Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00709
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/26/2004
PARCEL: 2S102DB -01801
SITE ADDRESS: 13235 SW BURNHAM CT
SUBDIVISION: BURNHAM PARK ZONING: R -4.5
BLOCK: LOT: 012 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:
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: 1
Remarks: Replace furnace & gas logs to fireplace.
Owner: FEES
DYGART, VIRGINIA L Description Date Amount
13235 SW BURNHAM. CT [MECH] Permit Fee 10/26/20( $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 10/26/20( $5.80
Phone: Total $78.30
Contractor:
SYSTEM AIRE INC
14444 SW FERN ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Heating Unt Insp
Reg #: LIC 38062 Final Inspection
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.
4 60.
Issued By: „1 Permittee Signature: ,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application Fox OFFICE USE -ONLY
City of Tiga'rd • f I> C!�'11i�m'V E® Date/By/ / 0 0 — fit, Permit No.:MC r-. i t� , / O
13125 SW Hall Blvd., Tigard, O;1 • Plan Review 11 ``
Phone: 503.639.4171 Fax: 503.598.1960 Aaau' Date/By: Other Permit:
Inspection Line: 503.639.4175 OCT 2 6 2004 G a � d '.i Date Ready/By: y
W eady /By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
MTV OF T��
B`JQti COMMERCIAL 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.
CATEGORY OF CONSTRUCTION Value: $
1- an 2 dwelling C /industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ y g ❑ ❑ Accessory building
❑ Multi - family 111 Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: / / Air ning h pm
' � . �� - i3v A/Li j�{�i 7r (requir dition site plan showor ing eat placem en t) 14.00
City/State /ZIP: 7 // } ti ,� 3 Furnace 100,000 BTU (ducts/vents) / 14.00
S 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
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
❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: /it /• �V D Environmental exhaust and ventilation •
6 Range hood /other kitchen
Address:
2 - 3 ; -�, / ?u Ti/04j 6¢gs,. L .ti- equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: 93 ) 6 8' y _ / 33 4 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
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: ( ) Fax:: ( ) Water heater
Fireplace /
E -mail: Range
CONTRACTOR Barbecue
Business name: 5 So c�-7 # Y Clothes dryer (gas) -
Other:
Address: (t/ / 4i 7 ti ii J .-j ( -,o .5'y MECHANICAL PERMIT FEES*
City/State /ZIP: i r . ) Q - 7 2 2 2_ 3 Subtotal
Phone: (�C �) 5 Le- 5 - 1 —
/ Z 7 Fax: ( ) Minimum permit fee ($72.50) -7 ,3
Plan review (25% of permit fee)
CCB tic.: 3804 Z State surcharge (8% of permit fee) j I,
TOTAL PERMIT FEE I --r • a 7,
•-
Authorized signature: Ar This permit application expires if a permit is not obtained within
days after it has been accepted as complete.
Print name: (', ` L ( f3f it / . f- Date: * Fee methodology set by Tri-County Building Industry Service Board
J
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.
$100,000.01 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. •
is \Building \Permits \MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: ;- ' /- 4175
1 2
INSPECTION DIVISION, y ° Business Line: (503.�!���- --r J MST
BUP
Received Date Requested /b -a 7 AM PM BUP
Location 3 a- 3 •L., I Y2 ite (a c,200 -o0 7 0 g
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR A r
BUILDING Tenant/Owner ELC lNO-
Footing
ELC
Foundation
Ftg Drain Access; ELR
Crawl Drain
Slab Inspection Notes: - /, SIT
Post & Beam ��Z.�e- -�'X� —l_f �' Y.' '
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear n/1 .L ,�. �L 1.. EL- / 4,66 /
Framing V
Insulation
Drywall Nailing . .� c�
Firewall� 1` / /3 / d-
Fire Sprinkler 2 I
Fire Alarm ` -- S 4 ii l \ / ` (c) j / 3 Susp'd Ceiling ;/ / r
Roof 3 T L I / -
Other:
Final - -
PASS PART FAIL
PLUMBING \/
L
Q1J__:‘,,\ v .
Post &Beam
Under Slab �
Rough -In
Water Service
Sanitary Sewer S ,,,7_- n 0-.. ,(A, - P - 4---,..A...._
1 1
Rain Drains
Catch Basin / Manhole V\,..S2 a, k ',,Z C --(Z_S
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL ; !'
MECHANICAL Q
Post & Beam
Rough-In . Ce V
r .
Smoke D ampers -=
41A011) .
PART FAIL
RICAL _
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm -
Final' y:,. v 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
-
PASS 4 ��PART FAIL
SITE - ' ' ❑ Please call fo r=reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line ` JA-------
ADA `D I 71 /t) 'N Nib
Approach/Sidewalk Date - _ Inspector Ext
-- : * fr :
Final `D0_NO this inspection record from the job site.
PASS PART FAIL "' ` '- ' - .9;, -
t l