Permit CITY TIGARD MECHANICAL PERMIT
aorwse DEVELOPMENT SERVICES PERMIT #: MEC2003-00727
I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/23/03
PARCEL: 2S112BC -09600
SITE ADDRESS: 08085 SW VIOLA ST
SUBDIVISION: RAZE MEADOWS ZONING: R -4.5
BLOCK: LOT: 019 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install gas fireplace insert, gas pipe and outlet.
Owner: FEES
SUMMERS, JAMES B + ALLISON I Description Date Amount
8085 SW VIOLA ST
TIGARD, OR 97224 [MECH] Permit Fee 12/23/03 $72.50
[TAX] 8% State Surchart 12/23/03 $5.80
Phone: Total $78.30
Contractor:
ENERGY SAVERS PLUS, INC.
3747 SE 49TH AVE.
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Misc. Inspection
Reg #: LIC 103273 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 By: � ,Za/!L / ��f Permittee Signature:- �-"� , _ l'_- r 1
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
�,.., Received Mechanical
Date/By I o1� � . Permit No M 4
4003 - 0 7 7
Cit of Ti and Planning Ap rov Building
Y g Date/By Permit No
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 DateBy: Permit No
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
��� ,a Date /By Case No
Internet: www.ci.tigard.or.us 1 Contact tuns . ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method j i (.j 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
E dition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
Q-I & 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 - on air conditioning ** 14.00
Job site address: �O '65 $u , `J i „ 1,` .. Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: Hydrontc hot water system 14.00
�a ,,, s �" , _ 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: Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
S. -...4-ca (1 74, S C r.o i 1 a r -e Flue vent (water heater /gas fireplace) 10.00
�`� ,---k— Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert �c, ) 1 10.00 10. D
Chimney/liner /flue /vent ( 10.00 10 . p 0
- PR6PERTY OWNER ( ❑ TENANT Other: 10.00
Name: f Environmental Exhaust & Ventilation
J GL r, ` ^' ` ,, l Range hood/other kitchen equipment 10.00
Address: %OKS c , ) 0•,n � S.+
C /State /Zi ^ Clothes dryer exhaust 10.00
City/State/Zip: Y p'� i cl l a a g Single duct exhaust
Phone:(, ) lao - S I 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: F r- c4 ,l, Scu,„ �1,_ --.- Fireplace ( ** s. C)
Address: z-74--, .� f 0 4q +-~ Au Range **
BBQ **
City /State /Zip: 0 r-'rt r , _ .-. , , () i Z c7-() (o Clothes dryer (gas) **
Phone:(s - 1) -6,�Aci Fax:( ," 7- -c„- - i Other: **
CCB Lic. #: _ Total:
( a `7 �' - ( ni Mechanical Permit Fees*
Authorized - $ ,D , S 0
Signature• , -L, . z L.,_ ,� C —, ..pate: 1, _a 3 U 3 Minimum Permit Fee $72.50 $ jC
1 4_ , _A C. 1-4 r, s h 1.1 J Plan Review Fee (25% of Permit Fee) $
(Please print 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.
1 \Dsts\Permit Forms\MecPermitApp.doc 01/03
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.
r \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING Inspe 03) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
( / BUP.
Received � Date Requested ' l AM PM BUP
Location ' O g�� 1/ l O /go Suite MEC "7"00 72 7
Contact Person a/yy / Ph (S j) 912 ''76 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear / ¢ Q
6 q
Framing v ` C--•�- . X90 : ��
Insulation 2172 //94/gZ
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: A Final
PASS PART FAIL —' •■ ,"1-.-"!"4111.411M
MECHANICAL /
Post & Beam
..-
mo e
1
Post W
PART FAIL
CTRICAL
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 / , ',
Approach/Sidewalk Date Inspector Ext
Other:
Final - DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL