Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00552
_40,111 -' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/27/2005
PARCEL: 2S103DD -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 80 ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Hood system. Value: $8,000
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE:_ COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS: 1
FUEL TYPES 0 - 3 HP: DOMES. INCIN: •
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS ?: N 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Owner: FEES
D.W. SIVERS COMPANY Description Date Amount
4730 SW MACADAM AVE [MECPLN] Plan Rev 9/27/200E $48.88
#101 [TAX] 8% State Surcharl 9/27/200f. $15.64
PORTLAND„ OR 97201 [MECH] Permit Fee 9/27/200: $195.50
Phone: Total $260.02
Contractor:
CUSTOM METAL FAB INC
50602 BIRCH AVE REQUIRED ITEMS AND REPORTS
SCAPPOOSE, OR 97056
Phone: 503 - 543 - 3170
Reg #: LIC 64901
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.
AP
Issued By: 7 j ) �� Permittee Signatur ,A A
• Call 503 - 639 -4175 by 7:00 a.m. for inspections t . • business ay.
This permit card shall be kept in a conspicuous place on the job site until co pletion of the project.
Approved plans are required on the job site at the time of each inspection.
t.,
��j fW 1 , FOR OFFICE USE ONLY
Mechani a m><t A 1>lca on y
'
CE IV E 6 / DDate/By: D5�6 Permit No dyl� Received
�� �
City of Tigard I i
13125 SW Hall Blvd., Tigard, I r Plan Rev -
/" QJ
Phone: 503.639.4171 Fax: 503.598.1960 9 Ga ;r DateB i / Other Permit: „ — dO }I V
Inspection Line: 503.639.4175 0 7 2005 i _AI. ell R TN/r': /� �/ 12I See Page 2 f r
Internet: www.ci.tig ��� Notified/Method: Supplemental Information
CITY OF TIGARD .,l►!..'' i '!_i7NI PFINFOIP.
BOIL GI M COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement
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 lit Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Headng,/cooling
�-w E .c- , + -�; Air conditioning or heat pump
\
t Job sit
`3 t S 3 ( 1 ►'fe- ( i�l� I- -■ K r . k - -3 -„ (requires site plan showing placement) 14.00
City/State/ZIP: (
1 1 - j � i Furnace 100,000 BTU (ducts/vents) 14.00
ty 9 �� ((�
i # "` �� I Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: �'4 'Project name: /9TZ� NU V1�A Gas heat pump 14.00
Cross street/directions to job site: Duct work I 14.00
� n Hydronic hot water system 14.00
z/ 7 g- &- $jju �---9' 4c 1 17 -12.� Residential boiler (radiator or
l inn l lGii- l ffefir,u I/ V f (( ic) 14.00
")(/ 7 6, _ � � �1 pC/ Unit nit h heaters (fuel -type, not electric),
/ -
lei 6/ R t'/S / � `Pn 1't L iit-ey / /J� L t in -wall, in -duct, suspended, etc. 10.00
Flue/vent for any of above i 10.00
Subdivision: I Lot no.: Other: f 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
`7 t 6,IJ (� 6 f � _ c ,+ / �, _- u - 2 SS Rde eg Flue vent for water heater or gas
-,ClPP NA � �YtS�1(A- - �� l fireplace rt 10.00
e 10.00
,, I Log lighter (gas) 10.00
V ` J1 J � TRW M 1 / 1'f 4,1 -e Wood/pellet stove 10.00
.� fit, ��f!^ up ( j��' ��.,^ /��//�� ��(�� /( fire lac/inse
[ p I`i�.,(. dx) eZ - f`.d�..« l iz tt -Pr Wood Chimney fine vent 10.00
❑ PROPERTY OWNER I TENANT Other: 10.00
Name: T 1`t LL 41.„ tJ e../--
_ Environmental exhaust and ventilation
s • S 5 C Ra hood/other kitchen Address: 1 I c 5 La d_( c (L Li e q u ipment 10.00
City/State/ZIP: —7 4 )i c C& Ai 9/ 2.-2.-- Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (1) - 5308 Fax: ( ) toilet compartments, utility rooms) 6.80
p APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
,,�,
// �]]''1��0� Other: 10.00
Business name: C vt. i4
LcS+D t_44.14 )t14 e' • Fuel piping
Contact name: t_ U kE_ — 774.L /,p /� $5.40 for first four; $1.00 for each additional
/ Furnace, etc.
Address: cStee7O - RI i h A d e - Gas heat pump
City/ State/ZIP: 56 l 14_/* R. Q/Ii ? '7O s Wall/suspended/unit heater
Phone: q � t) Fax: : ( in S� 3 —29 7 Water heater
T Fireplace
E -mail: c" r..., ' 4PS e ar ia s a CIm 0441...&6€12. tf 1 Range
CONTRACTOR FAA 'J Barbecue
7
Business name: 6a U M Pi F h � �o , Clothes dryer (gas)
1 Other:
Address: &A Y11 (F ,S Cie . MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: (pi 0 t • State surcharge (8% of permit fee)
TOTAL PERMIT FEE
•� , This permit application expires if a permit Is not obtained within 180
Authorized signature: J � Fee methodology after it has been accepted as complete.
Print name:
t � ��(Pk_ Date: • hodology set by Tri -County Building Industry Service Board
CITY OF TIGARD
JR • , 1, .7 A
BUILDING DIVISION PERMIT #: MEC200S -00552
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2005
Phone: (503) 639 -4171 4°, Ilin
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/11/2005 TIME: 7:08AM PAGE: 84
SITE ADDRESS: 13815 SW PACIFIC HWY 80 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DONUT SHOP
DESCRIPTION: Hood system. Value: $8,000
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: CUSTOM METAL FAB INC PHONE #: 5035433170
Inspection Request Scheduled For: Date: 10/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 017927 -04 503-463-4500 N
Corrections /Comments /Instructions:
://\ _
M i
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL • CALL FO' INSPECTION ❑ ADDITIAL FEES ASSESSED
Inspector: dr' - / Date: ( T)( 1( Phone #: (503) 718-