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Permit CITY OF TIGARD MECHANICAL PERMIT 1 A' DEVELOPMENT SERVICES PERMIT #: MEC2004 -00784 ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/3/2004 PARCEL: 2S111 BA -00107 SITE ADDRESS: 14200 SW 97TH AVE SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5 BLOCK: LOT: 028 JURISDICTION: TIG 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: 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: 1 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Convert oil furnace to gas. Owner: FEES HARRELL, MATT Description Date Amount 14200 SW 72ND AVE [MECH] Permit Fee 12/3/200 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 12/3/200 $5.80 Phone: 503 - 570 - 4785 Total $78.30 Contractor: SOUTHWEST SHEET METAL 10415 SW 72ND PORTLAND, OR 97223 REQUIRED INSPECTIONS Phone: 503 Heating Unt Insp Final Inspection Reg #: LIC 00045089 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. Issued By: a f l4�:z Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day Mechanical Pe,mit.Application FOR OFFICE USE ONLY City of Tigard Received y b �D DateBy: / , I ei IV-- Permit No 1 \i i a de 7 / 7j. 13125 SW Hall Blvd., Tigard, OR 972 Plan Review Phone: 503.639.4171 Fax: 503. ■ �� /1"'R/p � i \ Date/By: Other Permit: Inspection Line: 503.639.4175 _ b� � Jans _' I,, Date Ready/By: . y y: ® See Page 2 for Internet: www.ci.tigard.or.us EC 0 , a91 Notified/Method: 1 ( ...r . Supplemental Information V S O COMMERCIAL FEE* SCHEDULE - USE CHECKLIST replacement New construction El WYr34e Mechanical permit fees* are based on the value of the work ❑ p 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* ❑ 1- and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating /cooling 7 Y Air conditioning or heat pump Job site address: 4 2- CO $ IA a 7 Ave_ (requires site plan showing placement) 14.00 City/State /ZIP: T i c O 12- q 7 2.2 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: 9 7 3 . A- g 5 DV 1N or Duct work 14.00 Hydronic hot water system 14.00 1 c- ' G ge5 1. $7 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 Gas fireplace 10.00 C eou ✓ -r © / 1 - I /0 40}`j 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 Chimney/liner /flue /vent 10.00 IQ PROPERTY OWNER ❑ TENANT ,{ Other: 10.00 Name: /►1,,-1T N',4j L .. L. Environmental exhaust and ventilation Range hood/other kitchen Address: /[f. LUD 5 q 7 t if-{/- equipment 10.00 City/State /ZIP: 77 4ezz Q 9 7 7,2 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (c/)( ) 570 . 41 Fax: ( ) toilet compartments, utility rooms) 6.80 Vj 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 Clothes dryer (gas) Business name: 5 wJRaT 5ice4, ' ,l.e vpft. Other: Address: 1 0 41 s '3•.✓ - 21' *JL MECHANICAL PERMIT FEES* City/State /ZIP: PrATL.4A i e.g. 'j 7 2 2- 3 - 9 7 3 Subtotal Minimum permit fee ($72.50) 72 . 5a Phone: (F03) �9-b • C 2$ 1- Fax: ( ) Plan review (25% of permit fee) CCB lic.: 4 S 0 8 `T State surcharge (8% of permit fee) 51e1 0 TOTAL PERMIT FEE ?g, 50 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 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. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. i:\Building \Permits \MEC- PermitApp.doc 12/03 2 CITY OF TIGARD 24 -Hour BUILDING y Inspection Line: (503) 639 -4175 INSPECT! N DIVISION Business Line: 1903) 639 - MST II BUP Received Date Date Requested ` AM PM BUP , J Location / �f - )116 4A) 97' iltl Suite 0.,�(�(� 4 - - 007g9 4 Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear < Framing A. . ■ �Q AL I ' Insulation ,►=i5 Y O �I Drywall Nailing ii���� Firewall Fire Sprinkler Fire Alarm 1 ( ,j y� ,� (Z , LO.Stiq ( 77 S' Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PAS ART FAIL &1140‘,$ M C AL Post & Bea Ro _ • -In' • - _ I ampers R IO 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 DAoach/Sidewalk Date /0)'t / Inspector Ent Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL