Permit r 1 CITY OF TIGARD MECHANICAL PERMIT
,, ,,,i DEVELOPMENT SERVICES PERMIT #: MEC2004 -00234
'` _ II 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: 5/3/2004
PARCEL: 2S111 BB -00800
SITE ADDRESS: 14265 SW 100TH AVE
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 016 JURISDICTION: TIG
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: 1 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:
Remarks: AC install
Owner: FEES
KADERLIK, MICHAEL Description Date Amount
14265 SW 100TH AVE [MECH] Permit Fee 5/3/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchari 5/3/2004 $5.80
Phone: 503 647 - 5531 Total $78.30
Contractor:
A -OK HEATING & AIR CONDITIONIN
19649 SW COLLINS RD
NORTH PLAINS, OR 97133 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 105729
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 4.-Lit—ei.A.-..c..,Z-C-6c P ermittee Signature: � i'/I` / , - �'R�V
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busin % /day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard r Receive I� PermitNo. /'h7y J • 2Q
13125 SW Hall Blvd., Tigard, OR 97223 DateB Q ..� 1 /l `�
Plan Re
Phone: 503.639.4171 Fax 503.598.1960 /ks;Ni� t\ Date/By: Permit:
Inspection Line: 503.639.4175 Ipf �1i 's:
Internet: www.ci.tigard.or.us ' Notifieed/MetdlMet Date y: hod: Supplemental Jw See Page for
upplementt al l Information
1, „, " � TE )` V/Ol
k _F;'v :nr �b � •` COM FEE SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction gAddition /alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
"� , _ " ti- ;14 6 b 01I:I KI CTION Value: $ •
RI- and 2- family dwelling ❑ Commercial /industrial RESLD NTIAL EQUIPMENT / SYSTEMS FEES*
❑ Acce building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
rQ $ 4 >v iN cO EO Y. cal
� Heating/cooling
Job site address: / if2.42, Po /Pop--f Air conditioning or heat pump
(requires site plan showing placement) / 14.00
City/State/ZIP: -7 D 2 9 72_2_ • 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: /vL/'G00ti _-c 1 Lv , n - f-, ,/,f Duct work 14.00
140‘.) 5' �� I) 1 12-0/4-D -re R esid n t i hot water a diem 14.00
S-� rvl T �[� � T Residential boiler (radiator or
(l P Del vs.4.Apcy 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
', ' I 1 1 Os s^ a ," i a ` Water heater 10.00
/� ;� Gas fireplace 10.00
TT 1 / T) I e it) D 1 D /i / i" 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
, i . AZ .1 Chimney /liner /flue /vent 10.00
� '`° % �= - t* N 4`.0 Other: 10.00
Name: 4/G �_ r/ 7 u 1< Environmental exhaust and ventilation
/ � 1 Range hood /other kitchen
Address: ( `- f )--4, S 5 vu tez riy� equipment 10.00
City/State /ZIP: 7?c tlLl7 0 2_ ' '2 -2-2- Clothes dryer exhaust 10.00
!!LL 3 D D Fax: Single -duct exhaust (bathrooms,
Phone:
yv ) 4, ( ) toilet compartments, utility rooms) 6.80
x z -' g a ,,,, Attic /crawlspace fans 10.00
I Other: 10.00
Business name: A _ K ,.Jc - L AjR d/v2) 1 7?O /,vZ
Fuel piping
pip' g
Contact name: ( A-j 5/t_ /71 $5.40 for first four; 51.00 for each additional
Address: C Lig Nw C....4-./ S i2 7
Furnace, etc.
Gas heat pump
City/State /ZIP: A.)4 2-7771- Pc.4/ Ns D g_- 1 - 7 (33 Wall /suspended /unit heater
Phone: ( 95 G ? 7 57.. Fax: : (5 by -7 _7 j (( Water heater
Z Fireplace
E -mail:
xrFf . "a =�fl; "T :tom` n , a, t Range
. s ' 'r . �`.... ' r.1£. ,,r, � f-4,1',''' .. la.. Barbecue
Business name:
Clothes dryer (gas)
Other:
Address: . .. ;
, t 1 M,I;'CITANICA :PE -idii 'F EES*
City/ State/ZIP: 5,404e / Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) -29_56
Plan review (25% of permit fee)
CCB lic.: iv 5 -7 * State surcharge (8% of permit fee) 5- 0
-arm' TOTAL PERMIT FEE irj(, ` ,C
Authorized signatur • 0'... I % This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name ?1 44 O J ti, Date: s -3 * Fe e m ethodology set by Tri- County Building Industry Service Board
i:\ Building \Permits\MEC- PemtitApp.doc 12/03 440 -4617T (11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total ?L.
$ 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
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busines Line: (503) 639 -4171 MST
BUP
Received Date Requested AM '" PM BUP
Location I (- 13 (os /OeYsM Suite MECCULY_
U 0
Contact Person Ph ( ) 7 ` 7 7 41 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Insp ctio SIT
Post & Beam C . '�
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm PAI lkf 1 ■ 1 4 L — 6 o a,2,
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
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
E CTRICAL
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 57 7 , - 0 Approach/Sidewalk Date � Inspector Ext p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL