
2 – ?s6.0 BUP
Received Date Requested AM IPM BUP
'` ,�fob ( I
Location �� : Suite
Contact Person Ph ( ) l ` 7 46 7
Contractor Ph ( )3q/– . ci 3 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: _ � a0 4 (_ O SIT
Post & Beam lt/ ls�
Shear Anchors 1! . L/12%-.6-1 �` Q io % 2
Ext Sheath/Shear t' W �-(�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL 1‘4
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
-tea
P PA T FAIL
Pos 1 \ /� ' S
Rough -In li
Gas Line
Smoke Dampers
n.
'WART FAIL
EL — ICAL
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 ,`�d Inspector r Ext
Other:
Final DO NOT REMOVE this inspection record rom the J site.
PASS PART FAIL