Permit CITY TIGARD MECHANICAL PERMIT
� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00057
+ � �I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - DATE ISSUED: 2/11/04
PARCEL: 2S 103DB -03600
SITE ADDRESS: 11260 SW QUELLE PL
• SUBDIVISION: GENESIS NO. 2 ZONING: R -4.5
BLOCK: LOT: 034 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: Replace gas furnace.
Owner: FEES
RUSSELL, H STEWART + LILA F Description Date Amount
TRUSTEES
11260 SW QUELLE PL [MECH] Permit Fee 2/11/04 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 2/11/04 $5.80
Phone: Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 76359
•
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
Issued By: 4 01k _ < < � Permittee Signature: � /
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received,/ (.... / 66 Mechanical HECEIVED DateB / Permit No.: lM 6C-oQO6 - 7
City of Tigard Planning Appro Building
Date/By: Permit No.:
13125 SW Hall Blvd. .
Plan Review Other
FEB 1
Tigard, Oregon 97223 CCD 2004 Date/By: Permit No.:
Phone: 503- 639 -4171 FaxC,E'Qfx Post- Review Land Use
��°AR �' +' '` � Date/
By: www.ci.tigard.or.aUILDI I II Y Case No.:
G /�SI, ^__� Contact uris.: Su See Page 2 for
24 -hour Inspection Request: 503-639:4 /� Name/Method: // ( e Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
4 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION • Furnace - add - air conditioning** / 14.00
Job site address: J /,,2 . o 11,1i 4 e /4 /6 /4--r , Gas heat pump 14.00
Suite #: I 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: I Lot #: Repair units • 12.15
Tax map /parcel #: Other Fuel Appliances
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
/Gc -C�li 94..o �-/,,A/, -7Ct� G� Flue vent (water heater /gas fireplace) 10.00
/ G Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue /vent 10.00
$ ROPERTY OWNER 1 ❑ TENANT Other: 10.00
Name: �� S S
7/ Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: 4.,76,/, fit/ .eu -r /4._ yo
Clothes dryer exhaust 10.00
City /State /Zip: 4ti,9( Single duct exhaust
Phone: o ?D f'24‘, Fax: (bathrooms, toilet compartments,
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: 1 0.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc. ••
Gas heat pump ••
E-mail: Wall/suspended/unit heater ••
CONTRACTOR Water heater ••
Business Name: Ca / ,,, 6. Fireplace ••
Address: ,oa 4,0x 2'3t397 Range ••
City/State/Zip: BBQ ••
Cit
y p: 7 Q,td c"2 9727 -3 Clothes dryer (gas) ••
Phone: ‘ 2 ya7o V Fax: „57/3- 7 - 7 0 Other: ••
CCB Lic. #: 74 3 5 f Total:
Authorized � � Mechanical Permit Fees*
Signature: : e Date�� / — V Subtotal: $
/�� ,
Minimum Permit Fee $72.50 S
/9 , ,&,4 Review Fee (25% of Permit Fee) $
(Please p • t name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
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.
i: \Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard - a :
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.
is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested a - AM PM BUP
Location ` l Z Ca v 61. _ ��° S uite q ` MEC / 6°°3-
Contact Person • I ® ►�:�� -Q.P T Ph ( ) o 2 0 - F 2 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: I a 0 0 "
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 7_3 SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
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
Catch Basin / Manhole � � �j / 0 3 L
Storm Drain
Shower Pan
Other:
Final
PASS __PART
Post & Beam
Rough -In
Gas Line
__Sm__l�e Dampers
RT FAIL
CTRI A
Service r \e-(3
Rough -In N '
UG/Slab
Low Voltage���
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA - S- i /
Approach/Sidewalk Date inspect .1 /_ / / .. /Y__ a
Other:
Final DO NOT REMOVE this inspection record fro ' the job si = .
PASS PART FAIL