Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00768
f II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/22/2004
PARCEL: 1 S 136AA -01500
SITE ADDRESS: 10313 SW 69TH AVE
SUBDIVISION: FUR VALLEY ZONING: R -4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R1 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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: AIR HANDLING UNITS OTHER UNITS: 3
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: (3) duct runs. Value: $300.00
Owner: FEES
LUKE -DORF Description Date Amount
10313 SW 69TH [MECH] Permit Fee 11/22/20( $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 11/22/20( $5.80
Phone: 503 624 - 0866 Total $78.30
Contractor:
EVERGREEN GAS INC.
2210 NE 102ND AVE.
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone: 503 Duct Inspection
Final Inspection
Reg #: LIC 158031
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: ' ,c. ,/ Permittee Signature:`
CaII (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit A licati FOR OFFICE USE ONLY
' Received f�
City o61'1 >igard E' Date/By: Receive d s'( o 2 r } o Permit No.: Lr t'�D �/• "
13125 SW Hall Blvd., Tigar {e -
Phone: 503.639.4171 Fax: 503.598.1960 �t rnq. A i�r • DateB Review Other Permit: j • o �0V .„ WYq
Inspection Line: 503.639.4175 V 2 2 2004 _ . �f I I
Internet: www.ci.tigard.or.us Nu _ .. Date ed /Met o furs: Supplemental See • age t 2 Information
AQ D Notified/Method: Supplemental Information
GITY OF TIG _
• �111tt�4 . _ ` . . COMMERCIAL FEE* SCHEDULE _ USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION -
Value: $ ZOO —
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: -
Description 1 Qty. Ea. 1 Total
JOB SITE.INFORMATION AND LOCATION : . Heating/cooling
Air conditioning or heat pump
Job site address:
J o3 / 3 Sw 6 ( 3 ta-' 4- (requires site plan showing placement) 14.00
City/State/ZIP: 1 OL 9 72 2,3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 5 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 trap /parcel no.: Other fuel appliances
DESCRIPTION OF WORK . Water heater 10.00
Gas fireplace - 10.00 •
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER 1 ❑ TENANT
Chimney/liner/flue/vent 10.00
Other: 10.00
Name: L j kL Z el f •�- 5-,,,, c Environmental exhaust and ventilation
Address: 1 "L Qj (p 0 6 ,A) r (. t `(-, i4 ,„) sod ' ( 1 15 Range hood /other kitchen
equipment 10.00
City/ State/ZIP: 4tlj 0 t 7 Z2 3 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.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
• CONTRACTOR Barbecue
Business name: Evil - yel`� S r✓tlL Clothes dryer (gas)
J Other:
Address: Z2- 1 o M& 1 I O2" — ` ) �( _ MECHANICAL PERMIT FEES*
City/ State/ZIP: ,--k ., ok CJ .22 7 0 Subtotal
Phone: (7' ) 4 k7 c i 7 i i( r Fax: (Vi) 90 8-9 3) c Minimum permit fee ($72.50) 07V 5Z)
Plan review (25% of permit fee)
CCB lic.: /53 03 I State surcharge (8% of permit fee)
TOTAL PERMIT FEE . t:
Authorized signature: ✓r/L� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: l (I6a.Vti Ze' � el/\„ Date/ I /Z2 /V 41 * Fee methodology set by Tri- County Building Industry Service Board
is Building \Pennits'.MEC- PennitApp.doc 12/03 440 -4617T (11 /02/COM/WEB)
Mechanical Permit Application - 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 $5,000.00 $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.
i:l Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested / J ? ( AM PM BUP
Location /63/3 (7 ' Suite MEC ZC ' co7C8
Contact Person
9.1i6 Ph ( ) WW /./ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner — ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - - %'
Roof
PLUMBING FAIL ESFOU
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
• MECHANICAL
Rough -In
Gas Line
ampers
PASS PART FAIL
TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE thls Inspection record from the Job site.
PASS PART FAIL