Permit CITY TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2003 -00597
..�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/14/03
PARCEL: 2S103BB -02100
SITE ADDRESS: 12195 SW 124TH AVE
SUBDIVISION: BROOKWAY ZONING: R -4.5
BLOCK: LOT: 021 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace
Owner: FEES
CORY STEETER Description Date Amount
12195 SW [MECH] Permit Fee 10/14/03 $72.50
97
TIGARD, OR R 97 223
[TAX] 8% StateTax 10/14/03 $5.80
Phone: 503 793 - 2379 Total $78.30
Contractor:
REQUIRED INSPECTIONS
Phone: Final Inspection
Reg #:
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
Issued By: Permittee Signature:
— \
Call (503) 39 -4175 by 7:00 P.M. for inspections needed the e u day
Mechanical Permit Application Received FOR OFFICE USE ONLY
/ Mechanical
Date/By: /0 6 0 3 Permit No.:Yfl k ,3 -It 557
City of Tigard Planning Approval Building
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 ,A. Post- Review Land Use
affINIVO Date /By: Case No.:
Internet: www.ci.tigard.or.us A i Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 I Name/Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
3ddition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
10 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule
• Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty Fee(ea.) Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: / 2, /q S 5) / z L,a ,4v.. Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Cross street/Directions to job site: (orid radiator boiler
� (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Tax map/ parcel #: Other Fuel Appliances
ax ma
P p Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
Ale t,.J 7 CV na'— /12 U Flue vent (water heater /gas fireplace) 10.00
reA C14— Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
PROPERTY OWNER I Q TENANT Other: 10.00
Environmental Exhaust & Ventilation
ame: Gel ` r-t -v Range hood/other kitchen equipment 10.00
Address: /L/ C _S1_.' / Z t' /4trz
City /State /Zip: i/ Clothes dryer exhaust 10.00
7 i,-.9( Single duct exhaust
Phone: 5) 3- 753 -2,3 Fax: (bathrooms, toilet compartments,
'APPLICANT 0 CONTACT PERSON utility rooms) 6.80
Name: - A � Attic /crawl space fans 10.00
Address: Other 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc. **
Gas heat pump **
E -mail: Wall /suspended/unit heater **
CONTRACTOR Water heater **
Business Name: ti-) Ali-?:-C_____ Fireplace **
Address: Range **
BBQ **
City /State /Zip: Clothes dryer (gas) **
Phone: Fax: Other: **
CCB Lic. #: Total:
Authorized Mechanical Permit Fees
Signature: li ' 4`! Date: l dV7 22 , Subtotal: $
Minimum Permit Fee $72.50 $ q a ,5O
�� —.547 ._/— Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ 5. ( KO
TOTAL PERMIT FEE $ 7 , 36
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
is \Dsts\Permit Forms\MecPermitApp.doc 01 /03
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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and
$1.10 for each additional $100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of plans.
i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD , 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business dine: (503) 639 -4171 MST
j BUP
Received Date Requested / U - 45 ---- AM PM BUP
Location / oZ / 9 5 / a. 4/4'k- Suite MEC 3 -D.4' 517
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ual■ 9 1 3 - - 7 9 ELC —O 0 6, 3 0
Footing
ELC
Foundation
Ftg Drain Access: I' rJ /Yl b 6) ..._- ELR
Crawl Drain J
Slab Inspection Notes: n� J SIT
Post & Beam
Shear Anchors � /j�j�
Ext Sheath/Shear T`� / .) d�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam (' ('
Under Slab ` M 1i J R;) cc �. r I a , * 5 ;_c) ( \ i fl
Rough -In q }- � Water Service r I • 0
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough-In
--••-/ b 9:1 1 f.--------------
Line
Line
Smoke oke D
Z— �ata PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fires Al rm
r in
PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE D Please call for reinspectio• RE: A , Vi) Unable to inspect - no access
Fire Supply Line /
ADA ` /�
Approach/Sidewalk Date _ 6 Inspect. _4(.... /L� Eat
Other:
Final DO NOT REMOVE this inspection record fr s m the Jo te.
PASS PART FAIL