Permit i
CITY TIGARD MECHANICAL PERMIT
,,� Ift DEVELOPMENT SERVICES PERMIT #: MEC2003-00737
DATE ISSUED: 12/30/03
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S104AD -03301 \\
SITE ADDRESS: 12950 SW WALNUT ST
SUBDIVISION: ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: Install new furnace in garage
Owner: FEES
LORENCE, WALTER P + DEBI D Description Date Amount
12950 SW WALNUT ST
TIGARD, OR 97223 [MECH] Permit Fee 12/30/03 $72.50
[TAX] 8% State Surchart 12/30/03 $5.80
Phone: Total $78.30
Contractor:
REQUIRED INSPECTIONS
Phone: Gas Line Insp
Final, Inspection
Reg #:
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: T Permittee Signature. _.--------- _
Call ( 03) 639 -4175 by 7:00 P.M. for inspections needed the ext business day
Mechanical Permit Application FOR OFFICE USE ONLY
Cl Ty ' of Tigard Received D�
Date/By. /.2._/.3,14 3 Permit No • )�..�� - 7� �J
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ^vim l
Phone: 503.639.4171 Fax: 503.598.1960 /Ga,�i Date/By Other Permit.
Line: 503.639.4175 , 1jJ,. n!' I Date Ready/By. Juris El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method. Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the wor
❑ New construction ❑ Addition /alteration/replacement 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*
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Descnpnon Qty. Ea. ( Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / Air conditioning or heat pump
/ 2 9 ' C j �t / (/ J (requires site plan showing placement) 14.00
City/ State/ZIP: ;' 4' /L D / 22 Fumace 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: 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
Flue /vent for any of above 10 00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10 00
e I _LJyt.4 , ?sf�._ _,L.- 4 - Flue vent for water heater or gas
X fireplace 10.00
eet A /l -Fe Log lighter (gas) 10.00
el et
stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10 00
1:PP16PERT OWNER ❑ TENANT Other: 10.00
4 /
Name: 1 Q, 9 J /C � ( e_ Environmental exhaust and ventilation
r ��� ) �� � 7`-' Range hood /other kitchen
Address: j2 7 f 5' W O equipment 10.00
City/State/ZIP: 7; q �/ 5 04 9 722 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (Spf) . 3-Z4SV / 22 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Fuel i in
P g
Contact name: $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City/ State/ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name:
Other
Address: MECHANICAL PERMIT FEES*
City/State/ZIP. Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
�/ _
— TOTAL PERMIT FEE
Authorized si ature: )" ' / This permit application expires If a permit is not obtained within 180
grt /� / 4 " days after it has been accepted as complete.
Print name: Arifi �l _ , - — Date: _ —rif ✓O * Fee methodology set by Tri- County Building Industry Service Board
i \Building\Pemuts \MEC•PemutApp doe 12/03 440 -4617T (I I /02/COM/WEB)
Mechanical Permit Application - City of Tigard
r :
Page 2 - Supplemental Information
Commercial Fee Schedule:
$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 \Permits\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 — / ( AM PM BUP
Location 9S& --6 Suite - °737
Contact Person Ph ( ) PLM
Contractor Ph ) SWR
BUILDING Tenant/! at) ELC Prr�k
c'
Footing 1 73 0 - D
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: • SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear "'
Framing " l�.Jv7 liV
Insulation
Drywall Nailing
Firewall
Fire Sprinkler I rip Fire Alarm s( '1-1 wq) J �fi 1 ' r q A 1)` OS t E f\ v r ip 5 J
Susp'd Ceiling 1
Roof � ' 5
Other:
Final
PASS PART FAIL / � �� P MO1 � ` � -, , l PLUMBING d �� OV
Post & Beam
Under Slab
Water Service
l �► lS � � L t ��
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P FAIL
Post & Beam
Gs
Gas Line
Smoke Dampers
40115
.1:r -- 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
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA g ( c+ '� L] i �
Approach /Sidewalk Date L i Inspector .� - � Ext
Other:
Final DO NOT REMOVE this Inspection record from_thlob site.
PASS • PART FAIL •