Permit A
CITY OF TIGARD MECHANICAL PERMIT
w il DEVELOPMENT SERVICES
PERMIT #:
: 10/12/2005 20005 0651
; DATE
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S136AB -01800
SITE ADDRESS: 10296 SW 72ND AVE ZONING: R -4.5
SUBDIVISION: METZGER ACRE TRACTS LOT: 004 JURISDICTION: TIG
Project Description: New gas furnace and gas line.
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: 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:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
ROGER/SUSAN WORF Description Date Amount
14861 SW CITRINE LOOP [MECH] Permit Fee 10/12/20C $72.50
BEAVERTON, OR 97007 [TAX] 8% State Surchar€ 10/12/20C $5.80
Phone: 503 - 524 - 4790 Total $78.30
Contractor:
TYGR CONSTRUCTION CO
ROGER WORF REQUIRED ITEMS AND REPORTS
11935 SW BURNETT LN
BEAVERTON, OR 97008
Phone: 524 - 9236
Reg #: LIC 85114
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.
Issued By: Permittee Signature: �, - -'� •
Cali 503 - 639 -4175 by 7:00 a.m. for inspections that bus'!. !s day.
. This permit card shall be kept in a conspicuous place on the job site until completion of the proje -
Approved plans are required on the job site at the time of each inspection.
Mechanical Per i OR OFFICE USE ONLY
�� V Le 1 Received / - OO /
City of Tigard DateBy (0 , 40, , 1 Permit No.: h , I ' ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503 . x1 960 `l 21 r Other Permit:
� 7 4 61n 1 Cr ., Itr, f.^ � ,` Date/By.
Inspection Line: 503.639.4175 tl ` -• J.- Date Ready/By: Effi ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ddition/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: mec materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
.
y g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
/� 9 S �� Air conditioning heat pump e
Job site address: (requires site plan showing wing pllacemm
ent) 14.00
City/State/ZIP: 7r . , q/ =� .9.74:5,2Z5 Furnace 100,000 BTU (ducts/vents) 14.00 .
f` Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: I Project name: Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00
0.€A/e.--/ _ ,!� R i d n en al boiler water system
or
14.00
CJ C1 � �� Residential (radia
/ hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision: I Lot no.:
er: 10.00
Tax map /parcel no.: /'S /., 4E5 9 / S O() Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Ai /6� 6 • 4�� Y 9QS Flue vent for water heater or gas
fireplace 10.00
/A/&' Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
• ROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: *,(,....? 12/....ce.„. 0 / /�, Environmental exhaust and ventilation
Range hood/other kitchen
Address:
/54 / S_60. C /- //t/F /--dZ, equipment 10.00
City /State/ZIP: Pik (/E,e7-clik.! p ,e_�_ 97007 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (s.s ) s 2y _ (./7 go Fax: (rte) $Z y- q236, 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
Clothes dryer (gas)
Business name: 6Fe e 74/ST.e�/c r/ A'
/ Other:
Address: /4/g6 / S<) C;7 / ^Q MECHANICAL PERMIT FEES*
City /State/ZIPr�� L/ ' X2" 1 ��i�' -� 1 7 f 7 Subtotal
) Fax: ( So3) 2 Minimum permit fee ($72.50)
Phone:
3 6S'Z ,.-/ 4 y 9Z Plan review (25 %ofpermit fee)
CCB lic.: -- 7 ' ` e q 9 7 _,' 8 5/ / L/ 0 y /d', State surcharge (8% of permit fee)
TOTAL PERMIT FEE / ic- 6C)
azure: �� This permit application expires if a permit is not obtained within 180
Authorized
�� X, .." ,f days after it has been accepted as complete.
Print n. , e: %iy- . Date:, 17T Q S • Fee methodology set by Tri- County Building Industry Service Board
i:\ BuildingWennits1 MEC- PennitApp.doc 12/03 li /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:\Building\Permits\MEC- PermitApp.doc 12/03 2
CITY (IF TIGARD
BUILDING DIVISION PERMIT #: MEC2005-00651
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 0/1 212005
Phone: (503) 639 -4171 1 � J A I
Inspection Requests (24 Hrs.): (503) 639 -4175 " _ ..
INSPECTION WORKSHEET FOR DATE: 10/2512005 TIME: 7:10AM PAGE: 16
SITE ADDRESS: 10296 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: METZGER ACRE TRACTS LOT #: 004 TYPE OF USE:
PROJECT NAME: WORF
DESCRIPTION: New gas furnace and gas line.
OWNER: WORF, ROGER /SUSAN PHONE #: 503- 524 -4790
CONTRACTOR: TYGR CONSTRUCTION CO PHONE #: 524 -9236
Inspection Request Scheduled For: Date: 10/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 019276.01 503.784 -8497 N
Corrections/Comments/Instructions:
r struc ( ti o s
_ A �► _ - tlY
b� � , �. fi r•
, Z.,........- ----
Gel
t- V
ASS ❑ PAIR TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CI LL FOR I SPECTION ❑ ADDITIONAL FEES SSESSED
llt 0 «
Inspector: 11 =//1, Date: P e #: (503) 718 -
\I `
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005 -00651
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/12/2005
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7:08AM PAGE: 34
SITE ADDRESS: 10296 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: METZGER ACRE TRACTS LOT #: 004 TYPE OF USE:
PROJECT NAME: WORF
DESCRIPTION: New gas furnace and gas line.
OWNER: WORF, ROGER /SUSAN PHONE #: 503 -524 -4790
CONTRACTOR: TVGR CONSTRUCTION CO PHONE #: 5249236
Inspection Request Scheduled For: Date: 10/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 019004 -01 503- 7848497 Y
Corrections /Comments /Instructions: / /�
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
AIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /o " 2/—e / Phone #: (503) 718