Permit C ITY OF TIGARD MECHANICAL PERMIT
L A ,� yl DEVELOPMENT SERVICES PERMIT #: MEC2005 -00019
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/13/2005
SITE ADDRESS: 09125 SW HILL ST PARCEL: 2S102DB 06500
SUBDIVISION: CHELSEA HILL NO.2 ZONING: R-4.5
BLOCK: LOT: 042 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
GAS 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: 2
> 10000 cfm: GAS OUTLETS: 2
Remarks: Gas line, fireplace, range and vent with outlets.
Owner:
FEES
ETTESTAD, KEITH A /WILLENE A Description Date
9125 SW HILL STREET Amount
TIGARD, OR 97223 [MECH] Permit Fee 1/13/200E
$72.50
[TAX] 8% State Surcharl 1/13/200f. $5.80
Phone: 503 620 - 1985 Total $78.30
Contractor:
T & K MECHANICAL
PO BOX 116
FOREST GROVE, OR 97116 REQUIRED INSPECTIONS
Phone: 503 357 - 4614 Gas Line Insp
Mechanical Insp
Reg #: LIC 121165 Duct Inspection
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.
Issued By: ��, �` Permittee Signature: / 2� ✓ ' . � 1 . f� C ✓�,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical 1' elrni it At p :- 1 FOR OFFICE USE ONLY
City of Tigard , Permit No,:�G� D__00 V < - 000
I3125„SW IJalt 131vd., 'Tigard, O rt Q� Platt Review
Phone: E0326'3 Fax: 503.598,1960 � '� , 4n,., \ Date/By QuwrPermit:
p
Ins ectio Line: 503439.4175 It i7 �`' , _`` j
\,P� r 2 w t- -- l Date Ready/By; See Page 2 for
Internet: www.ci.tigard.or.us r"l C`3 SX Notified/Method: Supplemental lnfurntatinu
'eNt it • .. 'a ' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction El . ,t) Qk:Iteration/replacement •
Mechanical permit fees" arc based on the value of the work
o performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit.
CATEGORY 01 CONSTRUCTION Value: $
1- and 2- family dwelling Q Mas Commercia ld atrial ❑ Other Accessory building EQUIPMENT / SYSTEMS FEES*
For specie! information use checklist.
❑ 01[i-family
❑Master builder ❑ Other: bcsctiption - Qty. La
. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
• dress: '] — ) j.-1; ( Air fires conditioning ho or ingp1
Job site ad t
( CCZ�� � t_.6 � ` (requires site Ian showi lacemrnt) 14.00
� - F ur nace 100 14,00
City/State/ZIP: ( • „• - --
. )• �:
Furnace 100,000+ BTU (duct avame) 17.90
Suite/bldg. /apt. Do.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work . 14.00
• Hydronic hot water system 14.00 •
Residential boiler (radiator or
hydronic) 14.00 Y4
Unit heaters (fuel -type, not electric),
in -wall, in -duet, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
_ Other 10.00 „-
Tax reap /parcel no.: Other fuel appliance '
DESCRIPTION OF WORK Water heater 10.00
------ (1 Gas fireplace ` 10.00 t 0 54-3
) • , - C..3-e4.5- ; ,r 2 \�t;,��, Flue vent for water heater or gas
•
A I ' , fireplace _ ; 10.00 (\� ,
I /,__ •� • l - - . 0 I .. • _ — . - - Log tighter (etas) 10.00
� QJ 1 �. Wood/pellet stove 10.00 1 ty Wood fireplace/insert 10.00
Chimney /liner /flue /vent 10.00
ZI PROPERTY OWNER ❑ TENANT Other; 10.00
Name: t"l .4.�� ' -'
k -+• {l s + oC Environmental exhaust and ventilation
Q -F `` i Range hood /other kitchen
Address: { I n s ( ) 4'1 t s+ equipment _ 10.00
r
City /Statc /ZJP: ' Clothes dryer exhaust 10.00
f �� � �� � ' � Single -duct exhaust (bathrooms,
Phone: (4 O3) CF v -. I I n Fax: ( ) toilet compartments, utility room-) 6,80
ist APPLICANT ,CONTACT PERSON Attic /crawls) ce fans 10.00
Other: 10.00
, ^ 0,,r),‘ ‘
Business came;
�4 l< rnp ( ■ ` i F ue l piping
Contact name: 1� $Sd0 for first four; $1.00 fur each additional
\ , 4 -P ^ Furnace, etC.
Add - res9: ?0 J U 1 t _ Gas heat pump
City /State /ZIP: q r , r , 9 S- O o V C�.e � ( � _ it t
Wall/suspended heater
Phone, (+�}'' ) • Fax; : (Sj) � a- ( Water healer (1
• Fireplace �
E -mail' R3Bge ' S.1 7"
CONTRACTOR Barbecue -.._
Business Mama: �!1 Clothes dryer (gas)
I I�O C G \� 1 I (Q. ' Other:
Address: PC,..) !3 ®k I I LQ MECHANICAL PERMIT FEES" r
City /State /ZIP: L o , - c I N Q., • 1(� _ Subtotal .
— Minimum permit fee ($72.50) ' ' a , S G=
Phone ( �) 3 �� 7 _ l t t Fax; ( C{Ct ^ �! �/ _ Plan review (25% of permit fee)
CCB lie.: 12 ( l ( 0" _ State surcharge (8% of permit fee) 'c' •'j e
TOTAL PERM IT FEE 'Z S. 3 O
/
� This permit application cxpirev if a permit in not obtained within 180
Authorized signature: days after it has been acceptad as comptet�
L Print name: \`,hc, K � a� Date: I ('� .— 3 I " Pee methodology set by '1'6-County Building industry Service Board
Ed Wd2T :60 S00Z ET 'Upf TST8 ZEB : '0N Xlld A' >I puul : klOi 1d
CITY OF TIGARD 24 -Hour
BUILDING 4 Inspection Line: (503) 639 -4175
IN ECTION D VISION B'ustr ss Line: (503) 639 -4171 ,° MST
-� �
t7 t " 1/‘4( BUP
Rec ' ed Date Requested AM PM BUP Z O �� J I
Location Z� rJ 1 Suite // I
Contact Person Ph ( ) Z71 4 / (/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation 41•06-S ELC
Ftg Drain AcceSS: ELR
Crawl Drain
Slab Inspection Notes: J �0 S_ COO tS SIT
Post & Beam v
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear � ��
Framing , O-S �s ' . T� r = z ? Z G:2 /S .14ii.1r
Insulation
Drywall Nailing 40 till h? /1147
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 FAIL
r SART
laCHANiCAL
Post & Beam
Rough -In
as Line
Sm
e Dampers
ina
- PART 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 I Please call for reinspection RE: El Unable to inspect - no access
, Ati. Fire Supply Line
ADA C� dS
Approach /Sidewalk Date /-' /a Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL