Permit ,, ` CITY OF TIGARD MECHANICAL PERMIT
4 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00785
cI 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/3/2004
PARCEL: 2S1 04AA -07600
SITE ADDRESS: 12715 SW KATHERINE ST
SUBDIVISION: BELLWOOD NO. 2 ZONING: R -4.5
BLOCK: LOT: 109 JURISDICTION: TIG
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:
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace electric w /gas furnace.
•
Owner: FEES
CAMERON, DOUGLAS Description Date Amount
12715 SW KATHERINE ST [MECH] Permit Fee 12/3/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 12/3/200 $5.80
Phone: 503 330 - 7807 Total $78.30
Contractor:
ABLE HEATING & COOLING INC
12420 SW SUMMERCREST DR
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 108535
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 —• TENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center: rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of th se rulo -••r =" • estions to OUNC by calling
(503)246 -6699.
Issued By: ����Z Permittee Signature: ,Ari ?���
Call (503) 639 -4175 by 7:00 P.M. for inspection neede th next business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received
City ofigard Date/By: �1 /9(.../ Permit No.:\ 4 e, ��
13125 SW Hall Blvd., Tigard, OR 97223 „ ri Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 ,^ , Date/By:
Inspection Line: 503.639.4175n ' I I - .'a I
�� Date Ready/By: 121 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 101 Supplemental Information
'. TYPE OF 'WORK ' - . ° : . ` COMMERCIAL FEE *' SCHEDULE j- USE CHECKLIST
❑ New construction Addition/alteration/replacement 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.
`CATEGORY OF "CONSTRUCTION,, Value: $
- RESIDENTIAL- EQUIPMENT / SYSTEMS "FEES':
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
. SITE TION AND. LOC : :,,,,' i ',`.,, Heating/cooling
JOB; STI' IlVFORMA _ , _ ,
T..h �:.o „t ._t,•o��• '/� (/ \ I I Air condmonmg or heat pump I I I I
I _ _ _ _ -_ _'" ___. `� \� �. "� )�ul�hrlr., >` �� i ::, .�� o„� y :w, a,.v:+,,: j ,;a:.:,iu� ,ij I ' i I
City /State /ZIP: •- or< C\ ' J ' I Fu rnace 100,0 0013'1'U ( ducts/vents) t ' 1 4.00 i i u
Suite/bldg./apt. no.: Project name: Furnace 100,000 +BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hvdronic hot water system 14.00
I I I Residential boiler (radiator or I I I I
I I i hycironii:) I I 14.00 I I
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 10 , 130
. Other: 10.00
Tax map /parcel no.: Other fuel appliances
s " DESCRIPTION OF WORK Water heater 10.00
/� Gas fireplace 10.00
(e_jO\i c ,t~. e I c I:twTn I41/ 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
' PRORERTY " , e .' - ' ` `. ❑ TENANT • , ::- .
Other: 10.00
Name:
` '`° tM- Zr6Ar■ Environmental exhaust and ventilation
Range hood/other kitchen
Address: ID--) IS 5 i.� . h- ,e_ 51 equipment 10.00
City/State /ZIP: t �- 6 „,A l N _ 0 1 7Q-23 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone:
('sg) 3 1 er Fax: ( ) toilet compartments, utility rooms) 6.80
0
APPLICANT r , h ' ❑ CONTACT 'PERSON. ° ' Attic /crawlspace fans 10.00
R„o M I I Gurei. 1 1 iv.00 1 I
i I Fuel piping
Contact name: I $5.40 for first four; $1.00 for each additional
Address: Furnace, etc. I 5.10
Gas heat pump
City/State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
- . T ` .. . , CONTRACTOR'. . Barbecue •
�. -A e� c �. Clothes dryer (gas)
Business name:
rr�� 1 Q4�� �{ 1 r. C ; Other:
Address: 1 � ,�C f7 51,3 ,ct -Pi".m- i/7Y - r V ' .. ME PERMPPLFEES*
I City /State/RIP; ¶.. M f 'i a2 I Subtotal I 29 I
i / , ` I I Minimum permit fee ($72.50) I 1 2 , SO I
Phone: (/ i v ) - -, � Fax: (fo3) 7 0\ ..c& v'1 * -
Plan review (25% of permit fee)
CCB lie.: f a.6 S , State surcharge (8% of permit fee) 5 -,..yo
TOTAL PERMIT FEE i7 J 0
/ � / - This permit application expires if a permit is not obtained within ISO
Authorized s'? afire' / days after it has been accented as comnlete.
I n_.:.. _______. �/ . + � s l:,.P .„nti,,.,l,.l,,,.. , t 1,.. T.;J'nnaf.. R.,7U7..o T..4,, ,t,-, CP.•..:�P R�o�.i
i:\Building\Permits ■ C- PennitApp.doc 12/03 441 •617T 1 /02/COM/WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ Q� BUP
Received Date Requested 1 2 — v AM PM BUP
Location __■ i, Suite
Contact Person Ph ( ) - �� PLM
Contractor Ph ( ) SWR
•
BUILDING Tenant/010 ID ELC
Footing � � Q-& 3 -3b -7 R>0 7 ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: � , ` - SIT
AI Post & Beam L4 _
Shear Anchors
Ext Sheath /Shear t2n - 4 - c �e?il /f/
ht Sheath/Shear (2— k
Framing ( 6
Insulation �I � ' iZ �'.2 � � l �--� , v
Drywall Nailing is-
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam f
Under Slab
Rough -In
Water Service ik w ` •
Sanitary Sewer �� —��
Rain Drains
Catch Basin / Manhole
Storm Drain
-
Shower Pan
Other:
Final
PASS T FAIL
H L ° �F
Post -& Beam
Rough -In
Smo e Dampers
PART FAIL
ICAL :. ,,,,
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection f -e of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE. 0 Please call f• r reinspe• ion RE: _ II Unable to inspect — no access 6 Fire Supply Line d `r i f
ADA
Approach/Sidewalk Date Inspector f Eat
Other:
Final DO N • T REMOVE this inspection record from the Job site.
PASS PART FAIL