Permit CITY TIGARD MECHANICAL PERMIT
r�" DEVELOPMENT SERVICES PERMIT #: MEC2005 -00712
�' I ° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/24/2005
PARCEL: 2 S 104 CA -05500
SITE ADDRESS: 13695 SW WESTRIDGE TERR ZONING: R -7
SUBDIVISION: HILLSHIRE LOT: 055 JURISDICTION: TIG
Project Description: Gas line to range.
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:
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
SAWIN, DAVID J + CLARISSA J Description Date Amount
13695 SW WESTRIDGE TER [MECH] Permit Fee 10/24/20( $72.50
TIGARD, OR 97223 [TAX] 8% State Surchaq 10/24/20( $5.80
Phone: 503 - 590 - 5625 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
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 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Issued By: Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for inspections tha business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit A Eolz OFFICE USE ONLY
City of Tigard Received Penult No. � - ,
13125 SW Hall Blvd., Tigard, OR 97223 D
Phone: 503.639.4171 Fax: 503.598.1960 OC T 2 4 t, -; , e yew Other Permit:
Line: 503.639.4175 J,l � _� Date Ready/By ® See Page 2 for
Internet: www.ci.tigard.or.us T I G .j.4 J Nobfied/Method Supplemental Information
C OF ITY pTt1ISInN
T� 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: $
✓� 1 - and 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Jx C� , Air conditioning or heat pump
Job site address: / �llQ 9S 540 3/i Y/ I �/ (requires site plan showing placement) 14.00
City /State /ZIP: ' o _rd ( 6 9 0 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
}� , - 1 ,,n ha/,4 / � Hydronic hot water system 14.00
T� t - v7 " )'1'7,7 h Residential boiler (radiator or
/ �� ` / , hydronic) 14.00
/ /' ^ 1 / ^ L ' "��` 5 i 7`���� Unit heaters (fuel -type, not electric),
ln� tai 771 idge 7 5p in -wall, in -duct, suspended, etc. 10.00
/ � l � 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
e . e 2( Gas fireplace 10.00
/ � `j P ,� � Flue vent for water heater or gas
1 fireplace 10.00
'� /' �- A-' �, k Log lighter (Ras) 10.00
4 •
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
ROPERTY OWNER I ❑TENANT Other: 10.00
Name. N:A Q ✓,4,1.1 )/ A Environmental exhaust and ventilation
Range hood/other kitchen
Address: 0(0f Q /O ) t�� r �� ' /e equipment 10.00
City /State /ZIP: T /e•-:1 l Ds 9 ,5 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: a3) n - :577,.7 S Fax: S�l_ ,Og 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 a dditional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range I
CONTRACTOR Barbecue
—____, it - A Clothes dryer (gas)
Business name: ,�!- cJnc°� `
.. . 7 - 6 Other:
Address: Sri / MECHANICAL PERMIT FEES*
City /State/ZIP Subtotal
�, • 4 ..� _
Phone: Fax: , Minimum permit fee ($72.50)
_ . r - ..• '7 7 w .� [-P.") 7 — / Y 0 U Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
'. TOTAL PERMIT FEE 7K. 3c
Authorized si attire: This permit application expires if a permit is not obtained within 180
; _ / days after it has been accepted as complete.
Print name: c/ 0,3a , ,� /] `��` Date: )0/ r / � • Fee methodology set by Tri- County Building Industry Service Board
I.\ Building \Permas \MEC- PennuApp,doc 12103 C 440-4617T ( (I1 /02/COM/WIB)
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:\Building\Permits\MEC- PermitApp.doc 12/03 2
,
CITY OF TIGARD ,. �� ` $.twU 12- � • � 0
- 3
BUILDING DIVISION PERMIT #: MEC:200{i00712
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10124/20055
Phone: (503) 639 -4171 ;i�
Inspection Requests (24 Hrs.): (503) 639 -4175 ,'!�i !L
INSPECTION WORKSHEET FOR DATE: 4/28/2006 TIME: 7:02AM PAGE: 99
SITE ADDRESS: 13695 SW WESTRIDGE TERR CLASS.OF WORK:
SUBDIVISION: I LOT 0& TYPE OF USE:
PROJECT NAME: S■VVIN
DESCRIPTION: Gas line to range. '
OWNER: SAWN, DAVID J + C-t_ARISSA J, PHONE #: 503- 590 -6625
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 028886-01 503 - 590,5626 y
Corrections /Comments /Instructions:
•
A.le__- "r
1: el
[f PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: tt�t� Date: '9 2a d Phone #: (503) 718-
z6