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Permit - ' CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2004 -00381 ^111 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/17/2004 PARCEL: 1S136CB-10500 SITE ADDRESS: 11194 SW 84TH AVE SUBDIVISION: ASH CREEK MEADOWS ZONING: R -7 BLOCK: LOT: 009 JURISDICTION: TIG CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: MF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN: ELE 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: FURN > =100K BTU: < =10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: AC install. Owner: FEES SHEPPARD, BEN Description Date Amount 11194 SW 84TH [MECH] Permit Fee 6/17/200 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 6/17/200 $5.80 Phone: 503 869 - 5619 Total $78.30 Contractor: B + S HEATING 67396 CRANE /BUCHANAN RD BURNS, OR 97720 REQUIRED INSPECTIONS Phone: 503 - 250 - 0558 Cooling Unt Insp Final Inspection Reg #: LIC 45838 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 t UNC by calling (503)246 -6699. / 01 Issued By: l/ Permittee Signature e Call (503) 639 -4175 by 7:00 P.M. for inspections nee s ed the ne business day MEehawical Perin i o_ , FOR OFFICE USE ONLY City of Tigard l 1 i V L7, Received ' / / By� 07 Permit No.p) 642_,,,,,, L ,L �D 9' 13125 SW Hall Blvd., Tigard, OR 97223 Date Plan Revi 2 `�v //� / Phone: 503.639.4171 Fax: 503.598.1,960 ' / /m Other Permit: Inspection Line: 503.639.4175 ,,, , s+ . � / \ L . �. 7; 1 � I ' � Date � Date /By: Ready/By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us C�TY ® F . � GARD Notified/Method: -r l C1 Supplemental Information dUiLDI C ' I .6 � - TYPE O COMMERCIAL FEE *. SCHEDULE -iISE. CHECKLIST . ❑ New construction jddition/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: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* and 2- family dwelling ❑ Cortunercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: it S r /�/ I • L ! ' k Air conditioning or heat pump QV I J � (requires site plan showing placement) l 14.00 1 L i City/State/ZIP: r i 0 ( LI ) Z 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 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 map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 1 � p n Y J d / Gas fireplace 10.00 ILL � L l ei✓(t tit c_ /44 ` Lcr K: / coo l y( 1 Flue vent for water heater or gas J fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00 Other: , , 10.00 ,^� Name: 1 €'V s � D c„.-d, Environmental exhaust and ventilation Address: / 1 1 y /� 1 . cF 1 I, Range hood /other kitchen equipment 10.00 City/State/ZIP: `l't' d ®n, 5 ) 2-2-3 Clothes dryer exhaust 10.00 �� S !J ` f� F ax: Single -duct exhaust (bathrooms, Phone: (5 03) 8. 0 ( ) toilet compartments, utility rooms) 6.80 ,APPLICANT VONTACT PERSON - Attic /crawlspace fans 10.00 Business name: R .3 ; ., Other: 10.00 f-a S Fuel piping Contact name: f3240 J , rA'4/ $5.40 for first four; $1.00 for each additional Address: Pc d c AD x (J //•L 3 Furnace, etc. _ rr,//J as heat pump _ City/ State/ZIP: ®' 0 � \ v ap ZQ 9S Wall /suspended/unit heater Phone: (SO 3) Z, S S Fax: (Si (5j S) %e (j. Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: A_ MECHANICAL PERMIT FEES *, t:''',,.' City/ State/ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: y .g. g ., £ State surcharge (8% of permit fee) /4 6 1510 4'...... - 4 4 4°I TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after It has been accepted as complete. Print name: &co-1 7 s Date: 6 -i/24,-,195 ,195 ' Fee methodology set by Tri- County Building Industry Service Board is\ Building \Permits\MEC- PermitApp.doc 12/03 440-4617T(I1/02/COM/WEB) w Mechanical Permit Application - City of Tigard ' Page 2 Supplemental Information - Commercial Fee Schedule: • lot_41 Valuation _... ;' Pernut -u � ` = r $1.00 to $2,000.00 Minimum fee $72:50 • $2,001.00 to $5,000.00 $72.50 for the first $ 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 l'. 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 V $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and V $1.10 for each additional $100.00 or fraction thereof. 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' - CITY OF TIGARD 24 -Hour BWILDING Inspection Line: (503) 63 5 INSPECTION DIVISION Business Line: (50 9 4171 MST Received Date Requested 7 AM PM BUP Location 1 Suite �y MEC a d O'I — o 3 g 1 Contact Person Ph ( ) S� - 0 STS a PLM 7 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC UYl—R., Footing Foundation ELC Access: pF,� �' Ftg Drain ELR Crawl Drain Slab Inspection Notes: ` v � II � SIT Post & Beam iv Grd� 7o Ext Shear Sheath/Shear th / A J � �� �1 � Ext eah/hear P� � / T Int Sheath/Shear Framing - Insulation L/1/0—&-- Drywall Nailing Firewall Fire Sprinkler .Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING C il6 Post & Beam Under Slab • ff Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL • Post •& Beam Rough -In. Gas Line Sm • ke Dampers . ART - FAIL RICAL 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 this Inspection recor from the Job site. PASS PART FAIL