Permit r/0 , 1141114(1` 6 61/46-ftz,L0
C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2005 -00063
,�y� DEVELOPMENT SERVICES DATE ISSUED: 2/18/2005
1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 103 B A -00143
SITE ADDRESS: 11825 SW LYNN ST
SUBDIVISION: LERON HEIGHTS NO. 2 ZONING: R -4.5
BLOCK: LOT: 033 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: 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Furnace replacement gas to gas.
Owner: FEES
BARKER, KEN Description Date Amount
11825 SW LYNN ST. [MECH] Permit Fee 2/18/200E $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 2/18/200: $5.80
Phone: 503 -524 -9192 Total $78.30
Contractor:
JOHN C. LOOMIS HEATING & COOLING
15811 SE HAWTHORNS CT REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97233
Phone:
Reg #: LIC 61811
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
Notificat'- - =ster. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may • stain copie . oft -se rules or direct questions to OUNC by calling (503)246 -6699.
Issu - • By: `_ L '" Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next siness day
Mecl xi.---..._..4 �.i-. p t - i FOIt(FFI( I•: srO \L.)
City'o Tigard �' g— /s p 3'-- PermitNo.: /'Vle✓Gdiva — 620
13125 SW Hall Blvd, Tigard, OR 97223 plan Review
Phone: 503.639.4171 Fax: 503.598.196 Date/By. Other Permit:
Inspection Line: 503.639.4175 F E B 1 8 2005 —' `• 4- 'f 1! Date Ready/By. ® See Page 2 for
Internet: www.ci.tigard.or.us - Notified/Method Supplemental Information
CITY OF TI G ARD
Bm ,TYPl rd linCION 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: $
1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Multi - family El Master builder 0 Other: For special information use checklist.
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
E Air conditioning or heat pump
Job site address: " $ a,� J i D 1.__) 0 h St_ (requires site plan showing placement) 14.00
City/State/ZI L ok ,r 10, Q le-.23 Furnace 100,000 BTU (ducts/vents) \ 14.00 1
.( I Furnace 100,000+ BTU (duds/vents) 17.90
Suite/bldg. /apt no.: v 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
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
Gas fireplace 10.00
�Cr, � d Flue vent for water heater or gas
fireplace 10.00
v S l Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
PROPERTY OWNER I ❑TENANT Other: 10.00
Name: t e,:v - \ JP r p n Environmental exhaust and ventilation
Address: Range hood /other kitchen
\ \ g �� e,.> L/ n n ��fi equipment 10.00
city /State/ZIF -17: of r d q -)cr � C lothe d� ex (bathrooms, 10.00
1
Phone: ( (.� - C q Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: Other 10.00
Fuel piping
Contact name:- k 11 Q . -Lon rn 1 C $5.40 for first four; $1.00 for each additional
Address: \ .5R 1\ S-6, -• f t kO r Ir} Q C3
Furnace,
as heat pump
City /State/ZIP: 9 rte{- tom, a t ( 0 q `-? 3 Wall/suspended/unit heater
Phone: ) a(�. 3 C Ref Fax: : �� ����8 Water heater
, -
11 1 ;Zr) _-} Fireplace
E -mail: )�`�pm'is Gar f\C�Ot n I' Range
C NTRACTO Barbecue
n J^ ,Q,....... Clothes dryer (gas)
��
Business name ' ^ 1 n^ v v' S ��10 li Other:
Address: MECHANICAL PERMIT FEES*
City /State/ZIP: Subtotal
Minimum permit fee ($72.50) -7a' S0
Phone:( ) Fax:( )
Plan review (25% of permit fee)
CCB lic.: L (g 1 ) • a - I to 0 <7 State surcharge (8% of permit fee) , 6
TOTAL PERMIT FEE / "S C.)
Authorized signature: \\ A This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
I Print name: m C S� ev-v\„
I Date: + � � • Fee methodology set by Tri-Cotmty Building Industry Service Board
i:uildingmits \ MEC- Penn .doc 12/03 440-4617T \ B \ Pet (II1/ovcoM/w®)
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,
CITY OF TIGARD 24 -Hour k.
BUILDING, __� Inspection Line: 13)639 -4175
INSPECTION DIVISION Business Line: 503) 639 - 4171 MST
BUP
Received Date Requested , AM � PM BUP
Location $ a / ■•i/ Suite MEC Z 305— 6')')6, 3
Contact Person Pr ( ) PLM
Contractor (//LL ) c9-,s73 96 SWR
BUILDING Tenant/sal K LJ ELC
Footing 5 ? - Lf '- q/9;-, 9;-- ELC
Ft Drain
Foundation Access: 1,14cNVT G1/
i lIZ/ &YA
9 ' ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear .� nn - (AA/16 Z l Q � S
Framing Y V �(.� -i"� J
Drywall on •
Drywall Nailing /4-1A1711-.
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof -
Other: •
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains Ir
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: -
Final
PASS ART FAIL
M HA CAL
Post Beam
Rough -In 3 11 J ��
Gas Line
S . e Dampers
��� PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before ne 4 inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date S----Inspector Arirr �� Ext
Other:
Final DO NOT REMOVE this Inspection record fro ob site.
PASS PART FAIL