15750 SW HIGHLAND COURT Ln
u,
0
u•
z
�o
w
CL
C-)
0
c
h
c+
frr
1�
,amoz) ciNv, (4,)tH „'is
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMT1
13125 SW Hall Blvd,, Tigard, OR 97223 (503)639-4171 1,� RMTT #. . . . . . . Pl.-M97-008S
")PTF ISMIFl)- 0',/ F,/97
r-,P p(7F*V.: Q,6 1 1. 08100
701%1JNG-,- P-7
.. . . . . .. . . . . P-97 f1JFRTS*1)T(7TJ1'11N4.- TJG
GARPAGF r F.,rnpiv-s. 0 MOBILE HOW`
SP WA9HING MPC'i-1. . . . .. lb TIACKFI...OW r,RFIJNTRI,;. .
F-LOOR DPA TN!=,. . . . r P.P,qj. . . . . . . . . . . .
0 WATT P N=r-'I'T r-"R R. 0 17P7 7H RPc3TNG. 0
LAUNDRY TRfWG. 17t '.-IF K11\1 DRF)TW3. . . p V,
Up'11\1r.11, Ci. 0 f-3 R(7 A E T p P r,r)
F)PI T r-" 0 0-THl?P t- 1-Y'r1.JPFP3. . . 171
RAIN DRPJ'�'l ( N- ) . 0
ri n '�Jp(myji hv fJ,� t?
010, .T^T) 0—"/P,0/97 -c:--,
0. Aim—
pervit is issittO sub,,ect to the regulations contained in the I
Cede, State of Ore, Spp!!ijjty Cc-des and ill other
�icablp laws. All work will be done in accordance with Tnp—clilt 71
Will ave;— work is not started
tisuendod for tore
CITY OF TI 1ARU Plumbing Application RecaBv �'�
13125 SW HALL BLVD. Commercial and Residential nate Recd G-j zc" �
TIGAFr,, OR 97223 ^ate top E
cr
5031 639-•1171 Pe(mits
Print or Type Related SLUR I
Incomplete or illegible applications will not be accepted ailed—
Name it"evelopmentrProlect FIXTURES (individual) QTY PRICE AMT
Job I :� Sink 900
I �—
Address St.-Pet lavatory eet address Suite 9 00
,r czff �) .— ru0 or ruDrShower Como I 9 G0
3t:q s ��- CdyiState Shower Univ _- 9 00
r, —
f r �� V
Water Closet
.Name 9 00
Z Dishwasher E900
Owner
Garoage Disposal �- 900
Mailing address_ Suite �
�� !� Washinq Macnine I 9 00
i
C.av,SiatePhore Floor Drain --- 2- 900
i
J' —� 900
Name
a �._,-0:0:00
Water Neater
� Occupant Mailing address Suite - 900
— Laundry Room Tray 9.00
City,state Zip I Unnal
Name 9,
Other Fixtures ISneuty00
l g 00
� , '- _
900
Contractor M g Address _ Suite 900
W-3117& goo
iPnor ro issuance citvistateZip Phone I 9.00
3orticant must -�-- 0
�,' 4 i ---r--
Drovide ail Oregon - tst Cont. bard Exp Date - - 9 00
contractors 900
i license Plumbing I_ic.• Exp. Date Sewer-1st 100• d0.0o
I n(ormation �e Sewer•each additional 100' 25 00
:or COT COT?usmess ax or Metro s Exp ate
database). Water Service- t st 100' 3000
Name rater Service•each acedtonai 200 — 25 J0
Architect Storm 3 Ram Drain. '.st 100' - 3000
or Mailing address I Suite Storm A Rain Drain-each additional 100' 2500 I
Engineer tyiState Z; Phare Mobile Home Space 25 00 ! i
Commeraal Baur=ow t'revenuon Cevice or Anti-
Pollution Device
Oes.: oe work— New AcaaDon Alteration C RecairResidential Bacx1ow 0•evention 2evice' I :5 )o i
to re acre Residentiai O Von-residential V I1 —
---•••----��J � Ary 'r 3p or�.4as;e`tot Connected to a=fixture I I 900
�ccr onai deau:Dtion
of worn _
Gatoil 3asin I 3'0
i
nso or Existing:umoing I I s0 00 -
perrhr
'xist:rg use of
Sceraaily Requested Insoections a0 00
� _
ldirg or erooerty ^ xchr
�- ---- _ =ain rain s.ng.e`am r+C•xellirg - { 30 -0
cocsed use of Grease Traps I I g CO
uiidmg or prooerty_-
_ - QUANTITY TOTAL Ij
are ..:u caoorg moving or reciacing any fixtures' Yes No - Istxretrc x^sit a s�rarr. s� cuved f_uar y-.tai s >? {
itf yes see back of form) - 'SLI9TOTAl. i
^e'eay arxr.owieoge;hat 'lave read this appucation that'he mfomialion
5% SURCHARGE
:-Yell s correct that I am'lie owrer or 3uthonted agent of;he owrer and
:ha clans sucmitted are - _:mca n with Crtvon State Laws.
Signature of Own1enAge C Date PLAN REVIEW 25%OF SUBTOTAL
�' � �ecur!o r+ry f 5rure;rr •rsi s_>? ,,-�/
_oLC_L� I --- TOTAL I— V'
' ntPerson
act Name Phone
Minimum permit tee s 525 - 5%surcharge except Pesieential Backflow
Prevernon Cevice. which is S15-5%surcharge
fists olninv doc 1M
LEASE COMPLETE AS AP_Pa PR'.ATE TO PROJECT:
j Fixtures to be capped, moved or replaced Qty
� Sink
'LLavatory
Tub or Tub/Shower Combination
Shower Only ^+
[Water Closet
_Dishwasher
Garbage Disposal
j Washing Machine—
Floor Drain 2"
Water Heater _
Laundry Room Tray
Urinal_
Other Fixtures (Specify)
30MMENTS REGARDING ABOVE:
CI1,Y OF T I G A R D MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00357
13125 SW Hall Blvd., Tigard, OR .97223 (503) 639-4171 DATE ISSUED: 6/30/03
PARCEL: 2S110DD-08100
SITE ADDRESS: 15750 SW HIGHLAND C-T
SUBDIVISION: SUMMERFIELD NO.6 ZONING: R-7
BLOCK: LOT: 297 JURISDICTION: 1 I1
CLASS OF WORK: O'rR FLOOR TURN: EVAP COOLERS:
TYNE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 0 _ BOILERS/COMPRESSORS_ HOODS:
FU_ EL TYPES 0 - 3 HP: — DOMES. INCIN:
I PG 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAIR UNITS.
FIRE DAMPERS?: 30 - 50 HP:
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: Replace gas lireplace w/direct vent gas !ircplacc.
Owner: FEES
HANK HESS Description —Date `Amount
15750 SW HIGHLAND CT
TIGARD, OR 9723 �MG6/30/03 $72.50
TAX] 8° 5tate'Fa.r 6/30103 $5.80
Phone: 50.1-62.71 7?62 Total $78.30
Contractor:
FIRELIGHT LLC
17690 NE HILLSBORO HWY
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone: X03-554-0891 Mechanicallnsp
Final Inspection
Rsg #: LIC 148689
This permit is issued subject to the regulations contained it the Tigard Municipal Code, State of Ore. Specialty Codes
end all other applicable laws. All worts will be done in accerdar ce 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 18u days. ATTENTION: Oregon law
requires you la follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
1
Issued By: 1 f Permittee Signature:
Call (503)09-4175 by 7:00 P.M. for inspections neede a next business day
Mq1 allicai Permit Application ' ' 1Q, USF ONLA,
�. �... ^.,�...� Received /j hh Mcchanwell
B
Date : GIJ Q/ Permit No.: 7
It of Ti i1Cd Planning App al Building
y g Data/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Da*B : I Permit No.:
Phone: 503-6394171 Fax: 503-598-1960 Post-Review land Use
Date/By: _ Case No.:
Internet: www.ci.tigard.or.us Contact -J- See Page 2 for
24-hour inspection Request: 50:3-6394175 Name/Method: Su elemental 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/re Ip acement 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
-F
Accessory Buildin ] Multi-Family RESIDENTIAL EQUIPMENT/SYSTEMS 'E*SCHEDULE
LE
T Qty Fce ea. "total
Master Builder Other: _ — HentInSWIConlin
JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning** 14.00
Job site address: � �?�' r ✓/h� F. � Gas heat u!np _14.00
Suite#: I Bld ./A t.#__ Duct work 14.00
Project Name: -- H dronic hot waters stem 14.00
job site: Residential boiler
Cross street/Directions to
J for radiator or h dronic 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: o,,,,,r.- 4 e/._t_ _Lot#: Repair units 12.15
Tax ma / steel#: outer Fuel Appliances
1�P _.T Water heater 10.00
DESCRIPTION OF WORK _ Gas fireplace 10.00 0 •w
u ,c ! !.u^ t e Flue vent water heater! as fireplace) 10.00 , y
lighter as
W - 10.00
Wood/Pellet stove 10.00
Wood fire lace/insert _ 10.00
Chimney/liner/fiue/vent 10.00
PROPERTY OWNER . I�[ TENANT _- Other: _- 10.00
Name: Environmental Exhau..A Ventilation
----f=- �' Range hood/other kitchen equipment 10.00
Address: lr15z /«.��% c'-f --
-1, Clothes dryer exhaust 10.00
City/State/Zip: 72 Z Single duct exhaust
Phone: G -' I Z -—T—Fax: _ (bathrooms,toilet compartments,
APPLIC_A_NT CONTACT VERSON utility rooms) 6.80
Name Attic/crawl space fans 10.00
Address:
-� - �-- Other: 10.00
__--__- - _-- —_---------,_� Fuel Piping
City/State/Zip: _ **($5.40 for first 4 $1.00 each additional
Furnace,etc.
Phone: d't - Gas heat pump *•
E-mail: --M _ _ _ Wall/suspended/unit heater '•
CONTRACTOR Water heater "
Business Name: ( rt(r' L c: Fireplace •' -
Address' ATotal.-
Authori7.ed
tix� 2 $ figeCit /State/Zi C.2 1 z —p' 1ti� �� {� T Clothes dr er as' FaX' Other, -�� --Phone: 56,' 55th-t' 1��CCB Lic. #: 1f r/ �,��j Mechanical Permit Fees*
Signature: 2�J��f� Date: (i U 3 - _ Subtotal: S
—T Minimum Permit Fee$72.50 $ z . Sv
_l_1 f/n _ Plan Review Fee 25%of Permit Fee $ _
- -- -� - State Surcharge(8%of Permit Fee $
(Please print Hanle) _ TOTAL PERMIT FEE $
Notice: This permit application expires if a permit Is not obtained within *Fre methodology set by Trl-County Building Industry Service Board.
Igo days after It has been accepted as complete. "Site plan required for exterior A/C units.
i:lDstAPermit Forms\MecPemutApp.doc 01103
Mechanical Permit Application - City of Tigard
Page 2- Supplemental Information •
Commercial Pee Schedule: _
Total Valuation: _Permit:Fee: _
$1.00 to$5,000.00 Minimum fee$72.50
55,001.00 to$10,000.00 $72.50 for the first 55,000.00 and$1.52
for each additional$100.00 or fraction
thereof,to and including$10,000.00.
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and
$1.54 for each additional$100.00 or
fraction thereof,to and including
$25,000.00.
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and
$1.45 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,001,00 and up $742.00 for the first$50,00000 and
$1.20 for each additional$100.00 or
fraction thereof.
Assumed Valuations Per Ap Bance:
_-- -- -- - Value 'fnlal
Description. Qty (Ea) Amount
Furnace to 100,000 BTU,including 955
ducts&vents
Furnace> 100,000 BTU including ducts 1,170
&vents
Floor furnace including vent 955
Suspended heater,wall heater or floor 955
mounted heaW
Vent not included in appliance permit _ 445
Repair units 805
<3 hp;absorb.unit, 955
to 100k BTU
3.15 lap;absorb.unit, 1,700
101k to 500k BTU
15-30 hp;absorb.unit,501k to I mil 2,310
BTU
30-50 hp;absorb.unit, 3,400
1-1.75 mil.BTU
>50 hp;absorK unit, 5,725
>1.75 mu.dfU
Air handiting unit to 10,000 cfm 656
Air handling unit>10,000 cfin 1,170
Non-portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mec;ianical Uhaust 656 _
Domestic incinerator 1 170
Commercial or industrial incinerator 4,590
Other unit,including wood stoves, 656
inserts,etc. _
Gas pipiog 14 outlets 360
Hach additional outlet 63
TOTAL,COMMERCIAL $
VALUATION:
i\Dsts\Permit Forma\Mecf ermitApppr2.doc 01101
CITY OF TIGARD 24-liour
BUILDING Inspection Line: (503) 639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171
7 BUP --
Received —_ _ ._ Date Requested AM. PM SUP _-
Location _ `� ��� p� (?_& Suite MEC -
Contact Person ___ - Ph(__ ) PLM
Contractor -__ Ph(--) -
Cc
'- s _Af SWR
BUILDING FP,nanVOwner ����L L- - 7a - ELC --
Footing ELC
Foundation Access: ELF!
Ftg Drain
Crawl Drain SIT--
Slab Inspection Notes: SIT
Post& 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
---
Post&Beam
Under Slah —�
Rough-In
Water Service
Sanitary Sewer
Rain Drains --
Catch Basin/Manhole
Storm Drain - ---
Shower Pan _
Other: -------- --
Final
PASS PART FAIL
MECHANICAL - --
Post& Beam
Rough-In �eq Gas Line
Dampers -- - ----
C6S7 PART FAIL
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage --- --- -- _ -- _
Fire Alarm
Final C] Reinspection fee e, $_--— _.._._._ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_PASS PART FAIL
SITE Please call for reinspection RE: 4 _— E] Unable to inspect-no access
Fire Supply Line
ADA 7
Approach/Sidewalk Date _ +L Inspector fact-
Other:--._.-.T------
rinal DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL