Permit CITY TIGARD MECHANICAL PERMIT
AU-
DEVELOPMENT BMENg Tigard, -639 -4171 DATE E IS ISSUED: 9/13/2005 00567
13125 PARCEL: 2S115AA -03200
SITE ADDRESS: 16450 SW 108TH AVE ZONING: R -4.5
SUBDIVISION: DOVER LANDING NO.2 LOT: 071 JURISDICTION: TIG
Project Description: Install heat pump.
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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
BRIAN CONROY Description Date Amount
16450 SW 108TH AVE [MECH] Permit Fee 9/13/200f $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 9/13/200: $5.80
Phone: Total $78.30
Contractor:
WOLFERS, INC
290 YOUNG ST REQUIRED ITEMS AND REPORTS
WOODBURN, OR 97071
Phone: 503 -981 -4511
Reg #: LIC 1911
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 -80e- 32 -2344.
te.44.A14.4 L/�—
Iss ed B � Permittee Si nature: Y Signature:
503 - 639 -4175 by 7:00 a.m. for inspections that 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
of Tigard P e.rmit Application FOR OFFICE USE ONLY
J g and
City - - r . Received an Permit No. _ : t „ _ � /
i
Date/B :
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 // ,:; I•.\ Date/By Other Permit:
_J,
Inspection Line: 503.639.4175 l ' _ i l Date Ready/By: 55 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
• TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Er
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
and 2-family dwelling RESIDENTIAL EQUIPMENT/ SYSTEMS.FEES *'
y g ❑ Commercial /industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 11 � G S /Q g.1” Ij e r Air conditioning or heat pump �/ qt
I t a I (requires site plan showing placement) / 14.00 j /
• City /State /ZIP: --"•-• / ���) �'�/l C� - ` 2 r,) . Furnace 100,000 BTU (ducts/vents) 14.00
l ° `` ` Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: Cr.�N 2 d
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
DESCRIPTION OF WORK , ' Water heater 10.00
• /1e �� S J Gas fireplace 10.00
4- 4 r ,
X i /--) °Jc Flue vent for water heater or gas
fireplace 10.00
C..,i / t 1 �V / e\..) C e.' S.5741•KA.Th Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue/vent 10.00
PROPERTY OWNER ❑ TENANT
Other: 10.00
Name: J l ` 1 i /4.13 J Environmental exhaust and ventilation i‘i
Address: i Range hood/other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
. Phone: ( ) Fax: ( ) . toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address:
Fumace, 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: W o f f P S /- /-)�J�
O _)) Other
Address: 2 0 7"Oo - 'Ja SJ MECHANICAL PERMIT FEES*
City /State /ZIP: c C.`J d <JO,t.� l )cQ 7a 7 l Subtotal
�'
Phone: (Sc?j) 7g /-- �/ F. ( ,jv) ? / 0 —) Mi r ivie w(25 %itfeer mit fee (�1
\ Plan review (25% of permit fee)
CCB lie.: / y l,) 7) State surcharge (8% of permit fee) 5 , W
/L/ > TOTAL PERMIT FEE ?)j
Authorized signature: C �--� This permit app lication expires if a permit is not obta thin 180
days after it has been accepted as complete.
Print name: 6 r // Z ,.1 C /J 1'e 0 r .) Date: 9.--/,
. V. � * Fee methodology set by Tri- County Building Industry Service Board
. V
is \Building\Perm its \MEC- PermitApp.doc 12/03 440 -4617T ( 1 1/02/COM/WEB)
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.
•
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CITY OF TIGARD M
-D-,,,, - A A La..ek_
BUILDING DIVISION . . ,,,,
PERMIT #: MEC2005 00667
13125 SW Hall Blvd., Tigard, OR 97223
Alk DATE ISSUED: 9/13/2006
Phone: (503) 639-4171 141 . 1 41,4Ilt
Inspection Requests (24 Hrs.): (503) 639-4175 ,L44. IL
INSPECTION WORKSHEET FOR DATE: 4/28/2006 TIME: 7:02AM PAGE: 107
SITE ADDRESS: 16450 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: DOVER LANDING NO.2 LOT #: 071 - TYPE OF USE:
PROJECT NAME: CONROY
DESCRIPTION: Install heat pump.
OWNER: CONROY, BRIAN PHONE #:
CONTRACTOR: WOLFERS, INC PHONE #: 503-981-4511
Inspection Request Scheduled For: Date: 4/2612006 Pour Time:
Code # Inspection Description • Confirm # Contact # Message
699 Mechanical final 028693 503 Y
Corrections /Comments/ Instructions:
1 712 ■/7/"7.6 /I_ --ta(9 1 '-- 5 "'2
\
PASS I I PARTIAL APPROVAL 0 CANCEL ' 0 NO ACCESS
fl FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: - 4//Y \ M;- 40
q Date: —/--(--4 Phone #: (503) 718- 7
.2(49
CITY OF TIGARD
BUILDING DIVISION "} PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 _ _ DATE ISSUED:
Phone: (503) 639 -4171 , " ' M'yli I��j r
Inspection• Requests (24 Hrs.): (503) 639 -4175 - 7 \ ( V r2 4C M 1�
INSPECTION WORKSHEET FOR DATE: c -'?',; 1 0 (p TIME = _ems.... --= - PAGE:
SITE ADDRESS: 1(04S 5 W 1 O p k V ZJ CLASS OF WORK:
SUBDIVISION: 4 LOT #: TYPE OF USE:
PROJECT NAME: ,I m D S
DESCRIPTION: Ml `, N- �` Y`Q "
OWNER: B C /vJ ' PHONE #:(3 3) 5/ 7 - 4 448
CONTRACTOR: � - C --c_. PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments / Instructions:
i �,s� 1_ c�, l 5 Lo 74 7
El- L2' (Li (AL 1P N N2_ i
� o0
tz
c,-ef - 64.4..
1
1
A PASS I I PARTIAL APPROVAL ❑ CANCEL. _ NO ACCESS
I FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: G---(NIs � NCia LE Date: 2-P 6 Phone #: (503) 718 -'t44•