Permit C ITY OF TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00739
+- ��1.
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/12/2004 PARCEL: 25111 BA -02101
SITE ADDRESS: 09920 SW VIEW TERR
SUBDIVISION: INGEBRAND HEIGHTS ZONING: R -3.5
BLOCK: LOT: 009 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
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
GARCIA, ALBERT J JR Description Date Amount
CIO GUARDIANSHIP PLUS [MECH] Permit Fee 11/12/20( $72.50
HI SBORO, OR 97123 [TAX] 8% State Surcharl 11/12/20( $5.80
Phone: 503 640 - 0528 Total $78.30
Contractor:
PIONEER GAS FURNACE
3615 NE BROADWAY
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 36102
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)24 99. \
i I
Issue , By: Permittee Signatur • e ('%,,,r7 !1�!,�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
• l ical Peinii i o I ()It t,l l 11 I I 'I (
City of Tigard l V ] U eB Joe/ ..•� 1i Permit No y .. -mT3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 20 V 11 Date/By Other Permit.
Inspection Line: 503.639.4175 14. ` I Date Ready/By. ® See Page 2 for
Internet: www.ci.tigard.or.us CiiTY OF T dr -- Notified/Method: Supplemental Information
r1 [,:o CC ')ivi o�l
TYPE OF WOR 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: $
RESIDENTIAL EQUIPMENT /SYSTEMS FEES`
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: . sc•iption I Qt 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
c Air conditioning or heat pump
lob site address:
99 J O J &) v ( o � 'e r rme- e_ (requires site plan showing placement) 14.00
r City/State/ZIP: 1 p� 0 e9 7221 Furnace 100,000 BTU (ducts/vents) 14.00 I+ / —" / Furnace 100,000+ BTU (ducts/vents) 17.90
Sujte/bldgJapt. no.: Project name r (,' Gas heat pump 14.00
t �^
1 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
Re1i/aee " Ts 7-ternae_r Flue vent for water heater or gas
fireplace 10.00
Log lightcr (g::;) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
. ❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 10.00
Other: 10.00
Name: 11/her--t 7 /in f, )10. (/'+ Qr- L_ Environmental exhaust and ventilation
Address: `to tO total 7 t H N.)bk/ -I P P S/ / X !'� /21410 Range hood /other kitchen
equipment 10.00
City/State/ZIP:Pc, -Ao4, -5L1 i`a'l LLe602a d2, 971 7.3 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (a) j) to go • 5 a g Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax:: ( ) Water heater
• - -- --- —" Fircalace
E -mail:
R ange
CONTRACTOR — Barbecue
Business name: Clothes dryer (gas)
/d,:onee� 5 Aueliae e
Other:
Address:
3 eD 5 � VE U ro zi
i � . MECHANICAL PERMIT FEES'
City/State/ZIP: a ,.7L/ and OR 97Z3 Z Subtotal 14
Phone: ( 5o5 219 Fax: (503 249 g266 Minimum permit fee ($72.50) 72 ,� 0 review (25% of permit feee )
i
CCB lc.: 3C, /0 State surcharge (8% of permit fee) S go
TOTAL PERMIT FEE 7 g. 30
CCB
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
I Print name: Co /GC I Dale.: N,8. I • Fee methodology set by Tn -County Building Industry Service Board
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
1'otiilValuation: 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 \Permils\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 1
BUP
Received Date Requested / °� AM PM BUP
Location 7'72-6 V ` e4 -) /' '' Suite M EC & - 00 7 3
Contact Person ��c� Ph ( I,IJ ) 6 2 - O S Z PLM
Contractor Ph (WL 6 - 6 SST SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear O /�'
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
Storm Drain
Shower Pan
Other:
Final
PASS ART FAIL
AL
Post & Beam
Rough -In r � A A�.1 Chi
Gas Line T V"
Smoke Dampers - .
� S �4RT— FAIL
RICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final E Reinspection fee of $ required before next inspe tion. 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 Date / 2 a -
Approach/Sidewalk � Inspector
t Ext
Other:
Final - DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL