Permit A ,
CITY OF TIGARD MECHANICAL PERMIT
In DEVELOPMENT SERVICES PERMIT #: MEC2003 -00108
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/12/03
PARCEL: 2S1 04 DA -23600
SITE ADDRESS: 13175 SW WORCHESTER PL
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5
BLOCK: LOT: 062 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SFA 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: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas fireplace and gas piping.
Owner: FEES
BROWNSTONE QUAIL HOLLOW LLC Description Date Amount
12670 SW 68TH PKWY
STE 200 [MECH] Permit Fee 3/12/03 $72.50
PORTLAND, OR 97223 [TAX] 8% StateTax 3/12/03 $5.80
Phone: 503 - 598 - 7565 Total $78.30
Contractor:
THERMAL FLO
14865 SW 74TH AVE. #190
TIGARD, OR 97224 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 151847 Final Inspection
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 6'100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)2 6 -6 99.
Issued B it ', , /O -44 ,
Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Aanical Permit Application FOR OFFICE USE ONLY
Received / U Mechanical MCC / Ci
Date/By: : r Permit No.: 3'" O
Planning Approval Building Q
City of Tigard Date/13y Permit No : 1.—�-,966,9 /
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
A a Date/By. Case No.:
Internet: www.ci.tigard.or.us _ j i Contact Juris . ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 X "" Name/Method Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST • - .. ,
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
• ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
A ccesso Multi-Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
❑ ry Building ❑ amy Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
• JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: (.1 �!-j t,J C lt.a. Zi-a Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Hydronic hot water system 14.00
Project Name: 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
Lot # Repair units 12.15
Subdivision: Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
. DESCRIPTION OF WORK Gas fireplace / 10.00
Flue vent (water heater /gas fireplace) 10.00
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: �p / 1 U lp /V
n ,n _ I. TC Environmental Exhaust & Ventilation
I e , , R ange hood/other kitchen equipment 10.00
Address: I 2410 fit) Co y� q / �U u U Clothes dryer exhaust 10.00
City /State /Zip: bi U / 1 Single duct exhaust
Phone: 5 J�JS b'1 Pax: (bathrooms, toilet compartments,
❑APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name:
Attic /crawl space fans 10.00 Other: 10.00
Address: Fuel Piping
City/State /Zip: * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Phone: Fax: Gas heat pump **
E -mail: Wall /suspended/unit heater **
CONTRACTOR r I Water heater **
Business Name: , - osewT iew," • / ,M_.1 lD
_ Fireplace **
cf . S � 5tiJ 7 r( Range **
_ **
Address: T BBQ
City /State /Zip: 7/64-M % -`ZZ`F Clothes dryer (gas) **
Phone: (Q j0 0 1 .3 Fax: /-D . 104° `7 . Other: / **
Total:
CCB Lic. #: 1,5 L Mechanical Permit Fees
Authorized / ! Z Subtotal: $
Signature: IA ; Date: 1 Minimum Permit Fee $72.50 $ '7/ • 6- 0
Plan Review Fee 25% of Permit Fee $
State Surchar:e 8% of Permit Fee $ 5 _ ' ' a
(Please print name) TOTAL PERMIT FEE $ 7 $
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.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING ~ Inspection Line: (503) 175
INSPECTION DIVISION Business Line: (50 i` � 1
BUP
Received Date Requested V ° ( AM PM BUP Q�
Location 1 3 7-C IA Suite MEC `
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
I t -ath /Shear
at g ..d! t
r -1 '
` ^all ailing
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
Gas Line
Smoke Dampers
Fin.
i 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 Date 3 / 2 b 3 Inspector � - Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site
PASS PART FAIL