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Permit CITY OF TIGARD MECHANICAL PERMIT °T A' DEVELOPMENT SERVICES PERMIT #: MEC2004 -00672 VI II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/6/2004 PARCEL: 2S 103BB -10300 SITE ADDRESS: 12140 SW KATHERINE ST SUBDIVISION: YE OLDE WINDMILL ZONING: R -4.5 BLOCK: LOT: 023 JURISDICTION: TIG 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: 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 Remarks: Installation of gas piping for cooktop. Owner: FEES KEITH WOLF Description Date Amount 12140 SW KATHERINE ST [MECH] Permit Fee 10/6/200 $72.50 TIGARD, OR 97223 [TAX] 8% State Surchart 10/6/200L $5.80 Phone: 503 - 579 - 1979 Total $78.30 Contractor: R A WARNER PIPE CO PO BOX 820785 VANCOUVER, WA 98682 REQUIRED INSPECTIONS Phone: 360 Gas Line Insp Final Inspection Reg #: LIC 151329 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 -00 -00.10 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling ( 246 -6699: — sued By: � /J /Vi Permittee Signature: / / Call (503) 639 -4175 by 7:00 P.M. for inspections ne- •ed he next business day Mechanical Per ,f pp FOR OFFICE USE ONLY r` CAJ e i V C U Received /'� 13125 of Tigard Date/By: ! 4 el (alb /J7 Permit No. K� ^ i , � / 7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review A !lam Y� Phone: 503.639.4171 Fax: 503.598.& 0[ 200 /�i dB �� t 1Q)r l r D ther Perm t Inspection Line: 503.639.417 vv � I I Date/By: P I Date Ready/By: 1w H See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: / / r� - Supplemental Information U! t\ r.DVVIS 04 Or a /� s TAPE OF ��_ A ,�, „ -�..�, � ��- °e.�.._. _J_ - 'w� ._ �.,;;..._ , - r„:: � ° � °: �C011' , - l}S�:EC EHKLIST` ❑ New construction , ddition/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. =s ,-:« � :,:, F >p: a.•. -a=a, s >: .,, , :i -° ,r >;v Value: $ s , ". . = , CATEGOR , Y � OF CONSTRi)CTION ._mrv° . ..:m: o5-, =- + -. . RESIAENT SYSTEMS FEES* ,-1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total u- -= JOB SITE INFORMA ff9N Alj I OC ON Heating/cooling LC � . A^ Air conditioning or heat pump Z Job site address: ( ( L O S c.� / , �,e F (requires site plan showing placement) 14.00 City/State /ZIP: r- Avi d Al „ S Furnace 100,000 BTU (ducts /vents) 14.00 A v" " V1J' Furnace 100,000+ BTU (ducts /vents) 1 7.90 Suite/bldg. /apt. no.: 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 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Flue /vent for any of above 10.00 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances a� a� �� DESCRIP O . WORK.; b , N; ' Water heater 10.00 rt ..�' .' " a- r,;,:.mra'a* boa, .,_ .£..�� .Ali >m, .-. -�� A s, J�„a.:, � ._. /j r A - { '� ^ - `/c r7 Gas fireplace vent 10.00 (/ (/1 �- C'.k�( rap Flue vent foor water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 g x , . �- Chimney /liner /flue /vent 10.00 l .4.. :PRO„PFJ I •GW.NER •1 .. ? ,..I,.. ..,.. ` 'T 15A .; ,,- ,. , , ,, Other: 10.00 Name: ke ( v ( F Environmental exhaust and ventilation Address: / 2 / (Iv 51„..) /Z4 fit,,,. �,, t / Range hood /other kitchen 7 ",� equipment 10.00 City/State /ZIP: -, 1 e,yt -A. L C Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 fir. } X. - s':. s=,-� - : ^:; -.. -?� „-•€vim...,. ¢yam..,, ;,,,. ._..,,, • r�;sce.,.,:; .:.,, At tic /crawls ace fans 10.00 :° ', ® APP TGAN ° ` e s.. : COI TES ON . ,. Z ;6,11[ P :�.._� ��c., �. ...::�- �- .... -. �. Other: 10.00 Business name: V uu 1 p _ ' (R C- Ca Fuel piping Contact name: `acL (C C.A)AR-w Pte- $5.40 for first four; $1.00 for each additional Furnace, Address: `5 i (2 2 ()-7 Q� - Gas heat pump City/State /ZIP: OAK) c i 3 L_A.0 i / 1 _ c J 9g4 9 2 Wall /suspended /unit heater Phone: R (,t,;) v ro n - c - (3 Fax: : ( ) S A.v,____ -e Water heater Fireplace E -mail: `k Range 05.4 V "a a `" s: `-y€ . ^,. 3 . „ ixiu*s= IxNs'. - a^* v. 4 " , -w: 'tea• -e i ,, ,x CONTRACT( 14 ' � x %�. ,ti, t Barbecue - 1n^ A, Clothes dryer (gas) Business name: e, _ V )) vtr� t°_ p( I? 6 C 6 Other: Address (Pv �) 'f (92/0 7 u S .•:; - ,; E ; s '., . ;,� ••;f -- -: . ,. s .- .,..._ ;..- � � MECHANICAL PI;RIVTFT FE °ES* City/State /ZIP: () J t O.AAs -en-- 9 bbd Subtotal Phone: _(366 ) 8 9 b. 03 ,7 U - - Fax:_( ) S (/, ,,_,� Minimum permit fee ,permit fee) ��, Plan review'(25% of,permit ee) CCB lic.: ( 57 32 ( State surcharge (8% of permit fee) VO �� TOTAL PERMIT FEE 7� �O Authorized signature: Date: �(� G ` U�( This permit application expires if a permit is not obtained within 130 / days after it has been accepted as complete. ` Fee methodology set by Print name: a 4. GAL -rte_ Tr - County Building Industry Service Board is\ Building \ Permits \MEC- PermitApp.doc 12/03 440 -4617T (I I /02 /COM/WEB) ' Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total TRX Perm><t'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:\Building\Permits\MEC- PermitApp.doc 12/03 2 CITY OF TIGARD 24 -Hour BUILDING Inspection tine: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST 11 BUP / Received ` r )- D to Reque t � � S AM PM BUP Location 12 f `F n (1) Si Suite ,760 y' 006 2 0 1 ' Contact Person Ph ( 535 ) &roz -4 7 4 9 a V - d 2 9. 7' Contractor &AL • • _ ,, ( ) 77 - gv 0 SWR BUILDING Tenant/Owner - 5 V `? © EL61 oto V V Footing ELC Foundation Access: a Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors • Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing �( �) t� j , , Firewall K) 1' SO� J 3 I�, I° 0 s U 0� Fr° )1 Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS ART FAIL Post & Beam Under Slab Rough -In C-' Water Service - Sanitary Sewer Rain Drains Catch Basin / Manhole IC:311 Storm Drain Shower Pan Other: ,. PART FAIL CH 1r CAL'' „Y: m , . -.s & Beam Rough -In Gas Line S i• • e Dampers ina) ' PART FAIL CTR AL :° - Se - Rough -In UG /Slab Low Voltage F larm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. • S PART FAIL SITE • E Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Date / Approach /Sidewalk / / 9 Y Inspector Ext �� �1 Other: Final DO NOT REMOVE this inspection record from th = `ob site. PASS PART FAIL •