Permit CITY TI JARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00540
6 � l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/11/2004
PARCEL: 2S1 12C B -08700
SITE ADDRESS: 15094 SW KENTON DR
SUBDIVISION: ASHFORD OAKS NO. 2 ZONING: R -7
BLOCK: LOT: 101 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: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Installing gas line to BBQ.
Owner: FEES
MCCART, MARGARET Description Date Amount
15094 SW KENTON DR [MECH] Permit Fee 8/11/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 8/11/200 $5.80
Phone: 503 639 - 6857 Total $78.30
Contractor:
SUBURBAN @ HOME
6014 NE 112TH AVE.
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Final Inspection
Reg #: LIC 143335
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 • 7 •
Call (503) 6394175 by 7:00 P.M. for inspections ee(;ed the next business day
Mechanical Permit Application Received OFFICE USE ONLY , -,. .... .
i i , Mechanical _.,
Date/By:y ) - Permit No.: .'"\t k.....2V q- 6
Cit of Tigard i. Planning Approval Building
Permit No.:
13125 SW Hall Blvd. A Date/By:
Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Internet: www.ci.tigard.or.us , el:Itli.fl Date/By: Case No.:
n■ • Contact Juris.: 1:0 See Page 2 for
24-hour Inspection Request: 503-639-4175 ----"" ' . Name/Method: 1 )(r - Supplemental Information.
'=',1:::::0.-',:' N:VVCOMMElterAt;FEEtoS.CHEDUEEPUSErCHECKIASrlinL*
El New construction 0 Demolition Mechanical permit fees* are based on the total value of the work
—N 0 Other: performed. Indicate the value (rounded to the nearest dollar) of all
g:t,Ailk:ii:WATE.00i1VOFY.CONSTItt:ICTIONW,Zi*q,;AY;t mechanical materials, equipment, labor, overhead and profit.
..--ErT & 2-Family dwelling 0 Commercial/Industrial Value: $ See Page 2 for Fee Schedule
111 Accessory Building 0 Multi-Family '''ARESIDENTIAIEQUIPMENT/SYSTEMSTEEtISOHEDIZE
Description I Qty I Fee(ea.) Total
0 Master Builder 0 Other: . Heating/Cooling '
,,, - f; - ,:;:'i'VoN4CIOSITEINFORMATION4iii&LOGATIONki*'t7 Furnace - add air conditioning** 14.00
Job site address: \ f: Z(2 Gas heat pump 14.00
Suite #: Bldg./Apt.#: - Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
- (in wall, in-duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
_ .
Repair units . 12.15
Subdivision: Lot #:
Other Fuel Appliances
Tax map/parcel #: Water heater 10.00
'-'-3 , M,''Akilt.';itlit - 8,:eitilltON(QPNOttICI1 . .,7,Z 5 gli'-::7Kt:W4' Gas fireplace 10.00
T`ekce&St,i,n6 os.\--- •\ Flue vent (water heater/gas fireplace) 10.00
_____
lar---A Log lighter (gas)
10.00
Wood/Pellet stove
10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
J
Wittit -•' Other: 10.00
Name: \Se_ii■J 'M 6.>C..0.-Jr-\-- . " Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: \..Dc\\-\ 'J'}.. c?Va—) Clothes dryer exhaust 10.00
City/State/Zip: ,(wx- , -6)cp.. c\ ---aLk.
Single duct exhaust
Phone:C.03a\ ( Fax: (bathrooms, toilet compartments,
WP,ELIICANST:45 IS 'VOISITACtiktItSONNIM utility rooms) 6.80
Name: `0 (- ,,(Ne Attic/crawl space fans 10.00
:
Address: --(D \L s(
\ C \\...-
cRuej, Other 10.00
Fuel Piping . . ...
City/State/Zip--" G\r\-Z. **($5.40 for first 4, $1.00 each additional)
Phon--k3if Fax aEs; ,--1/4.,...D Fumace, etc. **
**
Gas heat pump
E-mail: Wall/suspended/unit heater **
::T1';',;5:: -7VCONTR Water heater **
Business Name: e \k Fireplace **
Address: Cov--\ \(\.e. ) cx\x_., Range **
BBQ % ** LAO
City/State/Zip:VoCA-\0,,,,(\&_) a cAe_--.--a
Clothes dryer (gas) **
PhoneQe: Fax -- k-.\ - 60 Other: **
CCB Lic. #: \ t--\c":5---- Total:
Mechanical Permit Fe
1
_ Date 1 \ I Subtotal: $
Signature:'"P■kl" -....._„_i. 0 6.- k
Minimum Permit Fee $72.50 $
APr
N II Plan Review Fee (25% of Permit_Fee) $
— 4. ..___ .. wfl■ 4..&
(Please print it. e) State Surcharge (8% of Permit Fee) $ ,.. egC.D
TOTAL PERMIT FEE $ '
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.
i:\ 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 $1 0,000.00 $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 Lire: (5C8) 639 -4175
INSPECTION DIVISION Bus Line: (503) 639 -4171 MST
BUP
Received Date Requested "'f AM PM BUP
Location 50 y` 4 Suite 0 7" - C O S�
Contact Person Ph ( ) 639- - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation $ S ,4"- � t1� � spic: , S
Drywall Nailing �( T�' 1 "+ V� c''
Fire wall O �A.(�O`��'`
Fire Sprinkler `�
Fire Alarm
Susp'd Ceiling ii / y
Roof Other: d ) I Sc)
I /.
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
W1E�bANICAL
Post &Beam ,^
Rough -ln
. a
Smoke Dampers
tir
*ASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date / ?/� Inspector ! �✓�'�� �. : / 4 Ext
Other:
Final DO NOT REMOVE this inspection record f m the Job ite.
PASS PART FAIL