Permit CITY c1GARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006
o l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/6/2006
PARCEL: 2S111 BA -02800
SITE ADDRESS: 09815 SW JANZEN CT ZONING: R -4.5
SUBDIVISION: MCDONALD ACRES LOT: 003 JURISDICTION: TIG
Project Description: Gas line to range.
CLASS OF WORK: ALT 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:
NAT 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:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
LARSON, DOUGLAS A AND Description Date Amount
AILEEN A [MECH] Permit Fee 2/6/2006 $72.50
9815 SW JANZEN CT [TAX] 8% State Surchar€ 2/6/2006 $5.80
TIGARD, OR 97223
Phone: 503- 620 -1753 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
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: Ap . �� 1 .. 411! . � Permittee Signature: �
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.
Mechanical Permit A t ls�_C +
11 lam! IVEll: FOR OFFICE' USE ONLY
City of Tigard Received P N
13125 SW Hall Blvd., Tigard, OR 97223 ?n Date/B U ` _job ��� . Phone: 503.639.4171 Fax: 503.598.1960 -N Plan Review
FEB 0 20 i mwlF o + ' Date/By Other Permit:
Inspection Line: 503.639.4175 a ar' iii'
r
_ ail _ Date Ready/By: lads See Page 2-for
CITY
Internet: www.ci.tigard.or.us y/ t Notified/Method: t 6, n ® / PP lemental Information
�j V O F 1 T11J � Jy���t Su
pp
��" COMMERCIAL FEE* SCHEDULE – U,SE'CHECKLIST
Mechanical permit fees' are based on the value of the work
El 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.
- -' CATEGORY OF CONSTRUCTION UCTION , ` . Value: $
RESIDENTIAL EQUIPMENT /;SYSTEMS FEES*
EL 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other:
Description Qty. I Ea. I Total
'. JOB SITE INFORMATION AND "LOCATION' ,, Heating /cooling
�
G/ �^ /� �) Air conditioning or heat pump
j
Job site address: / c7 a , �LQ.,VI.° L� 01, (requires site plan showing placement) 14.00
City /State /ZIP: " t ✓ A C DR yam y _ ,o y Furnace 100,000 BTU (ducts/vents) 14.00
� Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: i �� � i Gas heat pump 14.00
Cross street /directions to job site: �� 4 t_. � / si 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: /� q k s S Lot no.: Flue /vent for any of above 10.00
/ r `Q Other: _ 10.00
Tax map /parcel no.: Other fuel appliances .
` DESCRIPTION OF WORK ' Water heater 10.00
R---0,,,..4.6)z----"' Gas fireplace 10.00
171---0 �,(/lA _ fL Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
•
;5 PROPERTY OWNER , . , I- - , , TENANT . Chimney /liner /flue/vent 10.00
� Other: 10.00
Name: / Q 5 / 'e»_ f4 ) c ✓SO w Environmental exhaust and ventilation
Range hood/other kitchen
Address: 9$1,5 cs ,
,e.- 6t.Z.z.4>r el equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
)/� Fa x: Single -duct exhaust (bathrooms,
Phone: �
3 (9v� y 1 '7 5 ( ) toilet compartments, utility rooms) 6.80
. -=APPLICANT ❑ ,CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: 4 / 4<Ch 4 /6 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 I
CONTRACTOR ,., Barbecue
1 Clothes dryer (gas)
Business name: /� 91
.� +P�l1 .� Cv� �1/1, P / Other: .
Address: , MECHANICAL PER FEES* _ , ,
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: ' State surcharge (8% of permit fee) �`
�� /l �1 / / TOTAL PERMIT FEE �X/
t. Authorized signature ( /`/ This permit application expires if a permit is not obtained within 180
j days after it has been accepted as complete.
Print name: ` ^, p , P A • . 2.6?.VSO(A.. Date: * Fee methodology set by Tri- County Building Industry Service Board •
i:\ Building \Penniis\MEC- PennitApp.doc 12/03 440- 4617T(11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: ° . e . ; 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.
$100,000.01 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:\Buildin PermitApp.doc 12/03 2
C� OF TIGARD :-.
r EC-- B L:DING DIVISION y . PERMIT #:
�: 2_1)o4Q 7 s'
1312 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 / V� Q j�l I �
Inspection Requests (24 Hrs.): (503) 639 -4175 _��
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 7g s e CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: M n
OWNER: 0 /_ (C '�•� o 0 ‹-- L - I.\ PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 — ( — 0 Pour Time:
Code # Inspection Description Confirm # Contact # Message
A. 6/0 6 I t riekeil 6ao -/753
o ctions /Comments /Instructions: _ jl
4 / ,___. r i tr
t , ril 4
.,' .teal S ve. i ..( av lam,Ll
o r
PASS 1 I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i Date: / !hone #: (503) 718 -
i
C ITTO F TIGARD
,.
BUILDING DING DIVISION
I ,_
PERMIT #: MEC2006,00078
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/6/2006
Phone: (503) 639-4171 ./Atigiti t\
Inspection Requests (24 Hrs.): (503) 639-4175 - ..—.3* ' - .....
INSPECTION WORKSHEET FOR DATE: N10/2006 TIME: 7:04AM PAGE: '29
SITE ADDRESS: 09815 SW JANZEN CT CLASS OF WORK:
SUBDIVISION: MCDONALD ACRES LOT . 003 TYPE OF USE:
PROJECT NAME: LARSON
DESCRIPTION: Gas line to range.
OWNER: LARSON, DOUGLAS A AND PHONE #: 1303,02s) im.3
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2110/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 026676-01 503-620-1753 N
Corrections /Comments/ Instructions:
`
1 ‘ i{ e/ S
? F ee_.* ) 7 e t,(4 7 42
0 ., - -:- Jr ■1■ -a __A...... / _.__." .../ ..„/
al' APPV
" PASS PARTIAL APPROVAL fl CANCEL fl NO ACCESS
I I FAIL fl CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
7,7 Z 6
Inspector: — Date: 'M i dif Phone #: (503) 718-