13711 SW LAUREN LANE-1 �1
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13711 %1 LAUREN LN ,r
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MECHANICAL PERMIT
CITY OF TIGARD
DEVELOPMENT SERVICES PERMIT#: MEC2004-00175
13125 SW Hall Blvd., T igard, OR 91223 (503) 639-4171 DATE ISSUED: 4/7/04
PARCEL: 2S104CA-02000
SITE ADDRESS: '13711 SW LAUREN LN
SUBDIVISION: HILLSHiRE ZONING: R-7
BLOCK: LOT: 020 .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: 1
STORIES: BOILERSICOMPRESSORS _ HOODS:
FUEL TYPES _ _ 0 3 HP: i DOMES. INCIN:
l p, 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS Pi!ESSURE: 50 i HP: "LO DRYERS: I
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 100(10 cfm: GAS OUTLETS: 1
> 10000 cfm:
Rernarks: Uas piping anal outlet for(Iryer• fireplace insert, has existing pipingioutler.
Owner: _ _FEES
MARCH, HENRY Description Datc Amount
13711 SW LAUREN LN III Ilerniit fee 4/7104 $72.10
TIGARD, OR 97223
ITA X 1 `;°„state SureharF 4/7104 $5.80
Phone: 503-590-5987 Total $78.30-_�
Contractor:
I It)LMES INSTALLATION SERVICE
RAYMuND FLANDERS
33535 NW VADIS ROAD _REQUIRED INSPECTIONS _
CORNELIUS, OR 97113
Phone: 647-9320 Misc.
Line Insp
Misc. Inspection
Reg#: LIC 102473 f=inal Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will he done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
Issued By: vL.t/'i� �.�-,-�c� It, Perinittee Signature: � _ %4-4
Call (503) 639-4175 by 7:00 P.M. for inspections needed t e next business; day
Mechanical Permit Application FOR OFFICE ILISE ONLY
City Ill 11gard Date/Byd Permit No �i�i
13125 SW H,::!triad.,Tigard,CR 97223 Plan Itcvtc
Phone: 503.639.417i Fax: )03.598.1960 n Date/Iiy Other Parent
Inspection Line: 503.639,4175 Date Ready4ly: luris m ser rage z to.
Internet: www,ci.tigard.or us Notified/Melliod: �j Supplemental Infornu,t!on
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition/alter&.on/replacement — Mechanical permit fees'are based on the value ol'the work
performed. Indicate the value(rounded to the nearest dollar)of all
❑Dcnloliti m ❑Other: mechanical materials,equipment,labor,overheud,and rofit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES'
I-end 2•fantily dwelling ❑Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi-family ❑Master builder ❑Other: Description Qty. Fa. Total
JOB SITE INFORMATION AND LOCATION Heatin coolie
Y c�t/ Air conditioning or heat pump
Job site address: 3I
SkJ C:v (requires site plan showing placement 14.00
City/Slate/ZIP: \ C* IE' s f� r`` Furnace 111,100 bTU(ductsrve ns) 14.00
Furnace 100,000+BTU ducts/vents 17.90
Suite/bldg./apt.no.: Project name: Gas heat puly 14.00
Cross street/directions to job site: Duct work 14.00
M dronic hot water system 14.00
Residentiol boiler(radiator or
h dronic) 14.00
Unit heaters(fuei-type,not electric),
in-wall,in-duct,suspended,etc. 10.00
Subdivision: Lot no.: Flue/vent for any of above 10=;.o
00
Other: _ 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK — Water heater 10.00
Gas fireplace �� 10.0( I _
e�1157 iVAI C , +�r_/Z tiL (j� ) �e y c'rL.._ Flue vent for water healer or gas I
C ✓� �lM F'V' (C �... �NSt l fire lace 10.00
f-'r'
Lo lighter(gas) 10.00
Wood/pellet stove _ 10.00
Wood fireplace/insert 10.00
PROPERTY OWNER rJ TENANT Chi mne /liner/flue/vent 10.00
_ IU.UO
Name: Y•IN j- ov` rC Environmental exhaust and ventilation
--4-- Range hood/other kit.hen
Address: 7 ( ( S`� R t'�► `/�/ equipment 10.00
-
Ci /State/Zils: G ? Clothes dryer exhaust 10.00 —
tY �r� r , Z ` Single-duct exhaust(bathrooms,
Phone: � ) ro Fast:( ) toilet compartments,utility rooms) 6.80
❑ ANPLICANT ❑ CONTACT PERSON Attic/crawls ace fans 10.00 -
- Other: 10.00
Business name:
Fuel piping
Contact name: $3.40 for first four;$1.00 for each additional
Address: Y` Furnace,etc. _
Gas heat pump
City/Stale/ZIP: Wall/suspended/unit heater
Phone:( ) f Fax::( ) Water heater
Fire lace
E-mail: Range
CONTRACTOR Barbecue
Business name: p �N.tt•s' xv5-Ta(( cw: Clothes dryer was)
Other: _
Address: 7�?s`/J(•�/ V tl�1) t-5 t" __ MECHANICAL PERMIT FEES*
City/State/ZIPf V R o e t vyi;+ � 7( � --
_ Subtotal
--� _ Minimum permit fee($72.50) _
Phone: L1 ) 2�62 �� Fax ( ) Plan review(25%of permit fee)
CCB lic.: d State surcharge(8%of permit fee)
—7 — TOTAL
PERMIT FEE
/
Authorized signature This permit application expires Ifo permit Is not obtained within IN
e `'� days after It has been accepted as complete.
Print name: C� _ 'G t'�—,f _bate: 7 Fac methodology set by Tri-County Building Industry Service Board
itaundinalPemJtstMACPm,tltAppdoc 12/01 440.1617T(I1/02/170M/wEB)
Mechanical Permit Appiiu tion - 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$5,000.00p $72.50 for the tirit$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
$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,J00.00 $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
$t :0 for each additional$100.00 or
fraction thercof.
Note: All new commercial buildings require 2 sets of plans.
i:\Building\Permits\NEC-PermitApp.do. 12/03 2
CITY OF TIOARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
BUP
�//��,,
Received Date Reque ted __ / � AM _-_—_ Ph` BLIP
Location L, '7L� � Suite
Contact Person --- At"� & C4x Ph —
Contractor
----- ---- �.------- ----- -.-- Ph(—) — - ---- SWR
BUILDING Tenant/Owner _- ELC _ (I)i'. •�---
--Footing ---- -------- --- —
Foundation ELC --------.-_-__--
Fog Drain Access:
ELR
Crawl Drair. _
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors C a-u YZ D LIZ
Ext Sheath/Shear -AWL
Int Sheath/Shear -
Frarnin9 ----
insulation ,
DrywallNailir,e _-=' ��L / �i. i'i svi _�i. _ G/7�vL/L�✓�JCi+T
Firewall '
Fire Sprinkler -__--
Fire Alarm
Susp'd Ceiling - - ------ -----
Roof
Other: - -- - ---
Pinel - ---_
PASS PART FAIL
PLUMBINQ - ---
Post& Beam
Under Slab
Rough-In
Water Service - - -- -- - ----- -
Sanitary Sewer
Rain Drains - --
Catch Basin/Manhole
Storm Drain - ----
Shower Pan
Other: _.....-. . -------- - - -- - --
Final - -
_ PASS PAW FAIL
- _-- - -_
_IVfEC ANIC
Posf�.�in
Rough-In
Gas L_Darri`e ���� -- - ----
mo )(,rs - ----
__9_--PART FAIL
ELECTRICAL
Service — -
RoL gh-In
UG/Slab -- ---- _
Low Voltage
-- ----- ----
Fire Alarm -- --- - --- -- -Final Cl Reinspection tee of$_ required before next inspection. Pay at City Hall. 13125 SW Hall Blvd.
PASS PART FAIL_
SITE Plaase call for reinspection RE:- I_� Unable to inspect -no access
Fire Supply Line
ADA •_
Approach/Sidewalk Date Inspector r-- ��–�---- Inspector
Er..
Other:_
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL