Permit •
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005-00163
`'J 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/8/2005
PARCEL: 2S 102AB -00917
SITE ADDRESS: 12120 SW 92ND AVE ZONING: R -7
SUBDIVISION: KIMBERLY ADDITION LOT: 017 JURISDICTION: TIG
Project Description: Gas line to stove.
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:
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
NEWMAN, JASON Description Date Amount
12120 SW 92ND AVE
TIGARD, OR 97223 [MECH] Permit Fee 4/8/2005 $72.50
[TAX] 8% State Surcha 4/8/2005 $5.80
Phone: 503- 307 -0240
Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
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: _,2" fe,(1 , ���:� � , Permittee Signature: . G6/
Call 503 - 639 -4175 by 7:00 a.m. for inspections hat •usines•1ay.
This permit card shall be kept in a conspicuous place on the joo until c•mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
V, .,wr Permit Ariplieettion 4FOR OFFICE USE ONLY : ' ''. 7'' -"r4 ..t'' .. : ''-•
City of Tigard Received ..- ,...... -
No.:\Le.-e_jet) al it-
13125 SW Hall Blvd., Tigard, OR 97223 Permit
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Inspection Line: 503.639.4175 c .4.■ 16
Date/By:
. - e
Date Ready/By: = E1 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
0
performed. Indicate the value (rounded to the nearest dollar) of all
E Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
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XI* and 2-family dwelling 0 Commercial/industrial I: Accessory building
For special information use checklist.
0 Multi lil Master builder 0 Other:
Description Qty. Ea. Total
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MulbfAsvigk.V9i,m,mmmtmamiMps:q91:9a2tvu Heating/cooling
Job site address: 11._ \ '2L2 St.t...\ 9 -2_0 c-- A_ conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: v - 7 22--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: C.,- Si- 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
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
Z 0 ,'. 1 •"• , 5 ,, , ,, , , A1•.c, , •;1;, ,,, ,I. ,- .W__ .__2 X ,--% 'F'. .44;n1g.ITZTAM V 0 Water heater 1000
, , :w ,..-,: ,,p,,...,::
,at;. 4
i ,,,,,tat,,,• ,iDES01411.ERONP.O. F4VVORKI,,r0:,,,,,v,,,,„:w. ,',,-,„ „,:..',4,,,,,:zAr .
, M...s' . i...“.t.i- W:, za;UM qa,V4,,:fcit,,,31,-,:;,;•,',q,;61,1
Gas fireplace 10.00
.....\)e-%--- c- P(F17 4 E - 7 f't._.-- 124,-NICA V._ 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
V
:
NE 0: leZUWe..•.1, ifirfkM1US.0,,,wNA Chimney/liner/flue/vent 10.00
, -:,„-,micLu.4.; ':"+.?z ;;I:MRAACii.:1:4.4:,, .;;1,1•14.n.L.1;:eekaliaaej other, 10.00
Name: c \ 1 IA s4,...\.1.4pb.,....3 Environmental exhaust and ventilation
Range hood/other kitchen
Address: - 9 . i k org ____
equipment 10.00
City/State/ZIP: .--17 - CM__ Ill- 777---2-J Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: (cbl ) igis4 _g -67_4 0 Fax: ( ) toilet compartments, utility rooms) 6.80
kt r irW2;..:',V4:•W A14047,MRSA4,14111 Attic/crawlspace fans 10.00
W,1ig A Vt'ArN-Vi.,, ,,f," 1 ti:.::W:kkm
Other: 10.00
Business name:
Fuel piping
Contact name: _SAAAv $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail: Range
ifgOrSTCAfRnfailtV31"3-r:46Nra011)PMMMii%4•-rAtd1X,R$111, r.,4`14A - '',Ri4 Barbecue
iglikl 4iitft;,,,,,,h .itiitlatikkite*
Business name: Clothes dryer (gas)
Other:
Address: tArVtiYi . gi;IVICCU P INiefi , tWIWifiirgi'' ' ' ''...-
i,....--,,,,-,„...„,,,,,,,„.„,-,,,.,..,..„„,,,..--..
City/State/ZIP: Subtotal _
Phone: ( F )
Minimum permit fee ($72.50) z4...,5-0
ax: ) (
Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee)
M TOTAL PERMIT FEE IS>,, 0
Authorized siy ature:
This permit application expires if a permit is not obtained within 180
- AR Z----
days after it has been accepted as complete.
Print name: .W.VIMAIMIEM1111111 i. ate: Date: (Atir 0 S
criii_=.....—.3- . I, • * Fee methodology set by Tri-County Building Industry Service Board
I: \Building \Pe , 't• MEC-PlApp.cloc 12/03 4 0-4617T (11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total al^u;aJ ion ` ^ .. Pkei Eee:
$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 OF 11GA D-,. .
BUILDING DIVISION PERMIT #: MEC2005 -00163
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/8/2005
Phone: (503) 639 -4171 a �t�u��u�i�b,h t ill
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 26
SITE ADDRESS: 12120 SW 92ND AVE CLASS OF WORK:
SUBDIVISION: KIMBERLY ADDITION LOT #: 017 TYPE OF USE:
PROJECT NAME: NEWMAN
DESCRIPTION: Gas line to stove.
OWNER: NEWMAN, JASON, PHONE #: 603 -307 -0240
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 004864-03 503-307 -0240 N
Corrections /Comments /Instructions: .
(1 /nee' 4-44770 O /r / q,,f , ti, 4 K L y) IVO Al ai'�� 6
lr7 ( c T1 a n) 4-1✓ A ( cc="- 0 Ai A..),.-c
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ¢ !� 13 Phone #: (503) 718-