Permit 1111 4 CITY OF TIGARD MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: MEC2006 -00628
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/8/2006
PARCEL: 2S 104BA -02300
SITE ADDRESS: 12061 SW WILTON AVE ZONING: R -25
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT: 104 JURISDICTION: TIG
Project Description: Gas to gas furnace.
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:
NAT 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:
Owner: FEES
DAVE RICKARD Description Date Amount
12061 SW WILTON AVE
TIGARD, OR 97224 [MECH] Permit Fee 12181200E $72.50
[TAX] 8% State Surcha 12/8/200E $5.80
Total $78.30
Phone: 503 -524 -1197
Contractor:
COST PLUS HEATING + AIR
7132 N FESSENDEN ST
PORTLAND, OR 97203 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 286 -2009
FAX 503- 286 -6552
Reg #: LIC 47978
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.
fssu By: _ , � Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for inspections that 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 Application FOR 0FIICI: IiSF ()NIX
City of Tigard ,� ; /�/�
Other Permit: No. " '/ 461 ° 4? - g
111 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C • Phone: 503.639.4171 Fax: 503.598.1960 Date/By.
"1 - 1 G A It D Inspection Line: 503.639.4175 Date Ready/By: WI El See Page 2 for
Internet: www.tigard- or.gov Nomfied/Method: Supplemental Informat
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction El, 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: $
dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
et 1 - and 2 g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
• JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 17 ,0 (0 i s v ..) t L40 "..1 v G (requires conditioning ho or heat l a em
A 9teplansnowingplacement) 14.00 4
T
City /State/ZIP: 101 i4 l- . 0 (t q7 2 Z 3 Furnace 100,000 BTU (ducts/vents) ( 14.00 f t4 •
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
G is S '*O CG ovs PLAT ) ct C Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 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: b,„„, iQ t Lk _ A r a. Environmental exhaust and ventilation
Range Address: t- ZD (o ( s L ojt.0 v.." AL/ equipment ood/other
equipm 10.00
City /State/ZIP: - rig -- . fir" 'riaz 3 Clothes dryer exhaust 10.00
'b�) Fax: Single -duct exhaust (bathrooms,
Phone:
V y— / /g'7 ( ) toilet compartments, utility rooms) 6.80
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other:
Business name: 10.00
/— Fuel piping �
Contact name: , 54-Gue S'A,•v C e.rs4aI-J $5.40 for first four; $1.00 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State/ZIP: 7 g 1 --9040 t ytpd3t 1 --C Wall/suspended/unit heater
Phone: ( Vu3) 2 $L „.zz ID q Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Cps
Clothes dryer (gas)
P vs hie tti, Other:
Address: 7(3 Z n-) teeSSe►t rl MECHANICAL PERMIT FEES*
City /State/ZIP: ,C,y4. (Iy2 q7 z,o 3 Subtotal et
Minimum permit fee ($72.50) 7Z
Phone: (gb5) ,y g6 _ p y I Fax: (P3) 236 'CS Plan review (25% of permit fee)
CCB lic.: `. / q7 8 State surcharge (8% of permit fee) g o
TOTAL PERMIT FEE 73
Authorized signature: ,1 .44..` This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
I Print name: S /e G..P _s', c(G c -' I Date: , , — so 06 • Fee methodology set by Tri- County Building Industry Service Board
I U3uildinePermiti \MEC- PennitApp.doc 04 /06/06 440- 4617T(11 /e2/COM/WEB)
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 4,
$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.
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l: \Building\Permits \NEC- PamitApp.doc 12/30/05 2
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CITY OF TIGARD
BUILDING DIiSION PERMIT #: MEC2006 00628
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/8/2006
Phone: (503) 639 -4171 Amud
Inspection Requests (24 Hrs.): (503) 639 -4175 s __..
INSPECTION WORKSHEET FOR DATE: r TIME: PAGE:
'i 2Ji..,12006 7:04AM 6
SITE ADDRESS: 12061 SW WILTON AVE CLASS OF WORK:
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT #: 104 TYPE OF USE:
PROJECT NAME: RICKARD
DESCRIPTION: Gas to gas furnace.
OWNER: RICKARD. DAVE PHONE #: 503-524-1197
CONTRACTOR: COST PLUS HEATING + AIR PHONE #: 503 - 286 -2009
Inspection Request Scheduled For: Date: 12/15/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 04117301 503-524-1197 Y
Corrections /Comments/ Instructions:
Aiez,Ad 466
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /2–/s-6 Phone #: (503) 718 -