Permit C ITY OF TIGARD MECHANICAL PERMIT
, DEVELOPMENT SERVICES O' PERMIT #: MEC2000 -00024
1 DATE ISSUED: 1 /20/00
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 PARCEL: 1S125DA-00601
SITE ADDRESS: 09975 SW 65TH AVE
SUBDIVISION: 44'
ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR 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:
WOD 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: 1
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of woodstove and new chimney system.
Owner: FEES
SMITH, GARY C + ANNE H Type By Date Amount Receipt
11275 SW WALNUT ST PRMT DEB 1/20/00 $50.00 00- 321279
TIGARD, OR 97223 5PCT DEB 1/20/00 $4.00 00- 321279
Total $54.00
Phone:
Contractor:
TOM BISHOP CONSTRUCTION
11525 SW CANYON
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Woodstove Insp
Phone: 503- 626 -4652 Final Inspection
Reg #: LIC 00054696 r @@
E ti 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 N 1 - enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You y o btain copi: of the rul.�. or d' ect questions to OUNC by calling (503) 6 -9189. .
Issu By: / / L /_ � AA" //&,/,./ Permittee Signature: � ,( ,, y r ' 1, ��
Call (50 .39 -4175 by 7:00 P.M. for inspections needed the next siness day
CITY OF TIGARD Mechanical Permit Application Plan C
pp Recd y- ,
13125 SW HALL BLVD. Commercial and Residential RECEIVED Date Recd / as
TIGARD, OR 97223 Dots to P.E. -
(503) 639 -4171, x304 JAN 2 0 2Q00 Date to DST
I Print or Type Permit# Hica,0o - 60ea 4
Incomplete or illegible applications will not �beNacc ep t ePaENr card
Name of Development/Project Description
Table 1A Mechanical Code • Price Amt
Job ` S treet Address Suitefr A) Permit Fee ;; 16.00
Address cfq5 51..6 est. 1) Fumace to 100,000 BTU
including ducts & vents see footnote 1,2 9.65
Bldg# City/State Zip 2) Fumace 100,000 BTU+
including ducts & vents see footnote 1,2 12.00
Name (or name of business) 3) Floor Fumace
OWne C _ _ i ` G Q k l- including vent see footnote 1,2 9.65
Mailing Address 1 e 4) Suspended heater, wall heater
/� q n or floor mounted heater see footnote 1,2 9.65
' 5 s1._) Cos-EL. 5) Vent not included in appliance rmit 4.75
City/State Zip Phone Check all that apply: *Boiler Heat Air
T i c ct r (, 0 Y q 19 (av - /63,,, For items 6 see or Pump Cond Qty Price Amt
- Na or name of business) footnotes 1,2 Comp
• !/ 4 6) <3HP;absorb unit to
��� WI - 100K BTU I 9.65
Occupant Mailing Address 7) 3-15 HP;absorb unit
100k to 500k BTU 17.65
City /State Zip Phone 8) 15-30 HP; absorb
unit .5 -1 mil BTU 24.15
Contractor Name 9) 30-50 HP; absorb
unit 1 -1.75 mil BTU 36.00
Jbv i1 q ivp (04al -rac /Gt- 10) >50HP; absorb unit
Prior to rmit M Ding Address >1.75 mil BTU 60.15
issuance, //5 95 gl frl d 11 Air handling unit to 10,000 CFM
of all licenses State / Zip Phone , / 7.00
are required if � C--L,'� �U ✓t 0 7 6C(G' t 0 S 3, 12) Air • handling unit 10,000 CFM+
expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 11.75 _
database. ' , (e94-, 13) Non-portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
or 1 Mailing Address 4.75
15) Ventilation system not included in
appliance permit 7.00
Engineer City/State Zip 1 Phone 16) Hood served by mechanical exhaust
7.00
Desc be work to be done: 17) Domestic incinerators
12.00
New 0 Re air Replace with like kind: Yes 0 No O 18) Commercial or industrial type incinerator
Residential Commercial0 48.25
19) Repair units 1
Additional information or description of works nn II i 8.40
j j � 4c- )1
L. 1 1.6 vv v12, SL 5 d2 Po 20) Wood stove/gas FP /other units/clothe dryer /etc. I 7
7.00 04) NOTE: For Commercial projects only; Units over 400 lbs. re iuire 21) Gas piping one to four outlets
structural gas calcs. See footnote 1 3.75
Type of fuel: oil 0 natural gas 0 LPG 0 electric O 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 SUBTOTAL O
I hereby acknowledge that I have read this application, that the information j if % SURCHARGE 111.00 •
given is correct, that 1 am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL
the owner, that 1 sub itted are in compliance with Oregon State laws. Required for ALL commercial permits only
TOTAL „/� _
Signature, nt Date °7 _
ALA./IL/0 � � - Other Inspections and Fees:
' / ` -�� 1. Inspections outside of normal business hours (mininum charge-two
Co - = rso " , e Phone hours) $50.00 per hour
2 . Inspections for which no fee Is specifically Indicated (minimum
Q t/� LA I.� r 1ti 7 _ C1J - '-j J Q_____ charge -half hour) $50.00 per hour
Foonotes for 4mmercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge-one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical
units. *State Contractor Boiler Certification required
**Residential NC requires site plan showing placement of unit
v
1:1mechpern.doc rev 02/4/99 EXPIRED D