Permit CITY OF TIGARD MECHANICAL PERMIT
1
fir , DEVELOPMENT SERVICES PERMIT #: MEC2004 -00340
. 13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171 DATE ISSUED: 6/3/2004
PARCEL: 1 S125DA -02300
SITE ADDRESS: 09260 SW 69TH AVE
SUBDIVISION: KINGS VIEW ZONING: R -4.5
BLOCK: LOT: 008 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:
LPG 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:
Remarks: Replace gas furnace and piping
Owner: FEES
BECK, STEPHEN D AND Description Date Amount
CHRISTINE M [MECH] Permit Fee 6/3/2004 $72.50
9260 SW 69TH [TAX] 8% State Surcharl 6/3/2004 $5.80
TIGARD, OR 97223
Phone: Total $78.30
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 - 656 - 1184 Gas Line Insp
Mechanical Insp
Reg #: LIC 447 Final 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 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.
Issued By: 6 ` Permittee Signature: i¢ ", b/ < e
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
. *S)
.Met ical Pe , ph
cation p cation FOR OFFICE USE ONLY
� � Received Mechanical jA
• ^O Date/By: n Permit No.: N' l t c. 2e Q 4 - 00 j�
Cl of Tigard l• Planning ning Approval Building
`J g S 'O Date/By: Permit No.:
13125 SW Hall Blvd. -( 0. Q S ON Plan Review Other
Tigard, Oregon 97223 OF 01 0 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 50-`5 60 Post - Review Land Use
�� / /sJd� ' r ��i, i
. \ Date/By: Case No.:
Internet: www.ci.tigard.or.us gv t I
,, ,,,,� c �� Contact Juris.: See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
i.. "...?:' , .•' • -- TYPEOF WORK; . ::COMMERCIAliFEE* SCHEDULE -USE CHECKLIST,:. :.'
❑ New cons". *on ❑ Demolition Mechanical permit fees* are based on the total value of the work
[r Additio i'`' e • lacemen ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY-.OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
[yf 1 & 2- Family dwelling El Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family .= RESIDENTIAL. EQUIPMENT /SYSTEMS FEEtSCHEDULE;: :.'`
Description 1 Qty Fee(ea.) 1 Total
El Master Builder ❑ Other:
Heating/Cooling
. ' > ^:.'JOB SITE INFORMATION.and LOCATION . k
Job site address: 9a(o0 % tDc(T4k A.) R P� �R5 14.00 /
•� ea um 14.00
Suite #: I Bldg./Apt.#: (buct wor ( na.% B„ �) 14.00 ly,
Project Name: lug R Hy3 is hot wa ter system 14.00
Cross street/Directions to job site: Residential boiler
TP' IOQS _ t ^ ��pA (for radiator or hydronic system) 14.00
(t l4J - 1 Unit heaters (fuel, not electric)
—0e— (in wall, in -duct, suspended, etc.) . 14.00
T ki0 molds C,tJtt P� Re units 12.15
A#' (95501 Flue/vent (for any of above) 10.00
Subdivision: L t #: Other Fuel Ap ' Iiances
Tax map /parcel #: Water heater 10.00
"DESCRIPTION OF WORK - - . Gas fireplace 10.00
At 1iS '�rvet,JAC 2 PL_tX Flue vent (water heater /gas fireplace) 10.00
dcA�ca. — -o Mce.SZ\ t{E. C Log lighter (gas) 10.00
Wood/Pellet stove 10.00
G. n� -v�_ � Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
, ROPERTY.OWNER ' ❑ TENANT Other: 10.00
Name: GNA s• I1 )f__ 4E:47...C„K Environmental Exhaust & Ventilation'
Range hood/other kitchen equipment 10.00
Address: q 2 Loo 5"1 T'A A J Clothes dryer exhaust 10.00
City /State /Zip: c..,..AcKrAy/vAs 6D. 51223 Single duct exhaust
Phone(lo3) 3(. Fax: (bathrooms, toilet compartments,
' FZ(APPLICANT . ; . .. ❑ CONTACT PERSON . ... utility rooms) 6.80
Name: Si C om e . O J is o@. gat% Nr . Attic/crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: ` T *($5.40 for first 4, $1. each additional) _
Phone: Fit 2,t Furnace, etc. EiZre„1- �St01JtR t. ** S.'''' `` - \\ ` Gas heat pump **
E -mail: S • Si r.,.1 C�t1eb Vt2c czpt,) , N i Wall/suspended/unit heater **
.: CONTRACTOR Water heater **
Business Name: T.-4-1C_ Fireplace **
Address: �, 0 SG 1�5,.>P12ZA �J Range • **
BBQ **
City/ate/Zip: a CnOI rj Clothes dryer rY (gas) **
Pho :$ • t(qt-1 toSfv -'7a (( Other: **
CCB Lic. #• 1- „ lie 11 14 Total:
• Mechanical Permit Fees*
Authorized ^` ki Subtotal: $ 3'3.40 s; i „,, Signature: Date: OS' Z7 - V �1 Minimum Permit Fee $72.50 $ -1 a'Sv
JL tJ(1- DAVIS Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ ,�D
TOTAL PERMIT FEE $ 8
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri-County Building Industry S ervice Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
iviecnanicai rermit Application - City of Tigard
Page 2 - Supplemental Information
•
Commercial Fee Schedule:
•
Total Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
•
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 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 $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Ea) Amount
Fumace 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 heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
•
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
•
30 -50 hp; absorb. unit, 3,400 •
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
•
•
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 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 mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet • 63
TOTAL COMMERCIAL $
VALUATION:
i:\Dsts\Permit Forms MecPermitAppPg2.doc 01/03
CITY OF TIGARD" 24- Hour
BUILDING Inspection Line: (503) ti9-475
INSPECTION DIVISION Business Line: (503) 6394171 MST
�a`ol S ‘oh BUP
Received ! b Date Requested AM PM BUP
Location G L 7 5 (A) J Suite MEC °-- 6193410
Contact Person Ph ( ) 0 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear I � p
F aminath/Shear 3 EiE‘ 2s -L .c t A� l.4 ✓ L/ 64. g
Insulation
Drywall Nailing j� -�'`° ( Cs ' e�'`T
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS __PART FAIL
M {ANIC�L
Po Be
Rough -In
Gas Line
e Dampers
• A SS _PART FAIL
CTRICAL
Service •
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date 6 - - 9_C7
Ext
Approach/Sidewalk I nspector
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL