Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00604
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/9/2004
PARCEL: 2S 103BC -09100
SITE ADDRESS: 12860 SW BLUE HERON PL
SUBDIVISION: BLUE HERON PARK ZONING: R -4.5
BLOCK: LOT: 008 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm:
GAS OUTLETS:
Remarks: Installation of gas furnace push/pull.
Owner: FEES
MEIKLE, FREDERICK C III Description Date Amount
12860 SW BLUE HERON PL [MECH] Permit Fee 9/9/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 9/9/2004 $5.80
Phone: 503 430 - 8430 Total $78.30
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 222
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.
Issued By: . "-�,je Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the flex) business day
Mechanical Permit Ap • f - 1t . IVE FOR OFFICE USE. o>vLti
R e ceived
City o f Tigard Q �j Date/By: Permit No.:, a" e/ a o c/
13125 SW Hall Blvd., Tigard, OR 97223 SEP 0 9 20u '
Plan Review
Phone: 503.639.4171 Fax: 503. 598.1960 G ;,; 1.'S % Date/By: Other Permit:
Inspection Line: 503.639.4175 r e ..r f Date Read • B : June: RI See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TI a , Notified/ i I V Supplemental Information
BUILDING DIVISION
TYPE OF WORK ' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition/alteration /replacement 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: S
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
(i1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Fa. I Total
' JOB SITE INFORMATION ,AND ;LOCATION Heating/cooling
Job site address: ! aG 8 6,0 5 W (3 b4 q ejeO f) pk.
Air G res s to plan bo ing t p pump )
wires site fan showin placement) 14.00
City/State/ZIP: • - � ' ,I Furnace 100,000 BTU (ducts/vents) j 14.00 /4 di c � -/ � ' A • Furnace 100,000+ BTU (ducts/vents) 17.90 .
/
Suite/bldg. /apt. no.: Project name: Q J !cl� 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 D .61
Other: 10.00
Tax map /parcel no.: Other fuel appliances • - `: ,DESCRIP LQNi :OF.,: WORK - - Water heater 10.00 •
c S> `/ ( to r)e ei / /i9id/ Gas f 10.00 I
!/7 s 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;' - ' = . 0 TENANT • Other ' 10.00
Name: L. f , e f, t—icrie / / / Environmental exhaust and ventilation
•
Address: 1 0t 660 S) elm t-ieLle-on PL Range hood/other kitchen
equipment 10.00
City/ State/ZIP: / "L G d () .e7-7 2 c I Clothes dryer exhaust 10.00
J J Single -duct exhaust (bathrooms,
Phone: (5b3) LA /6 .. 91416 Fax: ( ) toilet compartments, utility rooms) 6.80
Atti crawl ace fans 1
. ❑ A PPL-ICANT:`;::�. -:° : . >. -.:- .'::: i ® PERSON ' .� sP
Other: 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
.- CONTRACTOR: ::;::., - - _ . . Barbecue
Business name: 9A a � g' JV li >/B Clothes dryer (gas)
/ /� r �J�! Other
Address: Cq q ®�'— i/ >� / l E `� J 7 r 7e t3lu MECHANICAL PERMIT FEES*
City/ State/ZIP: 6LA
eie �*7 ! f i9 O A -. Subtotal daZelp
�C Minimum permit fee ($72:50) "]a d
Phone: 5? Fax: ( 5a1 2 b t/ ! 55 Plan review (25% of permit fee)
CCB lie.: ga State surcharge (8% of permit fee) S. 6 i
TOTAL PERMIT FEE 7g, ` so0
Authorized signature: 6( — This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 63r,4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Reque ted AM PM BUP
Location % B (o c 1t A- /L Suite , o106 y —00 6 6 /
Contact Person 9.c. /yZ/,Yl/,t Ph ( ) ! ' 1 7 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear \ 0 - /1/7,4
Framing V J�n
Insulation
Drywall Nailing / * IIM
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
PASS PART FAIL
MECHANICAL
Post .& Beam
Rough -In .6
Gas Line
Smoke Dampers
ART FAIL
CTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date _,/d �' ���� Inspector .� Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL