Permit IL
� r
C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00159
° �f I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/7/2005
PARCEL: 2S 101 AB -01401
SITE ADDRESS: 07355 SW HERMOSO WAY ZONING: MUE •
SUBDIVISION: HERMOSO PARK LOT: 004 JURISDICTION: TIG
Project Description: Gas meter installation for water heater.
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:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
LYMAN, KYLE Description Date Amount
11326 SW 84TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 4/7/2005 $72.50
[TAX] 8% State Surcha 4/7/2005 $5.80
Total $78.30
Phone: 503- 598 -0736
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
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: 0, Z Permittee Signature: �`j
Call 503 - 639 -4175 by 7:00 a.m. for inspecti n t. iness day.
This permit card shall be kept in a conspicuous place on7— job : - until completion of the project.
Approved plans are required on the job site at the t e of each inspection.
Mechanical Permi Application . { . `' `': FOR,OFFICE USE ONLY' -.
City of Tigard Date /Byd y� -(125...-../2651Z_ 9
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.593.1960 t' l Date /By: Other Permit:
Inspection Line: 503.639.4175 L I J ' e ! Date Ready/By: taris: El See Page 2 for
Internet: www.ci.tigard.or.us Noufied/Method: 176- Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ 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 materials, equipment. labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
%I and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use check list.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Li - f Air conditioning or heat pump
Job site address:
3 S � c� ' ,�w,_ 6 S 6 Li (requires site plan showing placement) 14.00
City/State /ZIP: q .7-2-5 -----v\ j ,-(P\� Q C\-------_ Furnace 100.000 BTU (ducts /vents) 14.00
i 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: 7y /V� v T� Duct work 14.00
�� Hydronic hot water system 14.00
0 `N n ` v
-- f c w n 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: 4)'4 of n o.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
,, S _ �_ N) Gas fireplace 10.00
( `� h �-- F - �� - ��--- Flue vent for water heater or gas
l � , O �� � L replace 10.00
9 Log lighter (gas) 10.00
Wood /pellet stove t0.00
Wood fireplace /insert 10.00
`PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Y Other: 10.00
Name: /96, ty,�,, Environmental exhaust and ventilation
Address: // 2 5(./ 8� / U2 Range hood /other kitchen
equipment 10.00
City/State /ZIP: 7 /6 n 6 -4- 9?- Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( •) . • ' -D? Fax: ( ) toilet compartments. utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
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 .
Fax: Phone: ( ) ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) - 7, 7 ,..
Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee) ,5-
Authorized signature:
7
/ TOTAL PERMIT FEE ,7 ,� ?L� •
This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name: i Y/11/9--/t/ Date: G/ 7 - 65- ` Fee methodology set by Tri -County Building Industry Service Board
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 572.50
$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.
S5,001.00 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.
is \Building \Permits \iN1EC- PermitApp.doc 12/03 2
CITY OF TIGARD
, BUILDING DIVISION PERMIT #: MEC2005.00159
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4 /7/ 005
Phone: (503) 639 -4171 /�miiuylm
Inspection Requests (24 Hrs.): (503) 639 -4175 1.L
. INSPECTION WORKSHEET FOR DATE: 5/5/2005 • TIME: 7 :16AM PAGE: 40
SITE ADDRESS: 07355 SW HERMOSO WAY CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT #: 004 TYPE OF USE:
PROJECT NAME: LYMAN
DESCRIPTION: Gas meter installation for water heater.
OWNER: LYMAN, KYLE, PHONE #: 503 - 598 -0736
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 006177 -01 503- 957 -6969 N
Corrections /Comments /Instructions:
I --- _ I i LIB ' I I
e r• •! _
T ' PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL F ES ASSESSED
/
Inspector: ' Dater — v Phone #: (503) 718-
G