Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00617
dolk 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/21/03
PARCEL: 2S111 BA -02103
SITE ADDRESS: 09925 SW INEZ ST
SUBDIVISION: INGEBRAND HEIGHTS ZONING: R -3.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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:
Remarks: Replace furnace & flue /vent
Owner: FEES
WARREN, JACK R Description Date Amount
SHARON L
9925 SW INEZ ST [MECH] Permit Fee 10/21/03 $72.50
TIGARD, OR 97224 [TAX] 8% StateTax 10/21/03 $5.80
Phone: 503 639 - 3494 Total $78.30
Contractor:
BEAVERTON HEATING + A/C INC
5400 SW 170TH AVE
ALOHA, OR 97007 REQUIRED INSPECTIONS
Duct Inspection
Phone: 649
Final Inspection
Reg #: LIC 118441
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
Issued By: / Permittee Signature: �
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received Mechanical
,1 Date/By: Mb, O ) • r . , Permit No.
Mechanical., 777
Clt of Ti aCfl Planning Approva 1 Building
Y g Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
I Date /By: Case No.:
Internet: www.ci.tigard.or.us v.�( ) I � Contact Juris.: El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 _ Name /Method: Supplemental Information.
• - .xt-�� b.�," °E_i::ut�= 'iw-,�;`^:,a;' :. EJ,., R uIAI. =KL`I ,�:��.��`,
`' , �,;' - a�.�����'P�YPE °;OF:�WORIC =.�, ,. ,.g'� ,.... ,H.,..GOMME C F'EE,..:SCHEDUIEt�JSE-.CHEC ST._,.... t -.z
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
]' Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
� x r " �.� - mechanical materials, equipment, labor, overhead and profit.
r: i CATEGORY, fr:r 44
.., 4 OF��CUNSTRUCTION� , ..,. �� ,
171 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building El Multi- Family
i' : f RESIDENTIP EQUITICIENT /SYSTEMSTEE*nSC H �:DULIE ; K ;`
Description Qty Fee(ea.) Total
❑ Master Builder ❑ Other: Heating/Cooling
- ' `Y`;r`�: - JOB)SITE;INF „ORMATION audltiOCATION ':. ""”: t; add - air conditioning ** J 14.00
Job site address: �2.3 S's" /w£a s s urnac as heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
job site: (for boiler
Cross street/Directions to
1 (for radiator or hydronic system) 14.00
��An24s Unit heaters (fuel, not electric)
G— /00 "4," (in wall, in -duct, suspended, etc.) 14.00
L_ L•v £ ZZ Flue /vent (for any of above) / 10.00
Subdivision: Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
-,W - ;. ; . DESCRIPTION`OF;WOR'K c`':'« re °.O.1 ?.:-'i A Gas fireplace 10.00
4i/e%1/09C£, AT .y-- Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
217P12OPERTY'OWNEI ,. `I T''" "* ` _' `"`'" "-_ Other: 10.00
Name: ,T,�GiQ �/,e¢�2S/d Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: e99. - ,s ' Is C r.. S°r' Clothes dryer exhaust 10.00
City /State /Zip: 7•G,¢�D, GvQ Single duct exhaust
Phone: ,-o,d C '2 - '3.j9./ Fax: (bathrooms, toilet compartments,
APPLICANT F, ,.. , ° 'u .: e', ® CONTACTAPERSON : ` utility rooms) 6.80
Name: , / , ' r r Attic /crawl space fans 10.00
Address: va tg , Other: 10.00
! si9/ / 7 4 Fuel Piping
City /State /Zip:,4.o� d2 9"7dO 7 * *($5.40 for first 4, $1.00 each additional)
Phone: j 3 dig /Z 7/ Fax: ‘./.9 de/y-, Furnace, etc. **
Gas heat pump * *
E -mail: Wall /suspended/unit heater **
: :'',. _. ;a= -. . '.`.r " ;... n':':; .. "GQNTRACTOR +. K' ,5..- , ,. : ;* , :'`" :` Water heater **
Business Name: 61.Sd/roe>a y,04/ 7- /,p . ems, Fireplace **
Address: 'Si- ,y ,, 7o z ' 4 y II Range **
Cit /State /Zi CBQ
y p'��- �'�'�, U/L �}7dd � Clothes dryer (gas) **
Phone:5 --ecc? -/z 7 / Fax: 6 9 die 4 Other: **
CCB Lic. #: /49911/ Total:
Mechanical 'Permit Fees
Authorized
Signature: , �� Date: #d 2/ Subtotal: S
�-- Minimum Permit Fee $72.50 S 1 7 ?..1,573
/l "t /-, ,pi i4,L,‹ y Plan Review Fee (25% of Permit Fee) $ TT
(Please print name) State Surcharge (8% of Permit Fee) $ ,5, �U
TOTAL PERMIT FEE $ -7 g G3 0
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service Board.
180 days after it has been accepted as complete. "Site plan required for exterior A/C units.
is \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 Line: (503) 639 -4175
INSPECTION D9VISION Business Line: (503) 639 -4171 MST
)-z3 BUP
Received I Z �j Date Requested to1 i" AM PM BUP
Location q 7 2 - e z 5 Suite 4. 3- 00( 0( 7
Contact Person We. Y —Vl Ph ( .:i 2.) 63 3 4/9'1 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
`Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear "
Framing ' !! l��GTt2 ! L >� i nr -v.2 1-A &'L 5
Insulation
Drywall Nailing P -�'"" ( `r"--
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
PASS PART FAIL
MECHANICA,
Post & Bea
Rough -In 7 c
Gas Line • V4-r , 1 •
• - • e Dampers
anal
•ART 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 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL