Permit •
r. CITY ` OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00497
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/3/2008
PARCEL: 2S 115AA - 06600
SITE ADDRESS: 16430 SW 109TH PL ZONING: R -4.5
SUBDIVISION: REBECCA PARK LOT: 023 JURISDICTION: TIG
PROJECT: SCHLACHTER
Project Description: Gas fireplace insert with gas line.
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:
NAT 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:
Owner: FEES
JANINE SCHLACHTER Description Date Amount
16430 SW 109TH PL
TIGARD, OR 97224 [MECH] Permit Fee 10/3/200€ $72.50
[TAX] 12% State Surch 10/3/200€ $8.70
Total $81.20
Phone: 503- 620 -7085
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 692 -5563
FAX 503 - 691 -6855
Reg #: LIC 126881
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 B / l� - ermi e Si gnature 1 —
Ca' '.4175 by 7:00 a.m. for inspection of business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application - F OR O FFICE USE O
l ''''''c''' City of Tigard ® Date /By l '/ Permit No.:a , -. - 4 i i
ig v ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598. DateBy: Other Permit:
T LGA RD y Ju
Inspection Line: 503.639.4175 nn Date Ready /B r' FA See Page 2 for
Internet: www.tigard- or.gov 000 Notified /Method: Supplemental Information
T Y P E 0E-W OI ° �� � � g :�� COMMERCIAL ,FEE *: SCHEDULE - .•.USE - CHECKLIST;
ED New construction Addition /altera ty �7 - CI e x Mechanical permit fees* arc 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 CATEGORY OF CO - -. �
Multi-family „ Value: $
�,
LJ and 2- family dwelling ❑ Commercial /industrial ❑ Accessory� building RESIDE 'MENT. /'SYSTEMS.FEES *� .
lti- family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. I Ea. Total
; % ;-JO$- SITE INFORM ATION` AND LOCATION ' . Heating/cooling
7� Q , ) Air conditioning or heat pump
Job site address:
1 O 71.t 1 /69,01-k PL (requires site plan showing placement) 14.00
City /State /ZIP: l ' >9-Cs LD? c17 ZZq Furnace 100,000 BTU (ducts /vents) 14.00
� ,
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. no.: Project name: c.. A G / // Gas heat pump 14.00
Cross street/directions to job site: ` (/" / -� Duct work 10.00
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. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
' Other: 10.00
Tax map /parcel no.: Other fuel appliances
'.,t - " - DESC RIPTION ;OF - WORK` '` , . Water heater 10.00
• Gas fireplace l 10.00 (U
67a5 ;pJ ea.ce 1 el q / 5'7 Flue vent for water heater or gas
cJ fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
PROPERTY. OWNER ' ' ` ❑ TENANT Chimney /liner /flue /vent 10.00
:� Other 10.00
Name: j tt�t gr►► `„�1k� )%k-Ceram Environmental exhaust and ventilation
Address: tl, 1 % T V , 1,64=111.1 ' f gang p e hood/other kitchen
b"L . e ment 10.00
City /State /ZIP: C d t q 1 ZZq Single -duct exhaust (bathrooms, 10.00
Phone: (G)/P 6 gyp— ^�Q 5 Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT ❑ 'CONTACT PERSON - ° Attic /crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: ,' 1 n � S L. $5.40 for first four; $1.00 for each additional
Address: ' )( --- ^ ' S� L a ° ` PL Furnace, etc.
v Gas heat pump
City /State /ZIP: 7 \;e: _.,rci 1 4 ( 2_ 41 1 2 ^� t( Wall /suspended/unit heater
Phone: (s 3) 6 ' for
` ___ -go C E') S Fax: : ( ) Water heater
Fireplace 1
E -mail:
Range
` 'CONTRACTOR.. , °> .. - . 7 .t - Barbecue
Business name: ShertAbur Clothes dryer (gas)
Other:
Address: 7 b k) d _ MECHANICAL PERMIT - FEES*
City /State /ZIP: t ��1 ci -7 0 t. 2_ Subtotal IN. Minimum permit fee ($72.50) 74`'72
Phone: ( 65 2 -5 63 Fax:( ) f
,� Plan review (25% of permit fee)
CCB lie.: ( State surcharge (12% of permit fee) d
TOTAL PERMIT FEE S'(• .
Authorized signatu S' This permit ap plication expires if a permit is not obtained within 180
da ys after it Las been accepted as complete.
Print name: c.._\ 1 I schtac-1,,.1 -c-r Date: /6 3 -02) * Fee methodology set by Tri- County Building Industry Service Board
1 \Building \Permits \MEC- PermitApp doe 01/19/07 440 -4617T (11 /02 /COM /WEB)
Mechanical Permit Application - City of Tigard ..
Page 2'- Supplemental Information
Commercial Fee Schedule:
aotilValtiation: - who
$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.
1:\Building\Permits\MEC-PermitApp.doc 01/19/07 2
CITY OF TIGARD
BUILDING DIVISION
A PERMIT #:
t
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/3/20013
Phone: (503) 639-4171 utAltit
Inspection Requests (24 Hrs.): (503) 639-4175 ,,_...ta■ - -.... tViC20013-00497
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
1W13/2008 7:00AM 7
•
SITE ADDRESS: CLASS OF WORK:
16430 SIN 109TH PL
SUBDIVISION: .. LOT #: TYPE OF USE:
REBECCA PARK 023
PROJECT NAME:
SCHLACHTER
DESCRIPTION: Gas fireplace insert with gas line.
OWNER: PHONE #: 503-620-7085
SCHLACHTER, JANINE
CONTRACTOR: PHONE #: 603-692-5563
SHAMBURG HEATING LLC
Inspection Request Scheduled For: Date: Pour Time:
10113/2000
Code # Inspection Description Confirm # Contact # Message
6?5 'Yriecio /
610 CacIline— 076626-01 503-620-7085 N
Corrections/Comments/Instructions:
52-ct1 6X-f eV , :or"
. .,
C A-Se— --r- %/ye., \
/---1CsS 0 PARTIAL APPROVAL . fl CANCEL fl NO ACCESS
I I FAIL I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: ..--S Date: /3 6e7Ofit Phone #: (503) 718- 29=2
, .
CITY! OF TIGARD _.
BUILDING DIVISION PERMIT #: MEC2008-00497
.13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/312008
Phone: (503) 639-4171 :A.Phittiii?\
Inspection Requests (24 Hrs.): (503) 639-4175 ,....,311fr ILL.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
10110/2008 7:00AM to
SITE ADDRESS: CLASS OF WORK:
16430 SW 109TH PL
SUBDIVISION: REBECCA PARK 023 LOT #: TYPE OF USE:
PROJECT NAME:
SCHLACHTER
DESCRIPTION: .
Gat firepla. ce insert with gas tine.
OWNER: PHONE •
SCHLACHTE.R, jANI NE .
It 503-620-7005
CONTRACTOR: PHONE #:
SHAIvIBURG HEATING LLC 503-692-5563
Inspection Request Scheduled For: Date: Pour Time:
'10/10/2008
Code # Inspection Description Confirm # Contact # Message
610 Gm; line 076559-01 503-620-7085 N
Corrections /Comments/ Instructions:
a
Ci
..-----
. 2r....„...............________ ____.-- - "
I PA 1 PARTIAL APPROVAL 0 CANCEL • fl NO ACCESS
47 FAIL )CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: /e -/o - g Phone #: (503) 718- 2-C-A--
_,.
CITY OF TIGARD , ..
A
, ...
BUILDING DIVISION
AR PERMIT #: MEC200800497
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/312008
Phone: (503) 639-4171 iit,sy1450)1#
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/9/2008 TIME: 7:01AM PAGE: 27
SITE ADDRESS: 16430 SW 109TH PL CLASS OF WORK:
SUBDIVISION: REBECCA PARK LOT # 023 TYPE OF USE:
PROJECT NAME: Se. HLACHTER
DESCRIPTION: Gas fireplace insert with gas' line.
OWNER: SCHLACHTER, JANINE PHONE #: 603-670-7085
CONTRACTOR: SHAMBURG HEATING L PHONE #: 503-692-5563
W
Inspection Request Scheduled For: Date: Pour Time:
10/9/2008
Code # Inspection Description Confirm # Contact # Message
610 Gas line 07&16&01 503-620-7086 N
Corrections /Comments/ Instructions:
Vie-lc) ) :25" p5'. ,Co r 1.5
3 Q-cA 6 )( 4c_r 'Ai tkio, k ?e h -12 4 ret- i ci v`•
q sr co q 0,, ,41,j.,„.--- cr, e ur„ ii QeMe- 1 '-
[ fl PARTIAL APPROVAL El CANCEL El NO ACCESS
n FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
_
Inspector: 3-5 Date: 9 0 4 7o 1: Phone #: (503) 718- 2 `623