Permit ‘.11 TIGARD
V ITY O F I MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00265
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/8/2007
PARCEL: 1S134AD-04800
SITE ADDRESS: 10765 SW BLACK DIAMOND WAY ZONING: R -4.5
SUBDIVISION: BLACK BULL PARK LOT: 031 JURISDICTION: TIG
PROJECT: MONTY
Project Description: AC (previously installed)
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:
ELE 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:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
CHRIS MONTY Description Date Amount
11705 SW BLACK DIAMOND
TIGARD, OR 97223 [MECH] Permit Fee 5/8/2007 $72.50
[TAX] 8% State Surcha 5/8/2007 $5.80
[MECH] Investigation F 5/8/2007 $72.50
Phone: 503- 939 -9783 Total $150.80
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
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 -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.
1
Issued By: Permittee Signature: AA_ A \
•
Call 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 Permit Applica I + 1 F } FO OFFICE USE ONLY zxi •• ; ` -
Reived ^� �.,/y
11 City of Tigai;d Received
1114,4Y Re Date/By: ive �� 86 Permit N� E�/�(. • ...00,26„5 ...00,26„5 13125 SW'Hall Blvd., Tigard, OR 97223 L 3 2007
Plan Revie
Y Phone: 503.639.4171 Fax: 503.598.1960 Date/B Other Permit:
y
T GA R36 Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: la See Page 2 for
Internet: www.tigard -or goy BUILDING DIVISION Notified/Method: . Supplemental Information
-, ,, _, t •,TYPE OF WORK - COMMERCIAL' FEE* ".SCHEDULE ' USE CHECKLIST
[1] ❑ New construction Mechanical permit fees* are based on the value of the work
Addition /alteration replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
:,CATEGORY: CONSTRUCTION', .R .." " Value: $
dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* _` '
❑ 1 - and 2-family g ❑ Commercial /industrial ❑ Accessory building
Multi For special information use checklist.
1:1 y ❑ Master builder ❑ Other: Description Qty. Ea. Total
-,`• •, JOB' SITE INFORMATION AND LOCATION Heating/cooling
C �\ Air conditioning or heat pump
Job site address: 1 61 i� V \IV ()A pt 0 I RA 640 (requires site plan showing placement) 14.00
City/State /ZIP: 1 \ 1 D a� i� x'4 \ t�
`22-3 Furnace 100,000 BTU ( ducts/vents) 14.00
�"� Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no ": Project name: L k ' 04(� 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
E 1 C1 ,lv q p ` a coo), -\- 0 N 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 . .` ' _ : ; °� . ❑ TENANT � .' "> .. ,_
- Other: 10.00
Name: (-7-_,,.. it` 5 )-A. ay i Environmental exhaust and ventilation
5 r� Range hood/other kitchen
Address:
6� b5 `J Az" W who equipment 10.00
City /State /ZIP: — [ ywk...0 Q 12 ' C Ci -7 23 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (co) 5 ' S _ q---7 g3 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: Furnace, etc.
Gas heat pump
City/State /ZIP: WalUsuspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
' . • . • CO CTOR . Barbecue
� � Clothes dryer (gas)
Business name: �IVV
Other:
Address: ' • MECHANICAL PERMIT FEES* .•
City /State /ZIP: Subtotal
_ Minimum permit fee ($72.50) 7'p( ..se..) ( ) Fax: ( ) J l y,¢e l
/g e ) ''7.,. go
CCB lic.: State surcharge (8% of permit fee)
/ TOTAL PERMIT FEE /57) . 80
Authorized signature: a , //'� ` • This permit application expires if a permit is not obtained within 180
1111 �. days after it has been accepted as complete.
Print name: et 1 ..— ) ,\ s-r (0 E {\\ c i D. e: k 107 ' Fee methodology set by Tn- County Building Industry Service Board
I: \Building\Permits\MEC- PermitApp doc 04/06/06 • 44•-4617 r (1 i /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
,TOtal Yaliati� 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.
, .
\BuildingWermits\MEC-PermitApp.doe 12/30/05 2
i
n
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2007- 00265
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 51812007
Phone: (503) 639 -4171 :nmamyp ii ° t
Inspection Requests (24 Hrs.): (503) 639 -4175 ... 1.11- '111.
INSPECTION WORKSHEET FOR DATE: 5/30/2008 TIME: 7:01AM PAGE: 29
SITE ADDRESS: 10765 SW BLACK DIAMOND WAY CLASS OF WORK: I
SUBDIVISION: BLACK BULL PARK LOT #: 031 TYPE OF USE:
PROJECT NAME: MONTY
DESCRIPTION: AC (p,•eviously installed)
OWNER: MONTY, CHRIS PHONE #: 503 - 939 -9783
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/30/3 8 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 070588 1 503-312-0103 N
Corrections /Comments /Instructions:
7 0 )
4,, PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V /' Date: .0a ,e Phone #: (503) 718- a / -q
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ME C2007-00265
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ti/I312007
Phone: (503) 639 -4171 /m ui� itt
Inspection Requests (24 Hrs.): (503) 639 -4175 ' �.
INSPECTION WORKSHEET FOR DATE: 1112/2007 TIME: 7 :01AM PAGE: 9
SITE ADDRESS: 10765 SW BLACK DIAMOND WAY CLASS OF WORK:
SUBDIVISION: BLACK BULL PARK LOT #: 031 TYPE OF USE:
PROJECT NAME: MONTY
DESCRIPTION: AC (previously installed)
OWNER: MONTY, CHRIS PHONE #: 503 039.97B3
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
698 Mechanical final 0589240/ 503 - 312 -0103 N
Corrections /Comments / Instructions:
—1 7/
(\10 (910' 1/
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
K FAIL E CAL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: 0 Phone #: (503) 718-