Permit CITY OF TIGARD
MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00592
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/3/2008
PARCEL: 2S112DC - 01500
SITE ADDRESS: 15757 SW 74TH AVE 530 ZONING: I -P
SUBDIVISION: FANNO CREEK ACRE TRACTS LOT: 006 JURISDICTION: TIG
PROJECT: BRAND
Project Description: Installing (2) double - wall flues and 9 ft. of gas line.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: C ODSTOVES:
CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 2
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
JACK BRAND Description Date Amount
15757 SW 74TH AVE 530
TIGARD, OR 97224 [MECH] Permit Fee 12/3/200€ $72.50
[TAX] 12% State Surch 12/3/200E $8.70
Total $81.20
Phone:
Contractor:
NORTHWEST COOLING
21420 NW NICHOLAS CT
HILLSBORO, OR 97123 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 317 -0308
FAX 503- 746 -7526
Reg #: LIC 105911
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 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss d By: k _ //, Permittee Signature: / i
Call 503.639.4175 by 7:00 a.m. for inspections t at buss
This permit card shall be kept in a conspicuous place on the job sit until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application ` - FOR OFFICE USE ONLY
Cllr Of Tigard Date/By:
Permit No.: 4 , • �-
II y
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.5' l;14 D a t e /By: / Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: ® See Page 2 for
Internet: www.tigard - or.gov Z008
Notified /Method: Supplemental Information
DEC o
TYPE O F' WO - G ' C FEE* 'SCHEDULE -- USE CHECKLIST
❑ New construction )10 Addition /�} t ,s,. sl�oi *c, ION Mechanical permit fees* are based on the value of the work
D 1lL�V ► ►1` performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
"CATEGORY OF CONSTRUCTION • `. `. .. Value $ 1 0 cud
`'RESIDENTIAL EQUIPMENT / SYSTEMS:FEES*
❑ 1- and 2- family dwelling ommercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
` JOB S ITE INFORMATION AND 'LOCATION.. ,. - Heating/cooling
Job site address: / j 7s7 ‹zz .7K A 3 V Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: 6A/t',v Furnace 100,000 BTU (ducts /vents) 14.00
` Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: g"/v/p Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
LC//!fi/9 /X Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
' DESCRIPTION OF WORKS .
Water heater 10.00
Gas fireplace 10.00
/7.0.D/4/‘ ? ll ,6'1/7- Flue vent for water heater or gas
1�rE.S7i' 74V /70‘05/ ZL HOC'S L l igh �- 10.00 .0
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: JcA X � A .,t/ Z7 • Environmental exhaust and ventilation
Range hood /other kitchen
Address: 75-757 S4/ 70i if L, equipment 10.00
City /State /ZIP: 77- /' 4, O Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
„ :. [PPLICANT ` . -- „CI „CI CONTACT PERSON ' i Attic /crawlspace fans 10.00
Business name: / l elf Ca j h Other: 10.00
OD / / Fuel piping
-
Contact name: , / / Z � a �3e/� $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: 2 /5/-7 p 7 o /Vie/ y A // 1 c2 4s 7 Gas heat pump
4'
City /State /ZIP: tLS q/
"Wei 0 iii / / -3 Wall /suspended /unit heater
Phone: (3 ) Y /7 -D 3 0 g Fax: : (515) 7(/�_� ,2‘ Water heater
�/' , / /� , � 7 / Fireplace
E-mail: /Y Gf1 e, oz,,,( 6i ( 0n -'✓lCO - 5 / / Y 1' 7--
Range
CONTRACTOR - - Barbecue
�/ Clothes dryer (gas)
Business name:
/J/ f �DO1I1(16 �/ Other: �L CJ
Address: e90( 74 ,-- - 1. � , .o MEGIIANICAL PERMIT,:FEES*
City /State /ZIP: /-- &
b C l I / �,- � -77d-3 Subtotal
f Minimum permit fee ($72.50) 79
Phone _��� Fax: ( ) Plan review (25% of pernut fee)
CCB Iic.: t0s State surcharge (12% of permit fee) .-�
/ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete. e'
Print name: � 4oted.,L7 Date: IZ 3 * Fee methodology set by Tri- County Building Industry Service Board
C\Buitding\Permits\MEC- PermitApp.doc 01/19/07 44 461 (I1 /02 /COM /WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Totar Valuation: .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.
•
1:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MFC2008.00692
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 17J312OO8
Phone: (503) 639 -4171 4040 i f
Inspection Requests (24 Hrs.): (503) 639 -4175 R 'IL.
INSPECTION WORKSHEET FOR DATE: 17/412008 TIME: 7 PAGE: 5
SITE ADDRESS: 15757 SW 74TH AVE 530 CLASS OF WORK:
SUBDIVISION: FANNO CREEK ACRE TRACTS LOT #: 006 TYPE OF USE:
PROJECT NAME: I3PAND
DESCRIPTION: Installing (2) double - wall flues and 9 ft. of gas line.
OWNER: BRAND, JACK PHONE #:
CONTRACTOR: NORTHWEST COOLING PHONE #: 603,.317 -0308
Inspection Request Scheduled For: Date: 12/4/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 078795-01 503-317 -0308 N
Corrections /Comments/ Instructions:
�' ' ,--, M PARTIAL APPROVAL El CANCEL 0 NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-