Permit A: CITY OF TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00800
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/7/2004
PARCEL: 2S104CD -00201
SITE ADDRESS: 13553 SW HILLSHIRE DR
SUBDIVISION: HILLSHIRE ESTATES ZONING: R -7
BLOCK: LOT: 002 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 fireplace insert.
Owner: FEES •
KIM GALE Description Date Amount
13553 SW HILLSHIRE [MECH] Permit Fee 12/6/200 $72.50
TIGARD, OR 97201 [TAX] 8% State Surchar€ 12/6/200 $5.80
Phone: 503 - 539 - 0485 Total $78.30
Contractor:
NORTH PACIFIC SUPPLY
16256 SW EVELYN ST
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: Gas Line Insp
Mechanical Insp
Reg #: LIC 56866 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 -00 -e: : 'ugh OAR 952 - 001 -0100. You may obtain copies of these rules or direct • estions to OUNC by calling
(503 46 -6699. ,_ ■
Issu , d By: , , /', ..' Permittee Signa .. I
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next bu ass •
Mechanical Permit Application F OFFIC U SE ON
City cif Tigard Date/By: / 7 " Permit No.: .� od
13125 SW Hall Blvd., Tigard, OR 97223 ��
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
It 'i\ Date/B: Other Permit:
Inspection Line: 503.639.4175 SNP .' y
� � - �` = � W _ Date Ready/By: � RI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / /0 Supplemental Information
,,.t- '"V.el aF�:. ?., ,� ^ -E`s�, ✓fin e - ps �Prr.:A.::Y" :P5 ^m�4°;�,"vd� ^�'x�ye y: ;;�,. W �'+,�;yres._.� . °�'¢z«�arw ��'.; ,> _
: ..r te g .�, '' .e,Vv"- +, >., _.. ; , .: :•�:ssK, .. �. . . �s, ,.. :,....,� .
It ? 41. ; 1 s. , q ; TYPE :OR WORK a kn%- i ` - `: ,, ,, COMiVIE .
,.I *;;SCH„, - -. L • • T .
Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
. :: = e'�'3'S , i +'�� �1 : i' : , �w �. ...;�,- '^v'�'• =. a � €3ax ;�.� � � %�•� � ,a �;:ti� " .''.,' Value: $
t v .
" e I EGOR1"OFr - . ' , y tI -
- .. _ � ' . s ' Vii . s `RF T./ SYSTEMS' FEES*
111 1 - and 2- family dwelling El Commercial/industrial ❑ Accessory building � ' ° '° °' "' ^ "" " "' `'` ' '
Multi For special information use checklist.
El y ❑ Master builder ❑ Other:
Description Qty. Ea. Total
,l.." : '.a's i�A :u..sr .Ay�.lsvre,� *y. .:, .-. aa.az -.� „ -,:: 5 'i£"'r'.tl:
?y wdOB SITE - , FO A\D t OCON3 } Heain coolin
a,=, � �. `s asc , . , .a�i.zw:.�s �+ e �w� 3 ri ��a:,,:,wa'�s.,�ss,� s t� �,
Job site address: /35c3 ¢ r p Air conditioning or heat pump
W �- S� 1 �, pie • (requires site plan showing placement) 14.00
City/State /ZIP: 'T' i / n r) U' . Furnace 100,000 BTU (ducts /vents) 14.00
`'� � re Jpla 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: v v ` i l 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
,. i :, ' ' " g' ; DES(G�RIPTIO O Aigi ' q" ' � 5 1 Water heater 10.00
< Gas fireplace / 10.00
�- �//I� e_.-12-_, Flue vent for water heater or gas
!r fireplace 10.00
• Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
, .;' < .. a' a r a ., 4 Chimney/liner /flue /vent 10.00
. ,,,,V,,.-1:1,...4:,:, ° OPERT Y $ OW llr ER A tp . - ,, ;" T` rco ; ``i
w + :. ;:' ' a te .' ' . - . ,1 4v da , :Ui Other: 10.00
Name: k f 1/V(. i 1 ��
3 se Environmental exhaust and ventilation
Address: / 35 lls / j /-� v`/, Range hood /other kitchen
equipment 10.00
City/State /ZIP: ' i ` r 6/2-- Clothes dryer exhaust 10.00
r Single -duct exhaust (bathrooms,
Phone: (� - Fax: ( ) toilet compartments, utility rooms) 6.80
'; ta '+ �..'^ �, �,, �; 5 " 1: w'��k?�"�;.:'� �n� x -``K g ::•��z ;: "+""'- rah. K::.- ��..;, �.^. r:, �-. �' �.., z :::�uus< ":2:;a; <.' ",�i�:' +, Attic /crawlspace fans 10.00 "L,"
�� tCONTA oresis
�;t:�,�F . i. �- ,.;�.�. APPLLCAIV� ;.� "', . ..:� . '`�`��, .�r.. ,
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater y
E -mail: Fireplace /
Range
ai r - �. a - '
xk _' a'' s x�; ^ . CpN OR n .� a Barbecue
Business name: AZ 1 a C. Clothes dryer (gas)
Other:
Address: . :2x . .f�,w Fx',.;-,;.-z, -:::
/� - ' "'. ^MEG$AN)GAIPERM %IT F'E'ES*
City/State /ZIP: ,( ,„ jy � G - Subtotal
Phone: ( ) l Fax: ( ) Minimum permit fee ($72.50) , ±7
Plan review (25% of permit fee)
CCB lic.: / \ State surcharge (8% of permit fee) 6 $Q
TOTAL PERMIT FEE �8� ,-)
Autho d signatur . -4 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: C 1711 Date: / Z - / Fee methodology set by Tr - County Building Industry Service Board
4
i:\ Building \Permits\ME.C- PermitApp.doc I I 440 -46 I7T (I I /02 /COM/WEB)
Mechanical Permit Application- City of Tigard �•
Page 2 - Supplemental Information
Commercial Fee Schedule:
�; *- i.�a. �,,: • bt;" : ": ".'i•�'� §�1 t �";� _:..,,� : ",c �. -=. Yr:.zx �,a <��, x �k :�
Total Valuat><on , � i Peri t Fee p
� .._ �-�� �
$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.
i:\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
q BUP
Received I ll g Date Requested / / / AM PM BUP =�
Location / 3 5 5 3 l / 1 5 1 1 - i ve b V e Suite O 00 — "DDFoo
Contact Person /< ��✓ Crc Ph (C.e-11 ) 5D3) s3'- 6 46,) PLM
Contractor Ph ( L1/ (,5 °. i)fo 7 — o 7' 3 SWR f�
BUILDING Tenant/Owner ELC yv
Footing
Foundation ELC
Access:
Ftg Drain ELR
•
Crawl Drain
Slab Inspection Notes: ni SIT
Post &Beam r /eAS'e CAV /5M ;Au /e5
Shear Anchors � �
G `� e �� 6 f ��'�i�� l
Ext Sheath/Shear
Int Sheath/Shear
Framing
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
P T FAIL
OEC,HANIC
Pos r �''
Rough-In �/ '1,
Gas Line \/�
` Sce Dampers')
ma
ptriti',5,7=PAAf 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 � "L 9 "-� S Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL