Permit CITY TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00119
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/16/04
PARCEL: 1S134CB-02400
SITE ADDRESS: 12305 SW SUMMER CREST DR
SUBDIVISION: SUMMER HILLS PARK ZONING: R -4.5
BLOCK: LOT: 011 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:
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:
OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm:
> GAS OUTLETS:
10000 cfm:
Remarks: Installation of fireplace insert
Owner: FEES
LOVETT, JANICE Description Date Amount
12305 SW SUMMERCREST DR
TIGARD, OR 97223 [MECH] Permit Fee 3/16/04 $72.50
[TAX] 8% State Surchart 3/16/04 $5.80
Phone: Total $78.30
Contractor:
MR CHIMNEY
3051 N ADAIR CT
CORNELIUS, OR 97113 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 151739
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
req - you o • , rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
r
I- ued By: , ___.% ��% �f f mittee Signature• S"
Call ( 03 • . -4175 by 7:00 P.M. for inspections needed the next business day
Mecha�i _ ermit Application FOR OFFICE USE ONLY
City of Tigard DD aced /CA I/
13125 SW Hall Blvd., Tigard, OR 97223 y i� �� -06 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 A v,@ Date/By:
Inspection Line: 503.639.4175 l y
_ _� Date d/ o: See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Mil Supplemental Information
TYPE OF WORK CON MERCIAL 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 - RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ 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 • Heating/cooling
Job site address: /�• Air conditioning or heat pump
t .?N.3 0 S _ .S ./ tw t .. n [ r (rs551F 0 r" , (requires site plan showing placement) 14.00
City/ State/ZIP: 7, 6 rs d c2i? G 7 g...N Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: a 1 if y �-e 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
_ JJ Gas fireplace 10.00
1n5 /I' hS C. r t aM it e,n er 0"rPe / Flue vent for water heater or gas
fireplace 10.00
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: ..) ( 4, tout f , Environmental exhaust and ventilation
Range hood /other kitchen
Address: / 23 Sy) -sw w- Ci'CS - -01; equipment 10.00
City/State/ZIP: VrGa rd, CPI? q 727'1 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: �� Ch ,- in A,G +�� piping
Fuel t to
g
�
Contact name: o v f� $5.40 for first four; $1.00 for each additional
Address: 3 0� ( N -D w C,rr Furnace, etc.
ea
� Gas heat pump
City/ State/ZIP: corn G 4 c7e__ C' 7 ! i'3 Wall/suspended/unit heater
Phone: ( 603) 3i 7 0 3 / q Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: �� GAi Clothes dryer (gas)
Other:
Address: 3 i Ai '. ill ' Cam, MECHANICAL PERMIT FEES*
City/State/ZIP:c c /�f q � 3 Subtotal
Phone: 3) / , g o ' Fa ( _! ) Minimum permit fee ($72.50) 7a, . 5-0 hone: (so
3 S 3 ? Plan review (25% of permit fee)
CCB lic.: t I -7. g 9 4/ 7 /'-v' State surcharge (8% of permit fee) 5, SO (/ TOTAL PERMIT FEE '7e 5(J
Authorized signa This p ermit application expires if a permit is not obtained within 180
r a � � days after it has been accepted as complete.
Print name: .CGS Date: • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \PermitsVMEC- PemdtApp.doc 12/03 440.4617T (I 1 /02/COM/WEB)
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:\ BuildingTermits \MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
�> BUP
Received Date Requested 3 ib AM PM BUP
Location DAZA.e.i1.1 L9-k Suite MEC 1 / — /'a O irci
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
•
BUILDING Tenant/Own lirc 3.Sa ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain _�7
Slab , �! ction ote !� y _, / SIT
Post & Beam
Shear Anchors ; o / 1
Ext Sheath/Shear C�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling C
-
Roof
Other:
Final
PASS PART FAIL
PLUMBING 147
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
Rough-In
Gas Line WO- -
Smoke Dampers VV DO V
Final
PART FAIL
Service
Rough -In •
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: ❑ Unable to inspect — no access
Fire Supply Line
ADA i
Ext
l /8 Inspect.
Approach/Sidewalk Date 3 - � // - - ��
Other:
Final DO NOT REMOVE this inspection record 'tom the ' site.
PASS PART FAIL