Permit C fl OF TIGARD
MECHANICAL PERMIT
� A DEVELOPMENT SERVICES PERMIT #: MEC2004 -00646
'` '�I �! DATE ISSUED: 9/27/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 104CD -06300
SITE ADDRESS: 13620 SW WHITE CEDAR PL
SUBDIVISION: HILLSHIRE ESTATES ZONING: R -7
BLOCK: LOT: 063 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: 1 DOMES. INCIN:
ELE 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:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of a/c unit.
Owner: FEES
SWEARINGEN, VERNON R + Description Date Amount
BETTY L [MECH] Permit Fee 9/27/2001 $72.50
13620 SW WHITE CEDAR PL [TAX] 8% State Surchart 9/27/200 $5.80
TIGARD, OR 97223
Phone: Total $78.30
Contractor:
WILFERT SHEETMETAL + HEATING
430 NW 231ST AVE
HILLSBORO, OR 97124 REQUIRED INSPECTIONS
Phone: Cooling Unt Insp
hone: 648 - 1561
Final Inspection
Reg #: LIC 43885
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 e i s - : •h OAR 952 -00 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503) 6 -6699.
Issue By: , „ jampa ii / / Permittee Signature: 1�
all (503 • • • -4175 by 7:00 P.M. for inspections needed the nex siness day
Mechanical Permit Application FOR OFFICE USE ONLY
City-of-Tigard Da Re y 9 �7 U
4 Permit No. £ a' 6
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639 4171 Fax: 503.598.1960 /�- c I , \ DateBy Other Permit:
Inspection Line: 503.639.4175 _ Date Ready/By: t ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method. / f a Supplemental Information
' r - , TYPE O F WORK • • ' ' C FEE *. SCHEDULE' - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ 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. $
1 - and 2 dwelling Commercial/industrial • r • RESIDENTIAL, EQUIPMENT / SYSTEMS FEES*
12 y g ❑ ❑ A ccessory building
For special information use checklist
❑ Multi family ❑ Master builder ❑ Other: Descnpnon I Qty. I Ea I Total
' JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: ? ��// - Air conditioning or heat pump ` II , C
/ ✓ 62., O W �� f 1 CE /T - e A Cf (requires site plan showing placement) r 14.00 t V
City/State/ZIP: -7 / G i g CY C7 7 y z 3 Furnace 100,000 BTU (ducts/vents) 14.00
. /apt. no.: Project name: ff Qa Furnace 100,000+ BTU (ducts/vents) 17 90
Suite/bldg
Ce ►1t l / 1 la_ 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
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
T
L ,c r 0. (( C-e n fir^ Cn■ 4 (l2- C 0 f\_J- LT (9 �/�• Flue vent for water heater or gas
nit T fireplace 10.00
Iv Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10 00
•
Chimney/liner /flue/vent 10.00
❑ PROPERTY OWNER ❑TENANT
Other _ 10.00
Name: L/_e /i n or) J . 5 V . ej - yl �e 11 Environmental exhaust and ventilation
' , Range hood/other kitchen
Address: 13 (, Z(' 5v. 11.+ r h f "2 Ce_c) r r (0V-- equipment 10.00
City/State/ZIP: -) Cl : •(-" d 0 le 9' 7 a a 3 Clothes dryer exhaust 10.00
Phone: J Single -duct exhaust (bathrooms,
(�o3) 5 7 `I _7 S� S Fes ( ) toilet compartments, utility rooms) 6.80
❑' APPLICANT ,- _ •❑ ; . CQNTACT 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: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
. - CONTRACTOR Barbecue
Business name: (/l f1 4 1 = L gT '- S )+E fr FT/1 i_ ( O Tl t-t q Clothes dryer (gas)
J Other:
Address: 3 /v' u.1 0.3 1 S"- . MECHANICAL PERMIT FEES*
City/ State/ZIP: G—f ( I S b O r' o 0 R cl 7 Z 1 t/ - tal
Phone: (503) 6 (, f - / t" I Fax: ( ) inimum permit fee ($72.5 t) 7 • 6D
Plan review ee)
CCB lic.: Q 3 t) SS State surcharge (8% of permit fee) S • 8
TOTAL PERMIT FEE 78`• 3o
Authorized signature: U'Q /'K i) Yl Yom. SW. e 00— 1 a7 C k N This permit application expires if a permit is not obtained within 180
�1 days after it has been accepted as complete.
Print name:.— _ 7-- Date: ? /2-7 /111 4 • Fee methodology set by Tn County Building Industry Service Board
t.\BwidingTernutsNEC•PennitApp 12/03 440 -46177 (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
c Total valuation_,..
$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
i
511-
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 4503) 63 • 75
INSPECTION DIVISION- -• Business Line: (50 _ 9-4171 MST
BUP
Received Date Requested q AM PM BUP
Location - �o -, / Su ite I` a4 o .46 6
Contact Person V 1P/ZYU Ph ( O) 9 " � — 9 1 4 PLM
Contractor Ph ( ) SWR ^ o
BUILDING Tenant/Owner ELC o �-
Footing ELC
Foundation Access: - p- iiNi 'lam
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Framing /Shear 1 n �^✓ 1 t0 /o ? V
Framing l/
Insulation L//LP
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 FAIL
A N
Pos :eam
Rough -In Al
Gas Line
Smoke Dampers
PART FAIL
ECTRICAL
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
Approach/Sidewalk 0 Inspector _ Ext
Other:
Final DO NOT REMOVE this inspection re .17 from the Job site.
PASS PART FAIL