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Permit CITY OF TIGARD MECHANICAL PERMIT 4 0 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00675 s��� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/8/2004 PARCEL: 1S134CD-03000 SITE ADDRESS: 12040 SW 119TH AVE SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5 BLOCK: LOT: 058 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: LPG 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: 1 AIR HANDLING UNITS OTHER UNITS: FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Replace gas furnace. Owner: FEES PLUNKETT, BRUCE A AND Description Date Amount JANICE E [MECH] Permit Fee 10/8/200v $72.50 12040 SW 119TH [TAX] 8% State Surchar€ 10/8/200 $5.80 TIGARD, OR 97223 Phone: 503 - 590 - 5858 Total $78.30 Contractor: PIONEER GAS FURNACE 3615 NE BROADWAY PORTLAND, OR 97232 REQUIRED INSPECTIONS Phone: 503 Heating Unt Insp Final Inspection Reg #: LIC 36102 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 C By: h •ugh OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (50 rhA�(/ Iss Permittee Signatur Call , (503) .111:::41/5/1,3;A7:_0:1:: .M. for inspections needed the next usiness day Mechanical Permit Application l oiz t it 1 It I I .1 t t" l City of Tigard - • Received City Date/By: /o,i L , 7 /j M Permit No.: _ , / , ,. , ,' ill 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.59 r 4JEt v E 1,-. . , . , ,, , Date/By. Other Permit: Inspection Line: 503.639.4175 j, . •� - I� Date Ready/By: y: See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: II Supplemental Information q yx € . TYPE OF WOII 6 ARD COMMERCIAL FEE* SCHEDULE UHF a i t uIi s' , ❑ New construction Addition /akteratiitl e1filiaFi ent Mechanical permit fees* are based on the value of the work v , performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit. t ;Y = CATEGORY OF CONSTRUCTION Value: S yr and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /SYS11')3"•' For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Oty. I Ea. I Total ` JOB SITE INFORMATION AND LOCATION Heating/cooling Job site "Yt , e adds Q , ,p Air conditioning or heat pump O Q (.� 1 v� (requires site plan showing placement) 14.00 City/State/ZIP: I o r , kl.v\o\ / C q 7 2 23 Furnace 100,000 BTU (ducts/vents) / 14.00 /, era Pi t, . 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: 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 ` :; n ' ., '- DESCRIPTION OF WORK Water heater 10.00 ^nn �� Gas fireplace 10.00 J /ae Kr)a -Ce' Flue vent for water heater or gas yA.S C. fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 Chimney/liner /flue/vent 10.00 nµ [I'rROPERTY OWNER I ❑TENANT Other: 10.00 Name: ,Y , / 1 a _,f Environmental exhaust and ventilation Adtlregv. Range hood/other kitchen 5 /U a..5' ) equipment 10.00 City/State/ZIP: Clothes dryer exhaust 10.00 � Single-duct (bathrooms, Phone: 59 0 -.5$ Fax: ( ) toilet t compartments, utility lity rooms) 6.80 r * • ® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: 85.40 for first four; 81.00 for each additional Address: Furnace, etc. Gas heat pump City/State/ZIP: Wall/suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range -i° r w' CONTRACTOR - Barbecue Business name: /d/D!'! e ei,..- S �u /-,iac e Clothes dryer (gas) Other: Address: 3 S /1)E roO 1 ZL MECHANICAL PERMIT FEES° City/State/ZIP: H k -71/ ah0 oR / 7, Z Subtotal l g . 00 Phone: ( ^^�� ,�,�� f _ Minimum permit fee ($72.50) 72.,s e�.7 .2 �J ,e�(J'�� Fax: (5 ) 3 2 o LCO� Plan review (25% of permit fee) CCB lie.: dQ = State surcharge (8% of permit fee) 5 , ' Q W � �" TOTAL PERMIT FEE - 7 S • 3t This permit application expires if • permit is not obtained within 180 ry" Authorized signature: P `�`� days after it has been accepted as complete. Print name: Date• /O _ • Fee methodology set by Tn- County Building Industry Service Board Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: „ TotalV>nluution: 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. is\ Building \Permits\MEC- PermitApp.doc 12/03 2 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION . • Business Line: (503) 6 9 -4171 MST BUP Received Date Requested / 9 AM PM BUP Location j �- © 'i p // cf / -Q-- Suite MEC 00 4 1 — Z20 75 Contact Person s .rte Ph ( ) l) - - &S PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner / ELC Footing Foundation ELC Ftg Drain Access: /�/ ��° LYv � t / T ��/ " � � /'� ELR o� d 6 6 `3/ Crawl Drain d / 1 ► J Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING r f F7 Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final ) FAIL "' c M HA�C 'Posh CANIC Beam Rough -In Gas Line Smoke Dampers Fi FAIL LECTRIC Rough -In UG/Slab Low Voltage Fire Alarm F ii1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. �,t-�+ PART FAIL S E El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Date /7‘ Inspector Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL