Permit h .
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006-00509
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/20/2006
PARCEL: 1 S135DC -07000
SITE ADDRESS: 11675 SW 91ST AVE ZONING: R -4.5
SUBDIVISION: CHARBEN LOT: 8 -9 JURISDICTION: TIG
Project Description: Replace gas furnace, add water heater.
CLASS OF WORK: OTR 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
JOHN W. DRENNAN Description Date Amount
11675 SW 91ST
TIGARD, OR 97223 [MECH] Permit Fee 10/20/20( $72.50
[TAX] 8% State Surcha 10/20/20( $5.80
Total $78.30
Phone:
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
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: t / 1-2-(-/, Permittee Signature: ` t
Call 503 - 639 -4175 by 7:00 a.m. for inspections that b siness day.
This permit card shall be kept in a conspicuous place on the job sit until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. Mechanical Permit Application FOR OFl ICE USE ONLY .
City of Tigard ° E C . ' ' D �Y ��) ii Permit No
' •
'I 13125 SW Hall Blvd., Tigard, OR 972 - -
I i C Plan Review O ther Permit:
11 Phone 503.639.4171 Fax: 503.598.1960 T 2 0 2 Date/By. T IG A R D Insp Line: 503.639 Date Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov n ran
CITY OF T Notified/Method t Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
El New construction Addition /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: $
• [l - 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
Job site address: /! 6 ?5- S' y , q/ ST J C'r, Air conditioning or heat pump
/ (requires site plan showing placement) 14.00
City /State /ZIP: i / G ilA 1 An, f. 72-2, 3 Furnace 100,000 BTU (ducts/vents) I 14.00
l 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: N, wr co R N ,L ft o, q / 5 T 7; Duct work 14.00
Hydronic hot water system 14.00
. /-- / /� V 0 ( -A F, l /03 1)126- p Ji Residential boiler (radiator or
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: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater I 10.00
Gas fireplace 10.00
• _
IQ CPL/}G!E: 6 S ``U/2 /V/-}-l' /, 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 ❑ TENANT
, Chimney /liner /flue/vent 10.00
❑ : P
Other: 10.00
•
Name: To M N / Dn E/V/vAA/ Environmental exhaust and ventilation
Address: // 6 7c ; W q / S/; s-,77 ' Range hood/other kitchen
equipment 10.00
City /State /ZIP: . - / : / e 1 R l\ > D4, q 7 z 1 3 Clothes dryer exhaust 10.00
-� Single -duct exhaust (bathrooms,
Phone: ( 5 63q _ 5 - 2 G! L Fax: ( ) toilet compartments, utility rooms) 6.80
0 APPLICANT ❑ ; CONTACT PERSON . ' Attic/crawlspace fans 10.00
/ Other: 10.00
Business name:
[ /k) /vg Fuel piping
Contact name: To I-I N /j 1, /v/vA/V $5.40 for first four; $1.00 for each additional
Address: `/ ( 7 S `/,/ q / ST S T Furnace, etc.
Gas heat pump
. City /State /ZIP: f / 4/ 4 44 , ' 7 22. 3 Wall /suspended/unit heater
Phone: (5 0 3) 6 3q - 5- 7 q 2 Fax: : ( )
Water heater 4
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: /� � Clothes dryer (gas)
(� Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE ly,,,r (2
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Pernits\MEC- PermitAppdoc 04 /06/06 440 -46I7T (I I /02/COM/WEB)
•
Mechanical Permit Application - City of Tigard ' ' r' ,
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 12/30/05 2
CITY' OF TIGARD 01 EL
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: /v6_00501
Phone: (503) 639 -4171 ea i ilk i
Inspection Requests (24 Hrs.): (503) 639 -4175 �..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / / 6 73 �j/ _°` /d � - / y am CLASS OF WORK:
SUBDIVISION: / / LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: / —? ( --1.06 , Pour Time:
Code # Inspection Description Confirm # Contact # Message
(oqc Wl ems -
o rectio ommen s /Instructions:
APP
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, i AIP \ grip _ '
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C .
I PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
1 I FAIL n CALL FOR INSPECTION I f ADDITI NAL FEES ASSESSED
3(5)W Inspector: Date: (0 Phone #: (503) 718 - -AZS