Permit CITY TI CARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005-00701
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/19/2005
PARCEL: 2S1 1 OD D -05600
SITE ADDRESS: 10640 SW HIGHLAND DR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.4 LOT: 156 JURISDICTION: TIG
Project Description: Gas fireplace insert. (Gas line existing).
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: 1
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
BOB JOHNSON Description Date Amount
10640 SW HIGHLAND DR
TIGARD, OR 97224 [MECH] Permit Fee 10/19/20C $72.50
[TAX] 8% State Surcha 10/19/200 $5.80
Total $78.30 •
Phone: 503- 649 -1744
Contractor:
PIONEER GAS FURNACE
3615 NE BROADWAY
PORTLAND, OR 97232 REQUIRED ITEMS AND REPORTS
Phone: 503- 249 -5000
Reg #: LIC 36102
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: S_-t'-
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1
-• MeNitinical Pc m 01 r (►1tt,l -1Ir 1 t Nl u\1 1 ,,/
C$ty of Tigard 9 ° . a • EMINIMMI Permit Noq _ Y e .... J
13125 SW Hall Blvd., Tigard, OR 97221 i 2005 ERevicw
Ph 503.639.4171 Fax: 503.. Q I`y60 V /awl *,, ;', t.ate / It Other Pcmnir
Inspection Line: 503.639.4175 N l y
"sue ne: Y p P TIGAR - * ' I _ I Date Ready /By: ® See Page 2 for
Internet: www.ci.tigard.or.us Gay p1Vt S . '0 N - r . Notified/Method: Supplemental Information
BUILDIN G • - • ° 1 - ; ,, II• • TYPE OF WORK COMMERCIAL FEE" SCHEDULE '— IJ$E E� T"
El N ew construction Addition /alteration /re 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.
.;: Value: $
iZ ' . }} (' iip�;5si.,,. CATEGORY OF CONSTRUCTION r y ,
z' ''' ' ' RESIDENTIAL EQUIPMENT / SYST 4SVIE
1- a nd 2- family dwelling ❑ Commercial /industrial ❑ Accessory buildin -
f For special information use checklist.
Multi- faintly 0 Master builder ❑Other: Description I Qty. i Ea. I Total •
k j° x • v '� SITE' I AND LOCATION _ Ileating/cooli g
C.f Air conditioning or heat pump
F. Job site address: `D i 'Mt - II—. 0,2_,- (requires site plan showing placement) 14.00 •
City/ State/ZIP: l 0 -` -'l ZZy Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heal pump 14.00
Cross street/directions to job site: Duct work 14.00
I lydronic 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: I of no.: Flue /vent for any of above 10.00
Other _ 10.00
Tax map/parcel no.: Other fuel appliances
h: x, t ' ' - ` DESCRIPTION OF WORK Water heater 10.00
°t'
_ Gas fireplace I 10.00 / D
cp..an s2 F J p Uv S0;c -" Flue vent for water heater or gas
fireplace 10.00
— Log lighter (gas) 10.00
'.i; Wood /pellet stove 10.00
Wood fireplace /insert 10.00
" ... , ; - Chimney /liner /flue /vent 10.00
'1:' . M1';P.ROPERTY OWNER ❑ TENANT
u,:. �_ Other: 10.00
`' Name: ' - bC () �t� 5�1 Environmental exhaust and ventilation ,
. < `SE � equipment hood/other t-
Address: Q -menn -.
t ., < �� � 10.00
City / State/ZIP: �' .Fa 1
Clothes d ei;'exfiaust -- 10.00
c Single -duct exhaust (bathrooms,
Phone: tb3) ` — k 4` - fax: ( ) toilet compartments, utility rooms) 6.80
` . z �y { Attic /crawlspace fans 10.00
„a $, rAPPLICANT ❑CONTACT PERSON ,
• �� --- Other: 10.00
Business name:
46 PrI LQ-.�'S — 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
Fireplace
- E-mail:
Range
O `) rj .. CONTRACTOR Barbecue •
Business name: /D e e- • /2,- ae e Clothes dryer (gas)
Other:
Address: 5 Al • LA 0 4 , `41 MECHANICAL PERMIT FEES'' ,; . ' ' : : :' ' .•
t , City/State/ZIP: 0 6 1,..7t/01.0 ne 9? 2 Subtotal
f - Minimum permit fee ($72.50) - 7 Z�J-v-
Phone: ( 503 219 5600 , Fax: ( 503 24'? 8260 Ilan review (25% of permit fee)
CCB lie.: /D 2_ Slate surcharge (8% of permit fee) 5, to
n n — 'TOTAL PERMIT FEE 1 9— . 3-(2.' Authorized signature:
�» C - `tS20--( -4 (-.+ v
This permit application expires if a permit is not obtained within 180
_ days after it has been accepted as complete.
I f Print name. I I • ) l O _ l � �� ' Ice netlio<h logy set hy'fri- County Building Industry Service Board
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Infor
•
Commercial Fee Schedule:
daluatio j
n: Permit Fee:
" $1.00 to $2,000.00 Minimum fee $72/50
• $2,001.00 to $5,000.00 $72.50 for the f#st $2,000.00 and $2.30
for each additi nal $100.00 or fraction
• thereof, to an including $5,000.00.
$5,01 10 to $10,000.00 $141.50 fort e first $5,000.00 and
$1.80 for ea( h additional $100.00 or
fraction the of, to and including
$10,000.00
$10,001.00 to $50,001.1 $231.50 lot the first $10,000.00 and
$1.35 for etch additional $100.00 or •
• .ction thl reof, to and including •
•
$50,itI.Oli •
$30,001.00 to $100,000.00 $771.50 U. •e first $50,000.00 and
$1.25 for ach 'a .' .onal $100.00 or
•
fraction tI reof; to anc • hiding
$100,000..10.
$100,000.01 and up $1,396.51 for the first $100,000. . id
$1.10 for • ach additional $100.00 or
fraction tI ereoll
Note: All new commercial build' gs require 2 sets of plans.
•
•
•
•
•
•
• •
• _ •
•
• • •• . • •
•
•
i :\ Building \Pcrmils \MEC- Permitnpp.doc 12/03
2 •
CITY OF TIGARD
BUILDING DIVISION • ' - • A PERMIT #: MEC2006-00701
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/)9/2005
Phone: (503) 639-4171 1047 ,4011i'j .
Inspection Requests (24 Hrs.): (503) 639-4175 .4.1J■ IL
INSPECTION WORKSHEET FOR DATE: 10/27/2005 . TIME: 4:11PM PAGE: 3
SITE ADDRESS: 10640 SW HIGHLAND DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.4 LOT #: 156 TYPE OF USE:
PROJECT NAME: JOHNSON
DESCRIPTION: Gas fireplace insert. (Gas line existing).
OWNER: JOHNSON, BOB PHONE #: 503-649-1744
CONTRACTOR: PIONEER GAS FURNACE PHONE #: 503-249-5000
Inspection Request Scheduled For: Date: 10/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 019696-01 503-249-5000 N
Corrections/Comments/Instructions:
•
I
ASS , I PARTIAL APPROVAL 7 CANCEL El NO ACCESS
H FAIL CALL FOR INSPECTION
A 0 ADDITIONAL FEES ASSESSED
Inspector: , Date: ie-2.-F- Phone #: (503) 718