Permit •
eS
CITY OF TIGARD
MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00771
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/2112005
PARCEL: 2S104AA -11400
SITE ADDRESS: 12395 SW 129TH AVE ZONING: R -4.5
SUBDIVISION: BELLWOOD NO. 3 LOT: 133 JURISDICTION: TIG
Project Description: Replace gas furnace.
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:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
BURTON WHITE Description Date Amount
12395 SW 129TH
TIGARD, OR 97223 [MECH] Permit Fee 11/21/20( $72.50
[TAX] 8% State Surcha 11/21/20C $5.80
Total $78.30
Phone: 503 - 590 -3535
Contractor:
HEAT MASTER CORP.
P.O. BOX 301277
PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS
Phone: 503- 253 -2014
Reg #: LIC 146074
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 By: . 3 Permittee = ignature: � ��
Call 503 - 639 -4175 by 7:00 a.m. f-- r inspecti • s that busi • ss day.
This permit card shall be kept in a conspicuous dace o. a job site until completion of the project.
Approved plans are required on the ' • • ite at the time of each inspection.
Mechanical Permit Application colt omit I: I st: ()NIA
T ' 'i ty of Tigard E C E D D ' By / A -c Permit No.` l .) 7 '1
13125 SW Hall Blvd., Tigard, OR 9 Plan Review
`` �tJ
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Inspection Line: 503.639.4175 t Dat Date Ready/By: Re ®
NOV 2, 1 2005 1 . '_ ady/By: See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
L',1TY OF TIGARD
))OOGOVIS1ON COMMERCIAL FEE* SCHEDULE USE CHECKLIST
❑ New construction VI Mechanical permit fees' are 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.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT ! SYSTEMS FEES*
❑ I and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description I Qty. l Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1, Air conditioning or heat pump
,� : (requires site plan showing placement) 14.00
City /State/ZIP: - J 6,c 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
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
Gas fireplace 10.00
L/t, f■/ /4- G -1 S — f 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
Chimney/liner /flue/vent 10.00
❑ PROPERTY OWNER I ❑ TENANT
6-/A-A Other: 10 .00
Name: ' L Environmental exhaust and ventilation
Address: / 2 ' 5 (. J . / 2 S Range e hood/other kitchen
equipment 10.00
City /State /Z . 1 '� n /� Clothes dryer exhaust 10.00
Phone: . `�I6_3G l J F - 9 3 Z 75 6 toilet comp exhaust utility ��� �! � –° � �— C toilet compartments, utility rooms) 6.80
❑ APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 10.00
Business name: f /2, ,4S J & � / 2 Other: 10.00
Fuel piping
Contact name: - C - / , ,_ , $5.40 for first four; $1.00 for each additional
Address: /V U5`" 0 �� /,�� '7 �S , Furnace, etc.
/ 7 / '� Gas heat pump
City /State /ZIP: �j1e lay �i j r - Wall/suspended/unit heater
Phone: L7 l _....7 2 y `. 355 . F : 2 "' .•- ) 2 .- s 2. � Water heater
� '" Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: , -- Clothes dryer (gas)
�(= 1j ,�Y I T �' !c Otter:
Address: MECHANICAL PERMIT FEES*
City /State/ZIP: A , 1) e . Subtotal
Phone 3) 7 2 z ) 7 te° 'I Fax ,43 _5' Z S 6Q Minimum permit fee ($72.50)
7 � ' ° r Plan review (25 /o of permit fee)
CCB lic.: a ‘ , , , e / V 6 State surcharge (8% of permit fee)
f 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: e C (.... e, _ Dat:. C e, i • Fee methodology set by Tri- County Building Industry Service Board
i:\Building\Pennit• I • itApp.doc 12/03 '0- 4617T(11/0 COM/WEB)
Mechanical Permit Application - City of Tigard to
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.
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD
rn G
BUILDING DIVISION PERMIT #:ap0j -06 77
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 - 4171 " ^�bp�ioiff "�i'A ■ A____
Inspection Requests (24 Hrs.): (503) 639 -4175 .—_
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS:
S J " _
3 �/ � CLASS O
a OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
1 PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: / - 2O -6 (p Pour Time:
Code # Inspection Description Confirm # Contact # Message
6�t/� A b 0 as9yZ-a S9o- - .3 _5 25
1 1
Corrections /Comments /Instructions:
,-,<(--e,(AA4 0,C_.e___/
I
01 k; ' U/u( ' :E S - 7 Z6 c
1 OT 4
J \r'
PA€6 ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11C(114 Date: i h Oh b Phone #: (503) 718- 2_-(/ Z /
_____ _ _ _ _