Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00796
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/6/2004
PARCEL: 2S111 CC -05700
SITE ADDRESS: 10020 SW CENTURY OAK DR
SUBDIVISION: SUMMERFIELD ZONING: R -12
BLOCK: LOT: 080 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: 1 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:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replacement of furnace & A/C unit.
Owner: FEES
COOBS, KATHRYN Description Date Amount
10020 SW CENTURY OAK DR [MECH] Permit Fee 12/6/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 12/6/200 $5.80
Phone: 503 - 670 - 9160 Total $78.30
Contractor:
MORRISON HEATING & COOLING LLC
16409 SE DIVISION ST # 216
PORTLAND, OR 97236 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 160715 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 r es or direct questions • OUNC by calling
(503)246 -6699.
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Issued By: ,7 " „ J Permittee Signature: PA.' cal
v
Call (503) 639 - 4175 by 7:00 P.M. for inspections needed the next • usiness day
Mechanical Permit Application FOR OFFICE U SE ONLY
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City of VOrc RD Permit No 1 13125 SW Hall Blvd, Tigard, OR 9722
Phone: 503.639.4171 Fax: 503 . 598 . 1960 S raNi�I� I I D ateBy. Other Permit:
Inspection Line: 503.639.4175 DEC 0 6 200 . ti Date Ready/By: Efil H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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Pi=: IM ^= a, t r,S i `COM'NIERCIAI: FEE* 'SCHED.U1 E - v - E CHECKLIST'
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El New construction A ddition/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.
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,¢r m "' 1, ' " RESIDENTIAUE'QUIP1ti`IENT PSYStEMS FEES*
t .l - and 2 family dwelling El Commercial /industrial ❑ Accessory building "
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
_^ w , x : tJOBhITE INF®R11fATI N "1N 1 OC ON ` r „ -ant . Heating/coolin
Job site address: i O ^ (Ai
�t., Air conditioning or heat pump Q
rJ 5 (// Dr. (requires site plan showing placement) I 14.00
City/State /ZIP: y „,, 0 y, e r 22 Furnace 100,000 BTU (ducts /vents) j 14.00
Suite/bldg. /apt. no.: / Project name: -j Furnace 100,000+ BTU (ducts/vents) • 17.90
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
r "�' z E m ��+: �' `+ ' � � `� iF�' �-:i '� '$ � t , � I � g v« Water heater 10 -00
Gas fireplace 10.00
-.
tot X ( S rt nl ace_ ,4I r C� P� Flue vent for water heater or gas
I fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
r ¢ r , n x Chimney /liner /flue /vent 10.00
"�tPI 1PRQPE{RTYtOWNER c i K . ,... TEE N T" - ' `
,�... k.' ,.,. .. ,.. _„ �, Other: 10.00
Name: f l M vv._ Coo b5 Environmental exhaust and ventilation
Range hood /other kitchen
Address: l Q v 5 (Ai ( „,(,, a 05 - 1)r. equipment 10.00
City/State /ZIP: (tt G Q ( J►2 4 7-2.c/ Clothes dryer exhaust 10:00
/ Single -duct exhaust (bathrooms,
Phone: ( 53) (,90_' Q I Fax: ( ) toilet compartments, utility rooms) 6.80
-` L`'t -rr- °, , 3 x.:s. -. ,. 47-m z ut;� -i ��.,.. = = ..;�::a. �a•- «' T; <.xi
k i` Y ,, ... Vin. � APPLICANT ;,S” :4 rot ` " r ' G ®NT.AG 1' 4A 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: Wall/suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
N ON • .: :1.. s @ONTR Bair . -A 3P5% Barbecue
„�. , :.,tom . ati .: iAt . m < t IA:I t:-- F. _ _
r ( Clothes dryer (gas)
Business name: 1 , a l 1 (� et (OU/' 1' (...„(..c_
/ Other:
Address: P� / 1 � .. „�� �" ,.,z;» °.��rc..a: .�� ° -= "`,._ _. *-_.:,;.''; . .,
i ! C V 6 9 s e 3),".4 c1 ST. 5 v1 r' Z / td >' 'I1VIE,GH NICAL PER_ 1VIfT >FE
City/State /ZIP: 'P 6V_ 67123,6 Subtotal
Phone: (5 -A0-- 61133' Fax: (c7)3) 760_ (2S -7.__ Minimum permit fee ($72.5
Plan review (25% of permit fee)
)
CCB lie.: / 1'> 0 State surcharge (8% of permit fee)
( A TOTAL PERMIT FEE /� .. f lication expires if a permit is not obtained within 180
Authorized signature: � / /'/ �� This permit app
days after it has been accepted as complete.
Print name: -6)-41 A, 1 ,14 d tail Son) Date: ;2 /6 Ay . Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Petmits'MBC- PetmitApp.doc 12/03 440 -46I7T (I I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
I'otal�Valuaf><on Perm><t 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. •
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$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
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