Permit • i w.,
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00718 .
.�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/17/03
PARCEL: 1S134BD-01700
SITE ADDRESS: 11735 SW HAZELWOOD LP
SUBDIVISION: ENGLEWOOD NO.2 ZONING: R -4.5
BLOCK: LOT: 105 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:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 1
Remarks: Installation of gas insert into existing fireplace and gas piping.
Owner: FEES
POIRIER, MICHELE M Description Date Amount
11735 SW HAZELWOOD LP
TIGARD, OR 97223 [MECH] Permit Fee 12/17/03 $72.50
[TAX] 8% State Surchar 12/17/03 $5.80
Phone: Total $78.30
Contractor:
PIONEER GAS FURNACE
3615 NE BROADWAY
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 36102
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 -00
Is C ----
L • . ; ` u / a L (2.- GYA; Permittee Signaturey( .(', fL 01f14.P)L
Call (5C3-Y•39 -4175 by 7:00 P.M. for inspections neede 43 ' next business day
Mechanical Permit Application . Received ,FOROFFICF, USE ONLY
, . Mechanical , i
Date/By: /t?" /1 0 1 Permit No.: ri f &Avg-00
City o f Tigard Planning Approval
Date/By: Building
Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 s A Post-Review Land Use
,to. Niti I 1 ;
,. 61 I ' Date/By: Contact y:
Case No.:
Internet: www.ci.tigard.or.us
Jili:i6A 3 See Page 2 for
'"
24-hour Inspection Request: 503-639-4175 "'' --1 Name/Method: i 1(..i Supplemental Information.
':,', ::tOMMERCIAL FEESCHEDULE :
El New construction E Demolition Mechanical permit fees* are based on the total value of the work
Li Addition/alteration/replacement El Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead and profit.
; ::,•..: ' .:, '
0 1 & 2-Family dwelling 0 Commercial/Industrial Value: $ See Page 2 for Fee Schedule
0 Accessory Building E Multi-Family -'-';,:RESIDENTIALEQUIPMENT/SYSTEMS,TEESCHEDULE
Description I Qty Fee(ea.) Total
Li Master Builder El Other: - Heating/Cooling . . .
:..,: SITE ',' ':;.:,': ' Furnace - add-on air conditioning** 14.00 •
Job site address: )1735 ( 30) tozaj _) Lo to Gas heat pump 14.00
Suite #: Bldg./Apt.#: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in-duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
.
Subdivision: Lot # Repair units 12.15 :
Other Fuel Appliances
Tax map/parcel #: Water heater 10.00
;.DESCRIP.TIONOF - ,` x - . ... ,' Gas fireplace ,I 10.00
. en/0 UP, - -t EA300c1 _pixe#cuc.L. fb 6-1) Flue vent (water heater/gas fireplace) 10.00
Log lighter (gas) 4 0.00
qa.4. .
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
. : - XYPitOP.IERTY:s0WNEIt:., .i''','.r. fattNANT.';';':- :..T.L:lf: Other: 10.00
. . - • - EnvironmentalExhaust & Ventilation
Name: `1 Pni kJ 61-_ Range hood/other kitchen equipment 10.00
Address: It 11,13 3,O I v fa„t,c,c) )o LOOP Clothes dryer exhaust 10.00
City/State/Zip: -- 1 14 ) 0. 0R_ q - -7,2 9.3
Single duct exhaust .
Phone: 57J 7q57 Fax: (bathrooms, toilet compartments,
UOPLICANT:.', ., : ":::::? ItOlikCT,IPERgON-,'"‘:‘, utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Other: 10.00
Address: • •
Fuel Piping
City/State/Zip: **($5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc. **
Gas heat pump - **
• E-mail: Wall/suspended/unit heater **
. - ,:::: Water heater **
Business Name: A Nice,- UA, Et,uaio9a; Fireplace / **
Address: apir ,u.e. 9kofc[i„.,i),4' • Range
BBQ **
**
City/State/Zip: porzTu op_ g 7,9 :? 9 Clothes dryer (gas) **
Phone: 503.- c liq _g)00 Fax: Other: **
CCB Lic. #: 3 10 Total:
Mechanical Permit Fees*
Authorized . ., .
Signature: j ohle_ pyliy0A,
f
Date: la-11743 Subtotal: $
Minimum Permit Fee $72.50 $ 7,2. 56)
Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ .5 ,e0
TOTAL PERMIT FEE $ 7 ,30
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri Building Industry Service Board.
180 days after it has been accepted as complete. **Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
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 $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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and
$1.10 for each additional $100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of plans.
•
i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING Inspection title: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
J�/� � 75 ��
Received _14<, 1..S� Date Reques ed r AM PM BUP
Location 1 ` '7 5 7 6-2, Suite MEC C�� `�/ d
Contact Person Ph ( 503 ) 7' — Z5Z7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: //
Ftg Drain • —tom ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors 4 Woof
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: l Y
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--- 13A1R1
MECHANICAL
Rough -In
was Line
Smoke ampers
• FmI
PAS ART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage W' E L F P
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk ®ate/ / Inspector us.11I L' • i ��' Ext
Other:
Final DO NOT REMOVE this inspection record from the , b site.
PASS PART FAIL