Permit •
C ITY OF TIGARD MECHANICAL PERMIT
i l DEVELOPMENT SERVICES PERMIT #: MEC2005 -00382
~11 DATE ISSUED: 6/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 104CA -02500
SITE ADDRESS: 13599 SW LAUREN LN ZONING: R -7
SUBDIVISION: HILLSHIRE LOT: 025 JURISDICTION: TIG
Project Description: Installation of new duct work - basement.
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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
RICO, DANIEL S + STELLA Description Date Amount
13599 SW LAUREN LN [MECH] Permit Fee 6/23/200; $72.50
TIGARD, OR 97223 [TAX] 8% State Surchaq 6/23/200: $5.80
Phone: Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
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: ; 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.
A
-- Mechanical Permit Application FOR OFFICE USE ONLY .
•
City of Tigard j Rece Date/By. R v — ived , < ,e / j
Plan Review t Permit No.: C �� ��' -fjrf ^
13125 SW Hall Blvd Ti OR 97223 L!'
Phone: 503.639.4171 Fax: 503.598.1960 / i H a ;�M ; - r�, p��g Other Permit:
Line: 503.639.4175 i I
J , t N 2 2005 1 4.1 Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us 1 J Notified/Method Supplemental Information
(ITY nF TIGARD
R(IiEji9V ,i {OP COMMERCIAL FEE* SCHEDULE — 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 0 Master builder For special information use checklist.
❑ Other: Description I Qty. I Ea. I Total
JOB SITE, INFORMATION AND .LOCATION Heating /cooling
Q / Air conditioning or heat pump
Job site address: / s 9 / �,___5 X247 .� ,,S/ A (requires site plan showing placement) 14.00
City /State /ZIP: 7 ,09/2 �� ‘!'/z Furnace 100,000 BTU (ducts/vents) 14.00
1 // Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name:CuC/C i.('� / &. Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00
,,-- PE-- Hydronic hot water system 14.00
" 3 J Ai i,U.GtLC/vGf� Residential boiler (radiator or
hydronic) 14.00
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
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF ' WORK Water heater 10.00
'11 ( Gas fireplace 10.00
-43A / /) ei. c! � G{J �l / 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
PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: .4 2/g/i/ e0 lk; C--i) Environmental exhaust and ventilation
S - I � - 4/46N / 4J Range hood/other kitchen
Address: / 3
Gl equipment 10.00
City /State /ZIP: _. ,..f,ed e R / 7 .2.2 -. Clothes dryer exhaust 10.00
y.. s �_ Fax: ( ) � �- toilet compartments, exhaust (bathrooms,
Phone:-(3) rooms) (' � ` i toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: / e �� /-7-1 v ` Fuel piping
Contact name: $5.40 for first four; $1.00 for each a_ dditional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
.. CONTRACTOR - ` . Barbecue
) 1 Clothes dryer (gas)
Business name: ,,, I
`' ""L �/ Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) p er: ( ) Minimum permit fee ($72.50)
Plan review -(25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
/ TOTAL PERMIT FEE
Authorized signature: 4 ate: This permit application expires if a permit is not obtained within 180
_.� , days after it has been accepted as complete.
Print.name: / * Fee methodology set by Tri-County Building Industry Service Board
1: \ Building \Permits\Iv.EC- 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: 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: \Building\Permits\MEC- PermitApp.doc 12/03 2
CITYaOF
BUILDING DIVISION PERMIT #: MEC2005 -00382
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/23/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 Japvtilti,\
INSPECTION WORKSHEET FOR DATE: 6/28/2005 TIME: 7 :09AM PAGE: 91 .
SITE ADDRESS: 13699 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 025 TYPE OF USE:
PROJECT NAME: RICO
DESCRIPTION: Installation of new duct work- basement.
OWNER: RICO, DANIEL S + STELLA, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
625 Duct work 010275 -01 503 -624 -0882 N
Corrections /Comments /Instructions:
//i
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL . • CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: C- `' �— 2 Phone #: (503) 718-