Permit F.
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00578
" � II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/25/03
PARCEL: 1S134CB-01600
SITE ADDRESS: 12190 SW SUMMER ST
SUBDIVISION: SUMMER HILLS PARK ZONING: R -4.5
BLOCK: LOT: 017 JURISDICTION: TIG
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:
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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas insert and gas piping.
Owner: FEES
GALLOWA, R DOUGLAS JUDITH Description Date Amount
12190 SW SUMMER ST [MECH] Permit Fee 9/25/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 9/25/03 $5.80
Phone: Total $78.30
Contractor:
HOT SPOT FIREPLACE + PATIO
11525 SW CANYON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 00071782 Final Inspection
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 y: l � JLighe.r i Permittee Signature: c�
Call (503) 639 -4175 by 7:00 P.M. for inspections neede the next business day
� , ` ll FOR OFFICE USE ONLY
Mechanical ['II _p anon Received a 3 Pe a llo lyi c 7g
Date/By:
City of TiQand Planning Approval Building
b Date/By: Permit No.:
13125 SW Hall Blvd. 2003 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 B a x., ,11..5 , i�: 4 ,0 Post - Review Land Use
t l'
Internet: www.ci.tigard.or.us G DIVISION .11, . Date/By: Case No.:
Contact J ® See Page 2 for
-
24 -hour Inspection Request: 503- 639 -4175 - Name/Method: C p , 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 CONSTRIICTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
❑ Master Builder ❑Other: Description I Qty I Fee(ea.) I Total
Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: f � no � W (L ra rnstr Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Gn 11 oi, \tom 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
ax ma
P P Water heater 10.00
DESCRIPTION OF WORK Gas fireplace /A/ / r / 10.00
Flue vent (water heater /gas fireplace) 10.00
r
.i 00 1 (JTl. Q cti 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: 9, -per e`a n ... 1 u a i-� L A � d t�._ Environmental Exhaust & Ventilation
Address: /At et & g(,) J � nu hood/other kitchen equipment 10.00
Cit /State /Zi � ry Clothes dryer exhaust 10.00
y p : T J n 1 lJ on � Single duct exhaust
O
Phone: b 5' 7 q Fax: (bathrooms, toilet compartments,
❑ APPLICANT 0 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, 51.00 each additional)
Phone: I Fax: Furnace, etc. ••
Gas heat pump ••
E -mail: Wall/suspended/unit heater ••
CONTRACTOR Water heater ••
Business Name: 1,1 _1), / Ltinc_i Fireplace / *`
Address: j/ �, wYp Rang
.e
Cit /State /Zip: rA) ,O . '2 7e05 Clothes dryer (gas) •*
Phone: Zp,Z(p — '/1 — Fax: Other: ••
CCB Lic. #: Total:
Mechanical Permit Fees*
Authorized _
Signature:, _ _rL:Al 1_,_ .1 Date: Ci -' Subtotal: $
Minimum Permit Fee $7250 $ '� �
I Plan Review Fee (25% of Permit Fee) $
(Please print name) S tate Surcharge (8% of Permit Fee) $ 6". €0
TOTAL PERMIT FEE $ 7 % . 3 n
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
6•
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.
$100,001.00 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.
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i:\BuildingtPermit FormslMecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING InspectioVLine: 1503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / O --I AM PM BUP
Location / 2-190 Su M r of S+r • Suite i 3 - oo578
Contact Person jut Sy Ph ( ) 59 0- /794 i* PLM
Contractor Ph ( ) aHl — 2-9 Ng SWR
BUILDING Tenant/Owner ELC ( A & k_
Footing C -6 a I` - V ) L ELC
Foundation
Ftg Drain Access
Crawl Drain ELR
Slab Inspection Notes: f , SIT
Shear Post & Beam Lin S ) �- 7 J` 4 ?),)(i
Shear Anchors
Ext Sheath/Shear CHAS if R s p e ayJ
Int Sheath/Shear
Framing
Insulation
Drywall Nailing cr
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
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
mo e Dampers
PART FAIL -r•2G
ELECTRICAL
Service
Rough -In
L olt 314
Low Voltage �J f j
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 re'nspe ion RE. ❑ Unable to inspect — no access
Fire Supply Line
ADA
g'
Approach/Sidewalk D a Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record rom the job site.
PASS PART FAIL