Permit CITY TIGARD MECHANICAL PERMIT
A DEVELOPMENT SERVICES PERMIT #: MEC2003 -00696
-" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/8/03
PARCEL: 25101 BC -03300
SITE ADDRESS: 12419 SW KNOLL DR
SUBDIVISION: PP1994 -025 ZONING: R -4.5
BLOCK: LOT: 002 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: 1 VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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: 2
Remarks: Gas to free standing stove and water heater. Flue vent for water heater and 1 gas outlet.
Owner: FEES
KISH, ROBERT Description Date Amount
7510 SW ASHFORD ST.
TIGARD, OR 97224 [MECH] Permit Fee 12/8/03 $72.50
[TAX] 8% State Surchart 12/8/03 $5.80
Phone: 503 201 - 5725 Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Mechanical Insp
Final Inspection
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 -00
/ wi � / 4%
Issued By: i . Gt4 ect Permittee Signature: ` Aga
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next bu - in s day
Mech '
gal. Permit Application FOR OFFICE USE ONLY
Imo. I V I_ 1..., Received Mechanical
Date/By: al 8/05 Permit No.:yn dq0 3 - o4ly 9f'
City of Tigard Planning Approv I Building
R ���� Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 Fax: 503 -598 -1960 Post- Review Land Use
Internet: wwia'a�l trgard.or:us it ''"' i
�IMI� i , Date/By: Case No.:
' f_, Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New constru . * 1 ❑ Demolition Mechanical permit fees* are based on the total value of the work
❑ Additio a teratio - placement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CA RY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
� 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty Fee(ea.) I Total
El Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: / 2 '/ /9 S;,J X& 0 y Del yC 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
Subdivision: Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater t 10.00
�+ DESCRIPTION OF WORK Gas fireplace 10.00
J / N L M /55/ ,04 l�si z;ri 0 eU S 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
0 PROPERTY OWNER 1 0 TENANT Other: 10.00
Name: I p (3 T— 1< /5 / -I Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: `2 S 1 o A SH Pc1o2 T .
Clothes dryer exhaust 10.00
City /State /Zip: 7- / (r/ L , ( Single duct exhaust
Phone: Ep 3- .1cj j - b Z 2 Fax: (bathrooms, toilet compartments,
0 APPLICANT 0 CONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax:
Furnace, etc. **
Gas heat pump **
E-mail: WalUsuspended/unit heater **
CONTRACTOR Water heater 0 -T,,,f ,Qd
/ / s*
Business Name: r) /.0 Ii\J Fireplace **
Address: Range **
City /State /Zip: BB Q **
Clothes dryer (gas) **
Phone: Fax: Other: **
CCB Lic. #: Total:
Authorized � �� Mechanical Permit Fees*
Signature: �k Date: / (� Subtotal: $
Minimum Permit Fee $72.50 $ Pf ° �j , 50
P 0 0,E. 12 TS d _ K y5 N Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ .,8"0
TOTAL PERMIT FEE $ 7 K � 7
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
Inspection Line: (503) • . 4175 i '
BUILDING � ,� � '''- A ',
INSPECTION DIVISION Business Line: (50 i 1 `` 1 1
BUP t L
Received Date Re uested I - -- AM PM BUP t i/t 4 ( 11
Location / H I Suite "" }'"
Contact Person B 0.--G � -�- � Ph ( C ) _ /) I - 5 702 ' PLM
Contractor Ph ( ) SWR
V
' _' Tenant/Owner ELC ?. 1
Footing ELC HINEW ,�
Foundation Access: p is inv
Ftg Drain eiii, ELR
Crawl Drain Fr
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear a
Int Sheath/Shear W\ �cj 5 _ 0 / _ % P ∎ ■(- , ®b .
Framing �L
Insulation r _ (A/ 5 _ 1 7� - Z
41e ,
Drywall Nailing �-ca /` z /�
Firewall I) /■ S li,---5 W\ C.A.._-v"--_
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
T PART FAIL AlliMEMP —
BI NG _
Post & Beam L
,
Under Slab ,
Rough -In g ,
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL , p
IIIIIIIIIIIIIIINW "A 0 - 2(- ) 0 - I — 0 0 (Ce ( (i _ c44,e■--ec Post & Beam V
R 3/ JA
Rough-In
Gas Line
g Dampers 1"/� n vim_ � ‘-'-‘#...\ ,�J ..�`-�d �
PART FAIL
RICAL aL €3_,■-‘ c___e_ / 6 \e- -- \..9--- , <-- W
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final n Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line f ` I ,
AppP roach /Sidewalk Date I I 2 Z / 4 Inspector `' ''`'` Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL