Permit •
CITY OF TIGARD
MECHANICAL PERMIT
1A DEVELOPMENT SERVICES PERMIT #: MEC2004 -00602
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/9/2004
PARCEL: 1S133DA-06000
SITE ADDRESS: 12950 SW GLACIER LILY CIR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 082 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: 0
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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of venting & piping for range.
Owner: FEES
GARBARINO, GERALD LYNN Description Date Amount
12950 SW GLACIER LILY CIR [MECH] Permit Fee 9/9/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 9/9/2004 $5.80
Phone: Total $78.30
Contractor:
SUBURBAN @ HOME
6014 NE 112TH AVE.
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 143335
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: ,2)2 ;; Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permi :_ , i,_�. I.4 ED FOR OFFICE USE ONLY •
Cit f °T Igard Received - / f Permit ..e.- ' + , (J - b //
200 Date/By: `� 6 ■ 13125 SW Hall Blvd., Tigard, OR 97223 ,`
E[ U V Plan Review
Phone: 503.639.4171 Fax: 503.598.19
�G ��� / /i�V I � Date/By: Other Permit:
Inspection Line: 503.639.4175 p Ala
1 �Y 0 F TIGA ���.� Date Ready/By: Ma ®See Page 2 for Internet: www.ci.tigard.or.us
C DIVI SA. Notified/Method: Supplemental Information
s OLDING V
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` :. A V : T .•E OF.;WORI{ e " -W i : V$ 'a r' 4 . , ` _ FE i S HED�i = CHEGKLI T"�
=`�. == N. n. 4 . s '.: .: _ ' �i. :- • st5COM1,L'ERCI'AL.- r- E.='-..C_.•- - ..- . S'
❑ New construction tddition/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.
k' •'p ,> °1 yP U�S -,rte'- u' .s ::L;vara�:MZ,s'.«�m:i , w.- r -a. .' e ,. dp ,
x 4 v 9 � . ,, ,_ .., ,kt" I,.r Value: $
s - t" '`:- ,,. a :21 „- ,CATEGORY OF GONSTRUCTiO1V..;' ;,p -= ,x;I?1. =.
, w: .:�.- ..,^:�:.�w.�aa,.5�::.�s.�� _, sz:,sr. ;.�+r �uiu,, � ? ^ : : . = §w +� 7 ,I_:�, » "«.'3: y s' f�F sa „r:+uw,..;n�ir:.od��•:=�,.. *t . �„�;;r,; .,u���„
,.. ..1N- and 2- family dwelling El Commercial/industrial ❑ Accessory building ; ,RESIDENTIAL EQ UIP 1 v I EN T / ? SF STE iVIS FEES*
For special information use checklist.
3x E SN TI A L . E Q UiE E ..
ulti -famil
y ❑ Master builder ❑ Other:
�*,�.� � , �- �:� , -- �. � �wu ,�- �..- -�• w��,�� �� � . x.: � ,�: �.•... Description Qty. Ea. Total
: a r ' " ` .) i t SIT,E SITIS MATION Ab air fibi ea °v ;' �' 's
i > .. ,, -x A.,. .,a; <�� = ; �ai.,�: _, ,• . s ,": z `, ,a4 Heating/cooling
Job site address: `� ` Q- c.: � L` 1 Air conditioning or heat pump
°"0��! Ciyr wC./ (requires site plan showing placement) 14.00
Qee l � Fumace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: 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
sr+ ,� �d;'�r ti ;- zM s c �.. e x•-,a:- 10.00
>� "`;�. �� � i`� €;:. t � °., Water heater
k ill l , k F l iaMi ;,X 0 . , c4m ,,SC RIPT IO I . WORK` Al A` +' V'` 'lly -q i r W
u i��.,4�s.'�,�k.. i�"r -,# fir. ' �.' �.- >.., � :, ,
d, , �°. �s�F, �. ��c. �cw ..�»� .,�?s:�'., w+�SG.'@�_ .� N,,f
Gas fireplace 10.00
V e/vai, Ir\e& % cack Flue vent for water heater or gas
U fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
ax w ° rdif l a•:. 3i ?r 1t° ' "rid,+,.-° ti -�. F a i p i - - -_ Chimney/liner/flue/vent 10.00
I_ -;.. a ,y P Q W rI ER?e ; ; ; ' ; ., 1rT 1. t ` Y
._ � - u,�,a� ����k� .,m �...., a ?�# � - �`:s � �.�D f ,,�: $ „�. >,.'.,:��.. ����:�.���� Other: 10.00
Name: ���e�.cj �� 1 o .r r Environmental exhaust and ventilation
Address: « � % V�J Range hood /other kitchen
\ , _7'ti� � `l+ G � equipment 1 10.00 V:)•C
City/State /ZIP7c �` U Clothes dryer exhaust 10.00
Phone: ; a � Fax:
Single-duct exhaust (bathrooms,
( ( ) toilet compartments, , utility rooms) 6.80
k x';�ti' l P,L' K&NTleit'r 'tst `i '" lili : _ a. , l « � - �fi +. Attic /crawls ace fans 10.00
���'�= ``�.�i:...,.�C.Y .v.r�:��.s.�;;�� ���:'� ��� CON,T�.GT�= PERSO P
Other: 10.00
Business nam /nom ,�/
�� V /� �� Fuel piping
Contact name $5.40 for first four; $1.00 for each additional
G ,
Address:- LA 1f\0 \\
\J ems Fumace, etc.
`� `�' l Gas heat pump
City/State /Z c- c' ` °Gr� Wall /suspended/unit heater
Phone: ( t Fax a? Fax 5E5 - --`,3C) Water heater
Fireplace
E -mail: I %
Range
a ;g. 10, ` ig, .`.�y ». " ,, :ft.. i:`''; .ta:_r..�. to ws. s. x-s �,:r w . � ?-- :�. ,r ' a„
m ''` CONTRACT,OR . 'y�'� , y `w� '� s = .; Barbecue
Business name: �� Q. • ' �
Clothes dryer (gas) _...., Other:
Address: "' ° r a.4 f,, ..L,�•, .: . . �, _ ::.F l '�«.G. : .: , :.: , :
t , -? £` r1VtEGHAPIIC�'AIPERM *, -
City/State /ZIP: Subtotal t5,40
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) a
Plan review (25% of permit fee)
CCB lic.: \ --Va State surcharge (8% of permit fee) 4 5 . ,Itj
TOTAL PERMIT FEE ' AA 6 SO
Authorized signa . ` This permit application expires if a permit is not obtained within 180
• days after it has been accepted as complete.
Print names 4111111 Date: I'D OA ' Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits \MEC- PermitAppdoc 12/03 440- 4617T(1I /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule: " ` - ..) \ y
•- , , . ,.z"'`"r ': s""' =`:* ,'..;.^ .asza„`"y';,,:.za:#'':' ,.. � ,, : fr ;s�i':£,�,,:¢" . • ' �'� •
.10.1 Va .1.1*10 , f�� <�%:,A ? erm>< Feea° � , 0 .1 44 ,, �� <Y: 4,, , ,.
$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 r '
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.0,0 or ° r
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.
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i:\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGAR® 24 -Hour •-
BUILDING- Inspection Line: (503) 639 -4175
INSPECTION DIVIS4ON Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 5._ 37 AM PM BUP
Location 9. S O oir , a4 Suite - 6 o y -DO 6 6 2.
Contact Person gin - Ph ( (/ ) ? "7 - s`f 36 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: _ b - +� SIT
Post & Beam •
Shear Anchors
Ext Sheath/Shear �-
Int Sheath/Shear
Framing -r_ - /.-
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
MECHANICAL
Post & Beam
Rough -In
Smo e Dampers
Final
qvtesPAR_T FAIL
ELECTRICAL
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 9 — 2 7— C.1 i— Inspector , Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL