Permit A
f R " + CITY OF TIGARD
MECHANICAL PERMIT
4 0 , I, DEVELOPMENT SERVICES PERMIT #: MEC2004 -00544
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/12/2004
PARCEL: 2S 114BA -05800
SITE ADDRESS: 16530 SW GREENLAND DR
SUBDIVISION: PICKS LANDING NO.2 ZONING: R -4.5
BLOCK: LOT: 082 JURISDICTION: TIG
CLASS OF WORK: ALT 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: 1 DOMES. INCIN:
LPG 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replacement of Furnace and AC unit.
Owner: FEES
DICK, JACK E AND JUDY L Description Date Amount
16530 SW GREENLAND DR CITY OF TIGARD MEIN 8/12/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 8/12/200 $5.80
Phone: 503 449 - 0766 Total $78.30
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 447 Final Inspection
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. 1
Issued By: >! , Permittee Signature: Q fJ� ' (lee,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Applicatio V O FOR OFFICE USE ONLY
City of Tigard � � Received Permit No.:k 006
13125 SW Hall Blvd., Tigard, GR 97223 G e�
Phone: 503.639.4171 Fax: 503.598.19 1 1- „' I I Plan Revta ° Other Permit:
Y Date/By:
Inspection Line: 503.639.4175 ' i � Date Ready/By: J el See Page 2 for
Internet: www.ci.tigard.or.us *� � � O. Notified/Method: 1 f G) Supplemental Information
4'? _ .SS` �`r - 7 � t- .., ' .. a : ; : - '6 ,A.s . i s M arx; `t�s u7 9 i 9., - A CK .
El New construction id Addition/al ., • on/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.
ti 44 `�
s.54M t.V ` i R Value $
. mss ti ,4--,.' b
4 1- and 2- fami y l dwelling ❑ Commercial /industrial ,,. 1 t 1 PPS i SYSTEMS FEES*
❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Description I Qty. Ea. Total
„ 'i� o- t . ' t1� ' G � a , i , ,: i + k. f i ° ° , ': ' ' g
, ..� .�. , � s ! Y ; #,v� � . s � �. Heating/cooling
coolin
n' Air conditioning or heat pump I l
Job site address:
Lo 530 �x.►J � ( ` � (requires site plan showing placement) . 1 d 14.00 '
City/ State/ZIP: ^"- r .,� Qa Gt'�' i I Furnace 100,000 BTU{duwtctvents) 1, 14.00 t(,t
Suite/bldg. /apt. no.: Project name: " Furnace 100,000+ BTU (ducts/vents) 17.90
1 5 [ t 1 Gas heat pump 14.00
Cross aueet;dircctioi to job site: TlnotnnAS GV •,Di2 Ductwork 14.00
!_ Hydronic hot water system 14.00
D€) "s Residential boiler (radiator or
C .r'CfsS ""'T n 1 t �V7 I tP1: A '- �JI Q C _ Uni h - 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
r '' " tx .. E t �� 4 4 �+4 8� N ., i '' " " � ,. � Water heater 10.00
.:.Lad A_.. ,.r.. .,, ,V. . �,4. aS"' • : " p . ' " - a-,'A -. 1. `' � ,,,,V
-^ r Gas fireplace 10.00
Yom
f k ' 1C__ ZQchQCe__ Flue vent for water heater or gas
n�� fireplace 10.00
J C ".��.AC� `'* ?(Q e (_ Log lighter (gas) 10.00
Wood/pellet stove 10.00
r- t • , 1 11 ,_ lo. J 4.1 �S ., • n Wood fireplace/insert 10.00
{ . . .fs Chimney/liner/flue/vent 10.00
._ _..���,.t_ ��.?�•.> > � _. fi,�c� , 4•4 Other: 10.00
Name: 3AC- 1/4(7 - S - 0 D +�� Environmental exhaust and ventilation
� Range hood/other kitchen
Address: +'
1(o53C \ t�-[? .X P1tJ� R . equipment 10.00
City/ State/ZIP: T _ dot �� ji Clothes dryer exhaust 10.00
(5 I • D ( �.0 Fax:
Single-duct compartments, exhaust t s (bathrooms, rooms) ,
Phone:
G ) � ( ) toilet compartments, utility rooms) 6.80
t w ,; '., '.:' c #.'t L- � x,., ' '' '' : Attic /crawlspace fans 10.00
Business name: Other: 10.00
�� „ I Fuel piping
Contact name: S? c2 Ut c \��( / ) � _ $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: BELL HEATING. INC. Wall/suspended/unit heater
Phone: ( )
'4.4.f. ►iii r Water heater
' ' Fireplace
E -mail C, 7S
.s 1 t Range
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"�.... - kn _s�`� �z� - ..r ; 'u� �; r. - .vc., �z "1'; ..,.... s . �a ""r - r � �
Business name: Clothes dryer (gas)
Other:
,r
Address: BELL HEATING, INC. -„ ` ~li1f, ICP
City/State/ZIP: 16660 SE PIAZZA AVE. Subtotal i r u
`• ■► : - 7.2, Minimum permit fee ($72.50) �, y- /:
Phone: ( ) s'+
.� rs - . - Plan review (25% of permit fee)
CCB lie.: 44 I
41i I ! State surcharge (8% of permit fee) I aj, !✓'lr ,� ,� TOTAL PERMIT FEE - 7g , 30
Authorized ail., . / . CA-6 \ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: �� D ate: S /C (� . Fee methodology set by Tri- County Building Industry Service Board
- :t5 I
iaBuilding \ Permits ' \OC- ParitApp.doe 1:.'03 440461 7T(11/C2/COM'WBB}
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule: _
$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
$1.3.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.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEG2004 0054
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/12/2004
Phone: (503) 639 -4171 io o �u �Om�iii�lt " i
Inspection Requests (24 Hrs.): (503) 639 -4175 u'f L.
INSPECTION WORKSHEET FOR DATE: 23/2005 TIME: 7 :08AM PAGE: 95
SITE ADDRESS: 16530 SW GREENLAND 1 • CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.2 LOT #: 082 TYPE OF USE:
PROJECT NAME: DICK
DESCRIPTION: Replacement of Fuma • 1 nd AC unit.
OWNER: DICK, JACK E AND J IY L, PHONE #: 503 -449 -0766
CONTRACTOR: BELL HEATING PHONE #: 503- 656 -1184
Inspection Request Scheduled For: Date: 3/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 002530 -01 503- 449 -0766 N
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
IL r = ' os
Inspector: '1.1., Date: Phone #: (503) 718-