Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00799
VIII 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/5/2005
PARCEL: 1S135DB
SITE ADDRESS: 11280 SW 91ST CT ZONING: R - 4.5
SUBDIVISION: DAKOTA GROVES LOT: 003 JURISDICTION: TIG
Project Description: ] and 25' gas line.
Ft •2EfiL /-F -e.E.
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:
NAT 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
DIANE PALLAS Description Date Amount
11280 SW 91ST CT [MECH] Permit Fee 12/5/200E. $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 12/5/200` $5.80
Phone: 503- 430 -0799 Total $78.30
Contractor:
SHAMBURG HEATING LLC
PO BOX 829 REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Phone: 503 692 - 5563
Reg #: L I C 126881
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.
I /
Issued By: Permittee Signature: / l/ i ,
Call 503 - 639 -4175 by 7:00 a.m. for inspections t at business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit .21tpplicati'on' F D TOR OFFICE USE ONLY .
City of Tigard l I ` °" W p ate/By /..9..- , 0s 614 PermitNo.W1 e' �K/> 6,6)7.n -15`
13125 SW Hall Blvd., Tigard, OR 97223 yr
Plan Review
Phone: 503.639.4171 Fax: 503.598.19601 0 ' 2I �i D �,,;mp /ii ;uF l • /. Date/By: P
y: /
Inspection Line: 503.639.4175 UU n " , I 1 Date Ready/By: Qui Id See Page 2 for
Internet: www.ci.tigard.ocus CITY OF TIGArsu Notified/Method: Supplemental Information
•
Al_IILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
El 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
2. I - and 2- family dwelling ❑ Commercial /industrial El Accessory building
12 Multi For special information use checklist.
y ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
/ SITE INFORMATION AND/ O Heating/cooling conditioning
/ \�',(�l C Air cdti
Job site address: (re site plan showing placement) 14.00
City /State /ZIP: �/� 67 / ��� 6.L /73' Furna 100,000 BTU (du cts/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: 5 /� o 0 57— t Duct work 14.00
V 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 Q 10.00
N �� Gas fireplace Y 10.00
l / -� (J-f3 r___ r-e 4, / l / Flue vent for water heater or gas
J /, I_v v7 f ,�- fireplace 10.00
v !�/ Log lighter (gas) 10.00
� 1
(r....0 L ,A, 1 Wood /pellet stove 10.00
Wood fireplace /insert 10.00
OPERTY OWNER ❑ TENANT
r Chimney /liner /flue/vent 10.00
/', Other: 10.00
Name: A e C or ' r / Environmental exhaust and ventilation
Address: ' ` *i. CS Cd / Range hood/other kitchen
�J
equipment 10.00
City /State /ZIP: / �k y ,, � � i e ' ��� Clothes dryer exhaust 10.00
/ ., Single -duct exhaust (bathrooms,
�
Phone: wJ 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
' /„er ile--; Clothes dryer(gas)
Business name: ' ,J
Other:
Address: MECHANICAL•PERMIT FEES* .
City /State /ZIP: Subtotal
Phone: ( ) o Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: / A 6,4983 State surcharge (8% of permit fee)
/ methodology TOTAL PERMIT FEE 78. 6o
Authorized signatur ,�.e /� Th
-' is permit application expires if a permit is not obtained within 180
d ays a it has been accepted as complete.
ee set b ount Service Board
Print name: D 4 r `
Date: ��_ 15 Y Tti -C Y Building Industry
i:\ Building \Permits\MEC- PennitApp.doc 12/03 4404617T (I I /07/COM/WEB)
Mechanical Permit Application - City of Tigard q "
Page 2 - Supplemental Information
Commercial Fee Schedule:
' To t al Valuat Permit Fee: j
$N0 to $2,000.00 Minimum fee $72.50
$2,06, .00 to $5,000.00 $72.50 for the first $2,011.00 and $2.30
for each additional $101.00 or fraction
thereof, to and includi $5,000.00.
$5,001.00 to '. 1,000.00 $141.50 for the first $,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to . d including
$10,000.00.
$10,001.00 to $50,000.00 '.231.50 for the st $10,000.00 and
$ . for each • dditional $100.00 or
fraction r eof, to and including
$50,000.00
$50,001.00 to $100,000.00 $771.50 .r the first '. 1,110.00 and )
$1.25 f• each additional $101.1
fracti e thereof, to and including
$10'4,000.00.
$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.
is\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD _
BUILDING DIVISION PERMIT #: MEC2005 -00799
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/5/2005
Phone: (503) 639 -4171 4 j rp�ii �l lf'� l
Inspection Requests (24 Hrs.): (503) 639 -4175 .:' ■ ........
INSPECTION WORKSHEET FOR DATE: 12/13/2005 TIME: 7:02AM PAGE: 64
SITE ADDRESS: 11260 SW 91ST CT CLASS OF WORK:
SUBDIVISION: DAKOTA GROVES LOT #: 003 TYPE OF USE:
PROJECT NAME: PALLAS
DESCRIPTION: fireplace insert and 26 gas line.
OWNER: PALLAS, DIANE PHONE #: 503- 430 -0799
CONTRACTOR: SHAMBURG HEATING LLC PHONE #: 503 -692 -5563
Inspection Request Scheduled For: Date: 12/13/2005 Pour Time:
Code # Inspection Description Confirm # Contact # • Message
610 Gas line 023366 -01 503 - 730.3869 Y
0 F( (11 :co -6:30
Corrections/Comments/Instructions: �� o �
()
IF l .
I ri 1 ie
_ Oi
l - - - --/ - )1 - )_:-..
ASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
H FAIL . ❑ 0 LL FOR I SPECTION n ADDITIONAL FEES ASSESSED
ti -----
Inspector: Date: t 4 hone #: (503) 718-