Permit CITY OF TIGARD
MECHANICAL PERMIT
A**111r DEVELOPMENT SERVICES PERMIT #: MEC2004 -00641
III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/24/2004
PARCEL: 2S 103AD -04000
SITE ADDRESS: 13040 SW 107TH CT
SUBDIVISION: PATHFINDER ZONING: R -4.5
BLOCK: LOT: 030 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: 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: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installing gas log set.
Owner: FEES
MCCONNOLL, DILBERT Description Date Amount
13040 SW 107TH CT [MECH] Permit Fee 9/24/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 9/24/200 $5.80
Phone: 503 443 - 4811 Total $78.30
Contractor:
SUBURBAN @ HOME
6014 NE 112TH AVE.
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone: 503 Misc. Inspection
Final Inspection
Reg #: LIC 143335
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: �% � � Permittee Signature: Sew Cfi
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next bLsness day
Mechanical Permit ARratsliVED FOR OFFICE USE ONLY
(� Received " �,/ �� /+/ _ /� l(�
City 6T`T'igal� ^1 DDate/By: / 7 f/` / P ermit No. v \((' U( �'d 11 ! /
�
13125 SW Hall Blvd., Tigard, OR 97223 J '1004 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 2004 ',i 1iµ \ DateBy. Other Permit:
Inspection Line: 503.639.4175 _ • k 1 / � Date Ready Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD /M
Notifiedethod: .... V Supplemental Information
BUILDING DIVISION
-'- s r -z .. � � 4 e k 5 ) : f" ; -,a,, ', yx...:
` �':: � `?f:bMMERCIrkI: TEE* 'SCHEDULE -' USE CHECKLIST
❑ 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.
r 4 4t:'C?Ni'R T 1 Value. $
e .� .. , ,� a RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
'II 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
" zt :. n,. y3
Win.':: ., ,° -8 6 ti g >'I 1 ,', Q �'�. ry... Heating/cooling
Job site address: \7 >_ \(D \C5_\ CA Air conditioning or heat
(requires site plan showin g placement) 14.00
City/State/ZIF' — V \ (-,T� c\(' Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: U Project name: Furnace 100,000+ BTU (ducts /vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: 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
Subdivision: I Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
x, k ' : '., n. xt 'E'.n.t�-. '?y`"a °`- Water heater 10.00
..a B ! $' 1 't r ,� a x
.ek �� ::,4 �j.. �,. ^'� tit _ ^- "aJaritirsa'at . [ n HSe u- 9& ? , .. ,...�� � '�-
,^ Gas fireplace 10.00
\1( - " "�c1, GQ \ `; ) - 3 Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) .i 10.00 \O
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
'. 4 .,. , t k .; . Chimney/liner /flue /vent 10.00
Other: 10.00
Name: . \\ .\ C ....A : Ci\ Environmental exhaust and ventilation
Address: \J \ -N " c
Range hood /other kitchen
equipment 10.00
City/State/ZIP: 1 ' 6...) ° v ��.r - Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phoney "..._S `-6,1 Fax: ( ) toilet compartments, utility rooms) 6.80
J� i ' Attic/crawlspace fans 10.00
t \ ` Other: 10.00
Business nam \ _)( M ` ` ) G ` J Fuel piping
Contact namErVG Ne Z ` $5.40 for first four; $1.00 for each additional
Address: r \ ` \ %C� `\ O Furnace, etc.
Gas heat pump
City/State /ZIP��\ 0"\, Wall/suspended/unit heater
Phomi ` ) � Fax: ' `a�� -- \_\ — C - .)
Water heater
Fireplace 1 -,y0
E -mail: Range
: t'' Barbecue
f � ���.� mot. � * � e ,,�. � .� �. ,s4- x :
Clothes dryer (gas)
Business name: Other:
Address: M CH PERMIT "FEES*
City/State /ZIP: Subtotal ‘ '=�
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
_ Plan review (25% of permit fee)
CCB lic.: \ 1-- ���1.- State surcharge (8% of permit fee)
TOTAL PERMIT FEE .
Authorized signa This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. 9 M
Print lame: t ? Date:CA , l * Fee methodology set by Tti- County Building Industry Service Board
is\ Building \Permits\EC- PermitApp.doe 12/03 U •�
440 -4617T (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
$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 Inspection Line: (503) MST
INSPECTION. DI VISION - " Business Line: (503) b - 171 %�
Received Date Requested q �`� AM PM /�o > BUP
Location / 3 /e) 107 7 66 Suite ; 6 0641 SO4 ql
Contact Person Ph ( ) PLM
Contractor Ph ( ) .;.-5- .;.-5- 7 _ 5 (t3 d SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access:
ELR
Crawl Drain
Slab Inspection Notes: y) SIT
Post & Beam /T 62�.c -if
Shear Anchors a � ;Z 'C./ �� ;4
Ext Sheath/Shear / �
Int Sheath/Shear
Framing
Insulation a 5 ( `, 3 O 1 - J 6 / 2 y r-
Drywall Nailing � �/�Y
Firewall TD � S 1_ 7 -2_.- r)
Fire Sprinkler 'f�
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab f Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
_ P RT FAIL
ECHANIC L
R o s m kit
as'U
•
Smo.e Dampers
inal _
PART FAIL
E RICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line \./Z.
ADA Approach /Sidewalk Date 9 / Z' / C In spector � j2,....._ Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL