Permit CITY TIGARD MECHANICAL PERMIT
,1 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00111
--- Alp'
SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/10/04
PARCEL: 2S115AD -00900
SITE ADDRESS: 16790 SW 108TH AVE
SUBDIVISION: WILLOWBROOK FARM ZONING: R -4.5
BLOCK: LOT: 031 JURISDICTION: URB
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:
LPG 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: 1
> 10000 cfm:
GAS OUTLETS: 1
Remarks: Gas fireplace insert install with gas piping and outlet.
Owner: FEES
HOCHTRITT, ROBIN L + Description Date Amount
KIRK, M
SW 108
16790 SW 108 TH AVE [UMECH] Permit Fee 3/10/04 $72.50
TIGARD, OR 97224 [UTAX] 8% State Surcha 3/10/04 $5.80
Phone: Total $78.30
Contractor:
GAS CONCEPTS & CONSTRUCTION
P.O. BOX 86232
PORTLAND, OR 97286 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical lnsp
Reg #: LIC 133149 Final Inspection
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 -00
' I /
Issued By: V ��Z- Permittee Signature: Il1l
Call (503) 639 -4175 by 7:00 P.M. for inspections needed t ,e next business day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Daet yam' y O 0'1 2 PermitNo.: /2 � / - ///
13125 W Hall Blvd., Tigard, OR 97223
■ Plan Revie Other Permit:
Date Phone: 503.639.4171 Fax: 503.598.1960 /�yint /- ;lli,� I ,i\ Date/By:
Line: 503.639.4175 _ ' H See Page 2 for
Internet: www.ci.ti ard.or.us e Ready/By: runs:
g Notified/Method: t� Supplemental Information
tl, ..lip ,f° ,y 1( WQR ' � ' ., �'<.. �. ;., '�° ,COMNIthCrAL'FEE* •SCHEDULE - USE CHECKLIST
❑ New construction ddition /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.
s t E"u 57
,. . f .. , . �l R CO, , CJCT h °'`' a _ Value.
1- and 2 dwelling Com mercial /industrial ]IIBF�ITTAL FQUTPIVIEPIT / SYSTEMS FEES*
y g ❑ El building
For special injbrmation use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
t ;, ' ' , TE „-,:e4- O Ql A) O C ` T„ Heatingicooling
Air conditioning or heat pump
Job site address: 6790 ...1.,t) /0 7a (requires site plan showing placement) 14.00
City/State /ZIP: 77c44.4_ i) One ! 7Z Furnace 100,000 BTU (ducts /vents) 14.00
Suite/bldg. /apt. no.: 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: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
a :. s Water heater 10.00
,' � � � � � a �.,
' ': � < x �� ° ra t # # � ,, � . °
J � Gas fireplace �( 10.00
544-5 [ /(. /� S � Z_dL — 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
*5 , ' ci A , f.. r 4V i ii , ? Chimney /liner /flue /vent 10.00
Y 4440,44 -0 t a
a . `:. # i �. Other: 10.00
/ fj/
Name: /J� eC 2 L Environmental exhaust and ventilation
Address: / l 67 ?a 5 iJ /OS�� Range hood /other kitchen
/ equipment 10.00
City/State /ZIP: ry,147 O f1Q 97 ZZ V Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (5b5) 7, _ / 376, Fax ( ) toilet compartments, utility rooms) 6.80
C TL ' ; r `' 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: ( ) I Fax: : ( ) Water heater
Fireplace X
E -mail:
Range
i e F' e 1= - ' ',, K Barbecue
Business name: S (� ` c�p S Clothes dryer (gas)
Other
y
Address: () g 7)( A62_37_ l X MECHHA II X2MI FEE S*
City/State /ZIP: }'�a — !!�� D C�7�� Subtotal
Phone: ( 569 6,(.. 300,6 I Fax: ( ) Minimum permit fee ($72.50) tea—. CZ/
Plan review (25% of permit fee)
CCB lic.: /3 State surcharge (8% of permit fee) 8
TOTAL PERMIT FEE '7 g, 0
Authorized signature: Mi/fri4Z__ This permit application expires if a permit is not obtained within 180
da after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
is\ Building \Pernits\MEC- PermitApp.doe 12/03 440 -4617T (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
•
Page 2 - Supplemental Information r
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) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�,l ,/ BUP
Receive 7. Vf Date Requested 3 /./ Z 5 AM PM BUP
Location 76 7 0f Suite V //
Contact Person Ph (r5 ) 19 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Note SIT
Post & Beam ( P.(/ - __// C()/`-e
Shear Anchors a _
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof � - / � - e f5
Other:
Final
PASS
PLUMBING
FAIL f y 7 5
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 yGLtfieDQz2
Smoke Dampa T
Final
SS PART FAIL
EL 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 El Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line /,
ADA - f � Cy 9 Inspector - 431 %^ 0�
` -, Oct
Approach/Sidewalk Date
Other:
Final DO NOT REMOVE this inspection record from the )o site.
PASS PART FAIL