Permit ,f
CITY TIGARD MECHANICAL PERMIT
{
1 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00619
Ali 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/23/03
PARCEL: 2S114BA -11200
SITE ADDRESS: 16435 SW WOODCREST AVE
SUBDIVISION: COPPER CREEK STAGE 2 ZONING: R -4.5
BLOCK: LOT: 065 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Gas piping for range
Owner: FEES
CATHERINE VANLAAKE Description Date Amount
KATHLEEN A
16435 SW WOODCREST AVE [MECH] Permit Fee 10/23/03 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 10/23/03 $5.80
• Phone: 503 - 810 - 7014 Total $78.30
Contractor:
HOLMES INSTALLATION SERVICE
RAYMOND FLANDERS
33535 NW VADIS ROAD REQUIRED INSPECTIONS
CORNELIUS, OR 97113
Phone: 647 - 9320 Final Inspection
Reg #: LIC 102473
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: Permittee Signature: -,
Call (503) 9 -4175 by 7:00 P.M. for inspections needet9 the next business day
Mechani
4 ermit Applicatio FOR OFFICE USE ONLY
d Mechanical
Date/By Permit No O1,et:3 - 60 6 /q
City Tigard Planning Approval Building
,� g DateBy. Permit No:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By. Permit No
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
41 I I ' Date/By. Case No :
Internet: www.ci.tigard.or.us �•I I Contact Juns ` ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
, r� New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
a • ddition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
r 1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty Fee(ea.) Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: jb Lf 3 c S W 0-04 O Cy QS"') Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
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
,L/■.S - Ilk lL 5'03 ?i /y FA._ 14 Flue vent (water heater /gas fireplace) 10.00
CC/43 c Log Wood/Pellet (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
`PROPERTY OWNER I ❑ TEN T Other: 10.00
Name: C / e2, /lie. vF e d/ Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address / b y 3t, f/ l tDO I C•' S 7
Clothes dryer exhaust 10.00
City /State /Zip: i 5-0* -1 die. ��zLy Single duct exhaust
Phone: O- 73/ y Fax: (bathrooms, toilet compartments,
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: 10.00
Fuel Piping I
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 **
C ONTRACTOR Water heater **
Business Name: / %y 95' 7a / ] 5VZ. Fireplace **
Address: 7 /51" 7 gr "4-, V'A -{)l5 Range
City /State /Zip: co it u e 1(A 0 Clothes es dryer (gas) **
Phone: 6 v7 ? 32 P ax: Other: **
CCB Lic. #: / o 2 tF 7 f Total.
Authorized �� / Mechanical Permit Fees*
Signature: Date. ( J Subtotal: $
Minimum Permit Fee $72.50 $ of , $
/-lp. v ^er' Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ 5, . t..7 TOTAL PERMIT FEE $ S
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.
is \Dsts \Permit Fomu\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 $1 0,000.00 $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. y . 1\
$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.
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i \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc
2 4 -Hour .4'
CITY OF TIGARD � ,= " ,
BUILDING.‘_. ;'-- Inspection Line: (503) 633 -4175- MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested M 4 ' A . _ M PM BUP
■
Location / (P '1 3 JT w / [� `� t" Suite MEC 3 — /
Contact Person Ph ( ) PLM
Contractor 11 Ph ( ) SWR
BUILDING Tenant/Owner CO E,' 629' y ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain -- .. :: "y
Slab I nspection Nat s: /� _/ 4 ) 4 "'��"`` 'SIT
Post & Beam / / �,(,�
Ext Sr Sheath/Shear h / n v Y ► Jam„ y)
Ext eah/hear � /(/
Ina Sheath/Shear .. " ----: -----L_____,'
' I • j , _ -;- J J - `1 ��
Framing _
Insulation
Drywall Nailing /"- A-t i /a_Ut
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 PART FAIL
MECHANICAL
Post & Beam ' 6,5 , ut
Rough -In - n ,/�`
Gas Line ,/�_ n
Smoke Dampe s O ur
.4221 PART FAIL
ECTRICAL
Service
Rough -In .
UG/Slab .
Low Voltage '
Fire Alarm
Final 0 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 Date /0 - 2 - Y 03 Inspector Est
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL