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Permit . -. 1 C DT Y TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2005 -00637 . DATE ISSUED: 10/7/2005 - ` 1 3125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 104AA -00300 SITE ADDRESS: 12665 SW 127TH AVE ZONING: R -4.5 SUBDIVISION: BELLWOOD LOT: 052 JURISDICTION: TIG Project Description: Furnace, AC, gas piping. 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: 1 DOMES. INCIN: GAS 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: 1 AIR HANDLING 'UNITS OTHER UNITS: FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Owner: FEES CROMWELL, SAMUEL T Description Date Amount MARGARET T ATH [MECH] Permit Fee 10/7/200E $72.50 12665 S SW , OR 97223 [TAX] 8% State Surchar€ 10/7/200E $5.80 Total $78.30 Phone: 503 - 590 - 3209 Contractor: WILLAMETTE HEATING & AIR CONDITION! 4370 NE HALSEY ST REQUIRED ITEMS AND REPORTS PORTLAND, OR 97213 -1566 Phone: 503 284 - 3740 Reg #: LIC 154438 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 i n 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503- 246 -6699 or 1- 800 - 332 -2344. Issued By: • ,A , 4 r7 Permittee Signature: Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. .a MechanP:al Permit i 4 , a r : s; a vsf C —� t ` , , �� avd , :� I))S ONi l a r4 , 'tcr ,� , , a . 9 ` �' g Date/By l o /D S �g Permit No.: 6�— 0er 63 7 Ci of Ti a nd 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.19�`T 0 2005 /�m, Date/By. Other Permit: Inspection Line: 503.639.4175 Date e Ready/By: - chtree ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: upplementalInformation ( C , I t T _ CITY OF TIGARD ON °` B ' f1'E�E I Or WORK . COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction ,. Addition/alteration/replacement Mechanical permit fees* are based on the value of the work ' performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ l`- - and 2 dwelling . RESIDENTIAL EQUIPMENT / SYSTEMS FEES* . ' y g ❑ Commercial /industrial ❑ Ac cessory building For special information use checklist. ❑ Multi family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total - JOB SITE INFORMATION AND LOCATION- • - Heating/cooling Job site address: Air conditioning or heat pump y y �/C ^� L 7 (requires site plan showing placement) i 14.00 City /State /ZIP: Furnace 100,000 BTU (ducts/vents) 1 14.00 Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17.90 Gas heat pump 14.00 Cross street /directions to job site: Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 q ' " . �f,Q� --G / C / � ( Flue vent for water heater or gas / 9 fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 / ❑ PROPERTY OWNER I ❑ .TENANT - Chimney /liner /fiue/vent 10.00 S: 10.00 Name: r c — - ` � (��� f Environmental exhaust and ventilation Address: CJ Range hood/other kitchen equipment 10.00 City /State /ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT. PERSON ' . Attic/crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. 1 Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range . CONTRACTOR ACTOR Barbecue "�� Business name: i , 1��� e _ ""©' / Clothes dryer (gas) Other: Address: ? /�j J -���C� MECHANICAL PERM FEES* ' City /State /ZIP: p 6 , ,, (/' Subtotal Minimum permit fee ($72.50) Phone: ( `, Q �j 5' Fax: ( ) �'C /1 `7 / Plan review (25% of permit fee) CCB lic.: , � �y323 L,_ I on State surcharge (8% of permit fee) / TOTAL PERMIT FEE Print name Slgna[ule: This permit application expires if a permit is not obtained within 180 / days after it has been accepted as complete. Print name: �ee ' "5t ` / / Dater 6 //� * Fee methodology set by Tri- County Building Industry Service Board 1:\ Building \Permits\MEC- PermitApp.doc 12/03 • V 440 -4617T ( I /02/C Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: • Total Valuations - 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 $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 $100,000.00 $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. _ $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. is\ Buildin \Permits\MEC- PermitApp.doc 12/03 2 CITY OF TIGARD BUILDING DIVISION PERMIT #: MEC200S -00637 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/7/200; Phone: (503) 639 -4171 IC Inspection Requests (24 Hrs.): (503) 639 -4175 F - -.. INSPECTION WORKSHEET FOR DATE: 10/10/2005 TIME: 7:O4AM PAGE: 101 UM n/v l ' 7,5. SITE ADDRESS: 12665 SW 127TH AVE CLASS OF WORK: SUBDIVISION: BELLWOOD LOT #: 052 TYPE OF USE: PROJECT NAME: CROMWELL DESCRIPTION: Furnace, AC, { as piping. OWNER: CROMWELL, SAMUEL T, PHONE #: 603- 590 -3209 CONTRACTOR: WILLAMETTE HEATING & AIR CONDITION! PHONE #: 503.284 -3740 Inspection Request Scheduled For: Date: 10/10 /2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 017849.01 503 - 803-7074 N Corrections /Comments/ Instructions: 6 L/AJ � '7) /3' - r" - ^ gi PASS % P RTIAL APPROVAL n CANCEL n NO ACCESS I I FAIL C i L FOR INSPECTION n ADDITIONAL FEES ASSESSED .- / Inspector: _ ■ ---••••■--- Date: /0/0 #: (503) 718- ` A-1 P \ • or ‘kz-,