Permit A . CITY OF TIGARD MECHANICAL PERMIT
A
1- DEVELOPMENT SERVICES PERMIT #: MEC2003 -00679
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/1/03
PARCEL: 2S112CB -11900
SITE ADDRESS: 15414 SW 81ST AVE
SUBDIVISION: ASHFORD OAKS NO. 2 ZONING: R -7
BLOCK: LOT: 133 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Install gas fireplace insert
Owner: FEES
ART MAUER Description Date Amount
15414 SW 81ST AVE
TIGARD, OR 97224 [MECH] Permit Fee 12/1/03 $72.50
[TAX] 8% State Surcharf 12/1/03 $5.80
Phone: 503 598 - 3922 Total $78.30
Contractor:
HOT SPOT FIREPLACE & PATIO
11525 SW CANYON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone: 503 - 626 - 4652 Final Inspection
Reg #: LIC 71782
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 -00
�� Issued By: i,� P Signature: 6"7/
Call ( 03) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
�� Received 1 -0 Mechanical 1
DateBy:1 a Permit No.: 1 n "" an — do4,7 q.
Cit of Ti and Planning Approval Building
Y g Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us II) Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
`°t5 c;' ` :, f t.s .4k?_: , TYPE WORK,,. _4` Aft „ tx :YZ , ° ��,iCUM1YIERCIAtTFEE* SC11 DULE usze ms .;.r .t o
.. . . _ _ HEC T
El New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other:. performed. Indicate the value (rounded to the nearest dollar) of all
, _ ` w `M. CAT,EGORY,CI `CONSTRUCTION a .' mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building El Multi - Family RESIDENTIAL EQUIPMENT %SYSTEMSTFEE* SCFIEDUGE,f 4:'
Description Qty Fee(ea.) I Total
❑ Master Builder ❑ Other: • Heating/Cooling
•, - ,, t JOB SITE« INFORIMIATION,a1id LOCATION' ,.`r k. Furnace - add - on air conditioning ** 14.00
Job site address: /SW cj so 8 / ..st` ilvto Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
. Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
'-' r .. , x # /ESCRIPTICI ORNVORI , :4:: - ( r ` '
Gas fireplace 10.00
g ay/15 aS . j re pLo.c nSe r- Flue vent (water heater /gas fireplace) 10.00
i h S 1 L e c Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
• E PROPERTY.;OWNERG ,. .4! -t E (TENANT 4t rI a 7 Other: 10.00
Name: 4 y i /'1Q,citr • Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: IS V /4/ s to . 8/ SPi9 ve Clothes dryer exhaust 10.00
City /State /Zip: 7j p
etece / ' a y `/ Single duct exhaust
Phone: $ 9 g - 393 a Fax: (bathrooms, toilet compartments,
: ;APPLICANT . 4 .� t if
, s . (CONTACT VERSON 'T utility rooms) 6.80
Name: S' (3 41, u2. Attic /crawl space fans 10.00
Other: 10.00
Address: Fuel Piping •
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax:
Furnace, etc. **
Gas heat pump **
E -mail: Wall/suspended/unit heater **
,i '' `_`' CONTRA:C °_"-w f: ,: . $ L ' : '" Water heater **
Business Name: /Id S d f h P/IL4 G e Fireplace **
Address: Its Q c SO Cam yon 12d Range **
Cit /State /Zi eave4wi 0 2 4 ? Q **
y p :� S Clothes dryer (gas) **
Phone( 23)(0A(0-£l(PS2 Fax:C.5 (02{0 -913 8 Other: **
CCB Lic. #: Total:
Mechanical Permit Fees*
Authorized
Signature: ' � e Date: /e. —1-03 Subtotal: $
Minimum Permit Fee $72.50 $ 7,2 „6`0
Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ ,$. SO
TOTAL PERMIT FEE $ 7 g', 3 v
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service 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
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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and
$1.10 for each additional $100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of plans. •
•
is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received _`.3 S pv Date Requested ( 2 --/3/6,a AM PM BUP
Location / Y/ ,4v < Suite 3- On*
Contact Person Ph 0( '7Z Z_PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC f &
Footing
Foundation ELC
Access:
Ftg Drain 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
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
•
HA IC - AArI_
BeamF�
Rough -In
F' - as Lin -
'7Ye pampers
Fin.
PART FAIL
ICAL
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: 0 Unable to inspect — no access
Fire Supply Line
ADA ('Z 3-03
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL