Permit r
IN CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00087
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/20/2008
PARCEL: 1 S126DC -04800
SITE ADDRESS: 09495 SW LOCUST ST A ZONING: C -
SUBDIVISION: LEHMANN ACRE TRACT LOT: 004 JURISDICTION: TIG
PROJECT: KLEIN DERMATOLOGY
Project Description: Relocate existing AC. Value: $1200
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 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
BAKER, JAMES + Description Date Amount
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9495 SW LOCUST ST. #G
BAKER, DIANE R [MECH] Permit Fee 2/20/200E $72.50
TIGARD, OR 97223 [TAX] 12% State Surch 2/20/200E $8.70
Total $81.20
Phone: NA
Contractor:
THERMAL FLO
7236 SW DURHAM RD. STE 100
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 670 -8343
FAX 503- 670 -9064
Reg #: LIC 151847
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.
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Issued By: Permittee Signature: 1 A 1
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 oft - p oj-
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
C I}�� 13125 SW Hall Blvd., Tigard, OR 9722. of Ti and Received �y�
.. ` g f _ .. Plan Date/B: . I . Permit No.: ii /S �_/ 0 v 0015
1
_ Phone: 503.639.4171 Fax: 503.598.1'0 Plan evi w Other Permit:
Date /By:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: luris" ® See Page 2 for
Internet: www.tigard- or.gov FEB 2 0 1-" Notified/Method: Supplemental Information
TYPE OF., WO'1,1 TY Of- `G ` A c ® r ,' COMMERCIAL FEE* S CHEDULE =USE CHECKLIST
` Mechanical permit fees* are based on the value ofthc work
❑ New construction gAdditionIaIteraBU/in performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY. OF CONSTRUCTION . .
Value: $ 02-00
' RESIDENTIAL EQUIPMENT /-SYSTEMS FEES *`
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building
❑ Multi- family . El Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
- ' JOB' SITE INFORMATION AND LOCATION' Heating/cooling
^� Air conditioning or heat pump
Job site address:
9�9s OA 4.4_,(./, sT $ A (requires site plan showing placement) 14.00
City /State /ZIP: /027 ®2 97. Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. no.: .� Project name: / ,grae06.4 ReA".06x1.. Gas heat pump 14.00
Cross street/directions to job site: G / a/3 444 2 6 fi L 4 5 7- sr Duct work 10.00
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. 14.00
Subdivision: A// Lot no.: 1/4 Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: 7-7.5 / R/ ) r SeL 073 b Loy ��de), �) Other fuel appliances
J DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
_
� r 77 FX /,5T /,.J ' AA. 6/4/1 Flue vent for water heater or gas
fireplace 10.00
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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: /y 1gmi ��ore)4/-0GX Environmental exhaust and ventilation
91/05 S . 3 / /ST 3r 5 ' 4 Range hood /other kitchen
Address:
T equipment 10.00
City/State /ZIP: PD2T a 972-2-3 Clothes dryer exhaust 10.00
/ Single -duct exhaust (bathrooms,
Phone: (S 0 2‘ 7 6^... 9 Fax: (503) a Viz- t5W3 toilet compartments, utility rooms) 6.80
' g APPLICANT ❑ CONTACTPERSON A Attic /crawlspace fans 10.00
//�� Other: 10.00
Business name:
�L� • l3U�G f/ 5 L� 6... Fuel piping
Contact name: s°�77- 4 /2E60� j $5.40 for first four; $1.00 for each additional
Address: 69,60x 6 90 Furnace, etc.
/ Gas heat pump
City /State /ZIP: �O /eTf/ #lam /OV S ®x 9 7/3'.3 Wall /suspended/unit heater
Phone: (503) 2 1 aR A G Fax:: (S ) ii,ii 7.06 / 9 Water heater
CO > Fireplace
E -mail: m • 8 U /(D S C f 07 • ecin! Range
CONTRACTOR Barbecue
]� Clothes dryer (gas)
Business name: .1--- rl t p4AL 7v Other:
Address: $2 3( 5 to Da ./r k MECHANICAL PERMIT. FEES* .
City /State /ZIP: •--f- I. 6 AyL 0 o2 0'7 22 3 Subtotal
Phone: (56) 4,7 l) 3 `/3 Fax: ( ) Minimum permit fee ($72.50) 7� , •
Plan review (25% of permit fee)
CCB lic.: ( I 'L f `] a ;% j / State surcharge (12% of permit fee) 51. '76 `'
/ TOTAL PERMIT FEE g I ,.p.D
dass
Authorized signature: This permit application expires if a permit is not obtainedkdvithin 180
l ,.i ' .' / �A ..„/' days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
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h\Building\Permits\MEC- PermitApp doc 01/19/07 440 -4617T (11 /02 /COM /WEB) 'A
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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.
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I:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
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CITY �����7U���%����
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BUILDING DIVISION PERMIT #: tvIE{2008-00087
13125SVV Hall B|vd.. Tigard, ORA7223 c DATE ISSUED: 2[2012008
Phone: (5O3)G39'4171 v�
Inspection Requo��a(24Hraj:(503)83A'417S . "K�- ~ � � ]�
INSPECTION WORKSHEET FOR DATE: 311E*2008 TIME: 7:01.AM PAGE: 4
SITE ADDRESS: 0 LOCUST 5T A CLASS OF WORK:
SUBDIVISION: LE1IMANN ACRE TRACT LOT #: 004 TYPE OF USE:
PROJECT NAME: KLEIN DERMATOLOGY
DESCRIPTION: Relocate existing AC. Value: $1200
OWNER: BAKER, JAMES +. PHONE #: NA
CONTRACTOR: THBRk«/\L PHONE #: 603
Inspection Request Scheduled For: Date: 3V1912008 Pou,Timg: �~�
M «�.~
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Code # Inspection Description CoUfirm # Contact # &1ma�^ge 0 ^
699 Mechanical final 066972,02 • 503.'201-2956 V w•
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Corrections/Comments/Instructions:
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.��| PA3S 0 PARTIAL APPROVAL . , ri CANCEL I I NO ACCESS
| | FAIL El CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
� /�� )/ )9 � K ��p Inspector: �� �~���� "~ -- Datm� ^�/ � � / � P #� 8�O3\ 718'«- «���
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CITY OF TIGARD
BUILDING DIVISION % PERMIT #: MEC :003.00087
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 212011006
Phone: (503) 639 -4171 u iii @I �1#
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 31/812008 TIME: 7:00AM PAGE: 43
SITE ADDRESS: 0(k19 ; SW LOCUST ST A CLASS OF WORK:
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 004 TYPE OF USE:
PROJECT NAME: KLEIN DERMATOLOGY
DESCRIPTION: Relocate e: &ling AC. Value: $1200
OWNER: BAKER, JAMES +, PHONE #: NA
CONTRACTOR: THERMAL FLO PHONE #: 603-G70-8343
Inspection Request Scheduled For: Date: 3/18/2008 Pour Time: / I ' r ...
Code # Inspection Description Confirm # oritact # Message n / r
639 Mechanical final 066817 -02 ''/"' 503 -201 -2996 N
Corrections/Comments/Instructions:
j k) 0 0\NA__. 0____ _ 0 j /,_ 6A_S (1/L..a.- _c .
n PAS` PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED " 'Y Inspector: WV 14—--... Date:/ 1 6
Phone #: (503) 718- z,..T z /