Permit CITY TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00652
AAA!' — II 13125 SW Hall Blvd., Tigard, OR 97 (503) 639 -4171 DATE ISSUED: 9/29/2004
PARCEL: 2S103BC -00600
SITE ADDRESS: 12605 SW 121ST AVE
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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: 1 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of new A/C.
Owner: FEES
STEVENS, JAMES H AND LYNN N Description Date Amount
12605 SW 121ST [MECH] Permit Fee 9/29/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 9/29/200 $5.80
Phone: Total $78.30
Contractor:
HARDY PLUMBING + HEATING
14689 NE COUNTRYSIDE
AURORA, OR 97002 REQUIRED INSPECTIONS
Phone: Cooling Unt Insp
hone: 222 - 9654
Final Inspection
Reg #: LIC 00060947
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct qu stions to OUNC by calling
(503)246 -6699.
Issued By: * Z1J, Permittee Signature. /
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Perin�>�� FOR OFFICE USE ONLY
City T igard , +. -.j�k, Date/By: , �� I Permit No.: \ \i ( L2 /, y , � , L
13125 SW W Hall Blvd., Tigard, OR 97223 v� 1/U v�
Phone: 503.639.4171 Fax: 503.598. pet 4 � 4 "/ an Review
� (1 ��0� � ( ��'l l ? I � Date/By: Other Permit:
Inspection Line: 503.639.4175 J 1 c� Date Ready/By: furls: hJ See Page 2 for
Internet: www.ci.tigard.or.us vI I Y OF [ AOD Notified/Method: rib ._ Supplemental Information
' 05 s "7 W s. MER.CIAL >'FEE SCHEDULE — •USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
` °�! fIEN$ �: 4f_ Value: $
t� ,. .� ,. �, Q RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Nil- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
,x..1,74 ; 4 ¢ t` N e a? y Heating/cooling
� ..�,.._ .. .w� �� ��. „tea, °._ . ,.���.«i
Job site address: Air conditioning or heat pump
1 1 j P h s- SL...j / ) Sr- (requires site plan showing placement) 14.00
City/State /ZIP: T7 / Cy iz bat Furnace 100,000 BTU (ducts/vents) 14.00
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
f L ()U f _ 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
rr b MI d vI#t r Water heater 10.00
�
G as fir eplace 10.00
r �
r !�/ 19 - 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
i o i yt g t Chimney /liner /flue /vent 10.00
._.. x , .". �_. ° 7 : :. . Other: 10.00
Name: ST' J ,f� $ Environmental exhaust and ventilation
l� Range hood /other kitchen
Address: / '� S s7--- equipment 10.00
City/State/ZIP:2 ! Clothes dryer exhaust 10.00
/ �' o`il/ f Single -duct exhaust (bathrooms,
Phone: ( ) `, A r --)..,_, 9 Y Fax: ( ) toilet compartments, utility rooms) 6.80
I :7 ' , �' l ` , I s _' `1 Attic /crawlspace fans 10.00
Othe 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
E -mail:
Range
it ' V s wi Barbecue
�'ea'�3.. v ,' ° � � °� _ �. »u �' " s .. Y „.. Z ' viz ? °��
Business name: j 9 I a - 7 - 7 � 1 Clothes dryer (gas)
/ ' r � /�, �/ l� ' / i Co Other
Address: 1 L/ rr
4 ge-1 / /�' 02 (/71,r,) 7 ,2 S / 0 /7r ”. r cAU Pt MrfWES*
City/State/ZIP: 21 (� 2p / C/L 9-)161)2. Subtotal
Phone: (Sr) r)_,") _ 9 y Fax: (S63) 4,9"-) F - /, j�
Minimum (25% fee ($72.50) fee)
)
O 7 v Plan review (25% of permit fee)
lic.: r/ O ! 'y-) Pv_f / f — /5? `, 7 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
i:\Building\Permits\MEC- PermitApp.doc 12/03 440-4617T (I I/02/COM/WEB)
Mechanical Permit Application - City of Tigard - _ •
Page 2 - Supplemental Information
Commercial Fee Schedule:
- Total Vali itio
$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
4
12.) s�
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
1 CTION DIVISION_ - Business Line: (503) 639 -4171
l ( MST
BUP
Received S Date Requested / o / l AM PM BUP
Location lD / ) - / S Suite oU e ' f' 6
Contact Person W--6 Ph ( ) 2ZZ - 9(o V5' PLM
Contractor Ph ( ) SWR r
BUILDING Tenant/Owner ELC W
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear WV \ 5 Z/ 3 v 4
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P RT FAIL
CHIN AL
Post & Beam
Rough -In/
Gas Line C�
S ke Dampers
Ina
ASS ART FAIL
"ETEZTRICAL
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 Please call for reinspection RE: El Unable to inspect – no access
Fire Supply Line
ADA Date /6_ 4-- (1 (14 Ext
Approach/Sidewalk Inspector /
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL