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Permit CITY OF TIGARD MECHANICAL PERMIT i 1 - DEVELOPMENT SERVICES PERMIT #: MEC2004 -00837 r���. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/1/2005 PARCEL: 2 S 102 B D -00800 SITE ADDRESS: 12630 SW GRANT AVE SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: R -12 BLOCK: LOT: 009 JURISDICTION: TIG CLASS OF WORK: ACS FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: 1 OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN: ELE 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: AC exterior wall mount and bathroom vent. Value: $2,000 Owner: FEES ROMAN CATHOLIC ARCHBISHOP OF Description Date Amount PORTLAND IN OREGON [MECH] Permit Fee 2/1/2005 $72.50 2838 E BURNSIDE [TAX] 8% State Surchar€ 2/1/2005 $5.80 PORTLAND, OR 97214 Phone: Total $78.30 Contractor: ■ LUCIUS VALUSEK HOME SERVICES 12721 SW 131 AVE. TIGARD, OR 97223 REQUIRED INSPECTIONS Phone: 503 Cooling Unt Insp Final Inspection Reg #: LIC 138761 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)246 -6699. • v Issued By: �> � Permittee Signature: / ,�f� i Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day Mechanical Permit ApplicaRF CEI V ®. '' FOR OFFI USE ONLY - ' C1Lr O Rec .,' Tigard Date/By 1 j��lt�G1 P") / Permit No 6-C,,4.00 ,...' . 13125 SW Hall Blvd., Ttgatd, OR 97223 D[ 2 Plan Review ' i / C A Phone. 503 639 4171 ' Fax: 503 598.1960 ll�e 4 tt Date/By Other Permit > Z ©0� Inspection Line: 503 639 4175 CITY 0 a }141 1 111: Date Read /B lulls El See age e 2 for g Internet: www ci ti and or.us o c r " Ready/By BUILDING DIVISION Supplemental Information � m > . ? ' . ., = < « 'YP OS W • , : ' ; ;: . w : Ft_, : - " <: CO1VI . `SCHED,UT E= - :$[I SE ° CHECKLIST ,_. ..;.; ° A c � � -'F.<s '^ •'k# 8S� -�' �_., ....._a v,= f; c. . : N ' :bi.���r:` �^1-, �2�.` -'r = �• � -., -. .... � F_ , ......:.. .. .. ,� , .. - . , . -. �] New construction ❑ 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 matenals, equipment, labor, overhead, and profit *w M , F ? t - , , - ' • .sys+ , ,. ..'., x'sa;,: a � `�"` : 8'_; ,'- Value $ " 2_4 : i d . �., - ::�:� z';T�.�� a�` �E1' LEGORX' .40F��GONSTRiJGTION�.`` "�^.'s � .. '� � ` ;z? ° .`3 ate ' •,a _. : :s �. z . RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1 and 2 family dwelling ❑ Commercial /mdustria Accessory building For special information use checklist ❑ Multi - family ❑ Master builder ❑ Other: Description Qty Ea Total N `" $JOB ITE TNtFORM . k. ,k >: - ; ..- -1,,,::,,,,,,:- :° `i "' ,,S A TTONS'ANR L`O`GATIO N _ - ' cooe `;"�'i �. .�r..`,t.�',NF.h$s,��.�;� *sc.... �.-,. �. �= �."�^���e�,._�,�.®��.,�r�..� ..B <.e- a„x ^'t'akx; a' Heatin li � g Job site address: ( rte so S\V G e.a „Tr �YE Air conditioning or heat pump (requires site plan showing placements _ 14 00 (1-,a:7 City/State /ZIP: TcoAter) , 0. O 22'3 Furnace 100,000 BTU (ducts /vents) 14 00 . /apt no.: Project na Furnace 100,000+ BTU (ducts /vents) 17 90 Suite/bldg Now em�l..06 Gas heat pump 14 00 Cross street/directions to job site: S \\/ Cc4p_4 S, ca I KT Ees 101 Duct work 14 00 Hydronic hot water system 14 00 \V/ S \V Cr) c - . r4 z 1'F Residential boiler (radiator or Grp \ ' hydronic) 14 00 1 ^� Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc 10 00 � Flue /vent for an of above 10 00 Subdivision: Lot no.: , Other 10 00 Tax map /parcel no.: 2.. S 1 1 c) 2 fsD Other fuel appliances t ; vu 3"'a ;` sra .. - ,i; , rave . ni : =, ,.. £ , - , , v . r.,;„ `f Water heater 10 00 ;, , `'°''�.;` £ `pESCRIPTrIOksF OF ORK � / a., �.t " s s : Gas fireplace 1000 L_c91-45'1' }Q" / 10C') SF 'f)4;14b t 'S g�a� 01 _ Flue verat4er- wateTheater or gas 147c. 1/ , z% - 14 )(7/ 0 )' urbutA+ ) L l igh 10 00 (b, QQ - - Log lighter (gas) 10.00 ,/,�„ 4 ✓ t Wood /pellet stove 10 00 t Wood fireplace /insert 10 00 : my .,. <_ ,_- „ . , - > �=-�, i '- ]'fPR`O:',,,,,,,,O, ERTY'"OWNER`i,' - _ v . 7k i; t ®,TEN • . ' .. .�t�' ���'.�. , r<==t' ,. �?sy,az r;. ��.r:t . p ` "'F . s�+ ,n.m , s x..:�`t �:a� t �� " Chimney/liner/flue/vent 10 00 other 10 OO Name: andm C.11 6/94 op , -/ N (+Z©CQ Environmental exhaust and ventilation Range hood /other kitchen Address: ��3A t S I tyla.. equipment 10 00 City/State /ZIP: Po I L-L .40 4 o , r , e , 6) ? 21 ¢ Clothes dryer exhaust 10 00 Single -duct exhaust (bathrooms, Phone: (. 3 C.,'3•=9 C.,'3•=9 ) ^ 4 Fax: (65 f 2¢ �4 m — 23 toilet compartments, utility roo � 5 6 80 Co,80 1;/ �<:_ ��` � � '� , �° CO AC �_�, `4° Atuc /crawlspace fans 10.00 - `t ; APPLTGANT. :per , r, = . , rv` 4. - ;; `c ®. RA T f 1„ �`.. yea - Other 1000 Business name: C T 4l O tvy Q QA Fuel piping Contact name: 1‹ , K'c......6S f443 6o3 - 6030 -? I Q1 (9 $5.40 for first four; $1.00 for each additional Address: � Stu 0') t�l cam. Gas heat etc Gas heat pump City/State /ZIP: ��,, p QZ C PP 5 Wall /suspended /unit heater Phone: (503) C..4 )-- g-1 7 Fax: : (5 - 03) Cr„,-2_q_-2...43,_ Water heater Fireplace E -mail: Range - tt4,,. , ) ':,',` '`g ,' CONTRAGTQ r :, C.; � - s 5,: F.. ", . . : Barbecue T.`� n 9 �t� � ,''��:r ., �,.° . t b _ � _ `us+2'�a, � �.�, r Business name - re:.0 , 7fe,/'C /S p)ek Z6ff fjeyfir L/i'L Clothes dryer (gas) Other Address: 4 / ��/ .. , . .� t ,:;�� .,_ * ". , . �� �J -� d6 G /� t : _$, .; .` .lati ANTCAT , PERMIT'FEES City/State /ZIP: 7 / 1--R , pAL 9 7ZZ2 Subtotal � Phone: (, .Z 52 y •-7/ 10 Fax. ( ) / Minimum permit fee ($72 50) ,2 .50 0 Plan review (25% of permit fee) / - CCB lic.• /J' 76'"/ — I )-_) (a Lio, State surcharge (8% of permit fee) . ,�V j + + y TOTAL PERMIT FEE --- - 3D Authorized signature. Pi - . f�/ This permi app lication expires if a permit is not obtained within 180 t ` days after it has been accepted as complete. Print name: •4 ise2 -L ,(' " rzc Date: / 3 "0 7 ' * Fee methodology set by TT- County Building Industry Service Board I \Buddm \gPermits1MEC- PerttutApp doc 12/03 440 -4617T (1 I /02 /COM/WE / / / B) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: To ta l :Valuation . ,3 0:. V , " m; ..: r. $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. 1.\Buildmg\Permits\MEC- PermitApp doc 12/03 2 • CITY OF TIGARD BUILDING DIVISION PERMIT #: MEC2004 -00837 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1/2005 Phone: (503) 639 -4171 �A �NUu�u�pi @III Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 3/23/2005 TIME: 7:08AM PAGE: 107 SITE ADDRESS: 12630 SW GRANT AVE CLASS OF WORK: SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 009 TYPE OF USE: PROJECT NAME: ST ANTHONY DESCRIPTION: AC exterior wall mount and bathroom vent. Value: $2,000 OWNER: ROMAN CATHOLIC ARCHBISHOP OF, PHONE #: CONTRACTOR: LUCIUS VALUSEK HOME SERVICES PHONE #: 503. 5247170 Inspection Request Scheduled For: Date: 3/23/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 002479 -02 503.780 -8037 N Corrections /Comments /Instructions: . r I 0 /� � � /PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 5Z "A-' /3 L-OCr Date:./ / 6 � J Phone #: (503) 718- 293