10575 SW NORTH DAKOTA STREET is viOwa HISON MS SLSOI
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10575 SW NORTH DAKOTA ST
r CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00656
13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 11/14/03
PARCEL: 1 S134DA-03900
SITE ADDRESS: 10575 SW NORTH DAKOTA ST
SUBDIVISION: VENTURA COURT ZONING: R-12
BLOCK: LOT:004 JURISDICTION: TIG
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:
r 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: Install pas fireplace insert,piping and I outlet.
'fir -- -----.
Owner: FEES
DIEDERICH, MORIAH Description Date Amount
10575 SW NORTH DAKOTA [MECH]Pemit Fee 11/14/03 $72.50
TIGARD, OR 97224
[TAX]8%State Surcharl 11114/03 $5.80
+�
Phone: .503-.-22-4151 X12? Total $78.30----
Contractor:
MUEHE QUALITY HEATING INC
PO BOX 9
WEST LINN, OR 9i'068 REQUIRED INSPECTIONS
Phone: 241-5927 Gas Line Insp
5 0966 Mechanicallnsp
Reg#: 50096 Final Inspection
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0 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 160 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:� 7 'f'J
Call(503) 639-4175 by 7:00 P.M.for Inspections needed a next bu�lnesa ay
Mechanical Permit Application Rxeve� Mecianical
Date B Permit No.: -C
CitOf Ti and Planning pru I Building
y g f Date/By: Permit No.:
13125 SW Nall Blvd. / Plan Rev,cw Other
Tigard,Oregon 97223 Dated : Perm t No.
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
_ _
Internet: www.ci.tigard.or.us Date/By Case No..
V Juns.: 1 0 See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method. 7/C_ Supplemental Inrorm,.Wom
TYPE OF WORK COMMERCIAL FEE•SCHEDULE-USE CHECKLIST
w Construction I Demolition Mechanical permit fees'are based on the total value of the work
Addition/alteration/replacement 1 Other: performed. Indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit.
I & 2-Family dwelling Commercial/Industrial value: S See Page 1 for Fee Schedule
Accessory Building__ Multi-Family_ RESroENTIALU1PMENT/SYST.EMS FYE'SCiAMULK
HDescription —I Qty I Fee ea. Total
Master Builder _ Other: — Hemtln&VtCoolio
JOB SITE INFORMATION and LOCATION _ Furnace-add-on air conditioning" 14.00
Job site address: 1 Of7j-7 5 Sw N_Q �„ �- Gas heat pump ~14.00
Suite#: B�Idg./A—pt.#: Duct work 14.00
Project Name: D ;e er ill_ p 'AH tunic hot waters stem _ 14.00
- -�--- Residential boiler
Cross street/Directions to job site: for radiator or h dronic system) 14.00
G� l 6V,2c1 tV TiC(Ar t,e.4vo t o Unit heaters(fuel,not electric)
U in wall,in-duct,suspended,etc. _ 14.00
N -1)x v-0�t4 Flue/vent for any of above) 10.00
Subdivision: Lot W. Other Fuel Appliances Repair units 12.15
-fax map/parcel #: water heater _ I0.00
DESCRIPTION OF WORK Gas fireplace I NSE RT10.00
_ 1- - AS Flue vent water heater/gas f lace) 10.00
Log lighter as 10.00
— —' — Wood/Pellet stove 10.00
-- Wood freplaco-Ansert _ 10.00
Chimney/liner/flue/vent 10.00
ROPERTY OWNER� Other: _ 10.00 ,
Name: uln (,s Eaviroomeatal Exhaast&Ventilation
+ I Q Range hood/other kitchen equipment 10.00
Address: S- 5,12 ,U. -
Cit /$talc/Zi Clothes dryer exhaust 10.00
Q2 9 7 Z Z`1 _ Single duct exhaust
Phone.503 lZZ_y ur, Fax: _ (bathrooms,toilet compartments,
171 APPLICANT I LiJMNTACT PERSON utility rooms) 6.80
Name: V.- 1;kt k Attic/crawls ace fans _ 10.00
Address: - _Other: 10.00
-- Fuel Piping
Cit /State/Zi : T,, 4 (( 3e '"(55.40 for first 4,$1.00 each additional
,- Furnace,etc. ••
Phone:�,,$- -- 7M Fax:5e, s7o L 9
Gas heat pump _ _ ••
E-mail: �•
Wall/suspended/unit heater
_ CONTRACTOR Water heater ••
Business Name:MU£N f_ Fire lace ••
Address Range
"
10 7 D l Suw Iclo r���- rn BBQ
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City/State/Zip: „ 4 Clothes dryer(gasL ••
Phone:5c,3 Z41- Fax:503-598 Ocher: ••
CCB Lic. Tocal:
Authored
Mechanical Permlt Fees*
i Subtotal: S _
Signature: Date: �I I Minimum Permit Fee$72.50 S
jZ T„,,,,�a_► Plan Review Fee(25%of Permit Fee) S
�(P'Iea�se'p11riintt triune) _ State Surcharge 8%of Permit Fee S p
_ TOTAL PERMIT FEE S -]
Notice: This permit application expires If n permit is not obtained within 'Fee methodology set by Trl-f*oanty Building Industry Service Board.
Igo days cher It has been accepted as complete. "Site plan required for exterior A/C units.
i\Dsts\Permit rorms\MecPermitApp.doc C V03
Mechanical Permit Application - City of Tigard -
Page 2 -Supplemental Information
Commercial Fee Schedule:
TOTAL VALUATION: PERMIT FEE:
$1.00 to$2,000.00 Minimrtm fee$72.50
$2,001.00 to$5,000.00 Y $72.50 for the first 52,000.00 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 510,000.00 and$1.35 for
each additional$100.00 or fraction:hereof,to
and including$50,000.00.
$50,001.00 to$100,000.00 $771.50 for the first 550,000.00 and 51.25 for
each additional$100.00 or fraction thereof,to
and includiqg$100,000.00.
$100,001.00 and up $1,396.50 for the first 5100,000.000 and
$1.10 for each additional S 100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of pl*ns.
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is\Building\Permit Forms\MecPermitAppPg2 09-01-03 der
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (603)635.4176 0
MST
INSPECTION DIVISION Business Line: (603)635.4171
SUP
Received — —Date Requested , A 160 / PM _ SUP
Location ____.�S Z�� —_, uite
Contact Person
Ph(---) /O ' 7 S( PLM
Contractor_ Ph( ) ___ SWR
BUILDING TenantlOwner . ELC
Footing ELC
Foundation IQ+C�eSg ""�"""�' ---------
Ftg Drain ELR _
Crawl Drain
Slab Inspection Notes:
Post 8 Beam
Shear Anchors ^ \
Ext Sheath/Shear
Int Sheath/Shear —
Framing -
Insulation
Drywall Nailing
Firewall
Fire Sprinkler `-
Fire Alarm
Susp'd Ceiling -- --
Roof
Other: — --- -
Final
PASS PART FAIL — — -
PLUMBING _
Post&Beam —
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains - — -- -�
Catch Basin/Manhole
Storm Drain -- -- --- --- AN
—
Shower Pan
Other: -
Final —
PASS_PART FAIL -
MECHANICAL
Post&Beam
0 1 _ —
QimEampers --
1-
N SS PART FAIL --
E RICAL
Se ice
LO Rough-In
0 UG/Slab
W Low Voltage
Fire Alarm
Final C-� Reinspection fee of$. required before next inspection. Pay at City Hall, 13125 SW Hall Alvd.
PASS PART FAIL
SITE -- --- — U Please call for reinspection RE:_ —_ n Unable to inspect--no access
Fire Supply Line A ��
ADA il�.b— \, /2 1 `!✓_!�_—.
Approach/Sidewalk nspeakee- -- Lid
-
Other:
Final DO NOT REMOVE thls Insp*Won record from the job sib.
PASS PART FAIL
I