Permit 4
CITY OF TIGARD
MECHANICAL PERMIT
..T, Ik DEVELOPMENT SERVICES PERMIT #: MEC2004 -00776
+�- x - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/1/2004
PARCEL: 1S133AD-08900
SITE ADDRESS: 12825 SW CHICORY CT
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 133 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: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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: Replace furnace with like kind and new flue vent.
Owner: FEES
REISENBERG, AINO Description Date Amount
12825 SW CHICORY COURT [MECH] Permit Fee 12/1/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 12/1/200 $5.80
Phone: 503 - 590 - 2473 Total $78.30
Contractor:
COURTESY HEATING + COOLING INC
PO BOX 2248
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Misc. Inspection
Reg #: LIC 108655 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 d 'ec q estions to OUNC by calling
(503)24 - 699.
Issu d By: 1 Permittee Signature: ��� ,
- - Call (503) 639 -4175 by 7:00 P.M. for inspections ne -ded the next busin - s day
Mechanical Permit Application =FOR OFFICE USE ONLY
}r REEe' D2�� Permit No. 13125 SW Hall Blvd, Tigard, OR 97223 Pw "
Phone: 503.639.4171 Fax: 503.598.1960 O eJi l ° , Date/By: Other Permit:
Inspection Line: 503.639.4175 l d'I 11111
-
p � Date Ready/13y: Iuris. El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method:
(a, ' Supplemental Information
s=at. °,,�� ai �„ „,M. ' ..,x . _ . ,: , ; ...
v.�e:,. «,',_; -�.•: << c is,. �:� e'.'y;� r. ' 'p xt��. n . .,fir., .,:� `p" .• y, ";. � ..�- F ,. . - :,
� � �,.� �`�. `� > TX PE z OF�WO RI { � . �,.��- � ; ,va y,--„%.t O MM ERCIA L,FE E . 2.t - :USE C H ECKLIST" A
❑ New construction Add ition/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.
.4 r CATEGo �OF CONSTI2UCTI N g �: a . V 'Fi-N Value: $
4.`.: ,a, - .fc.4 °a o.... it » ,.. , «£ - t ,. .1 P,,,`c 4,.0 2.- u,,,, T'o .,« .i. f 2L..�� /b. . ,. ...� �� 3 ik, $
land 2 family dwelling 111 Commercial/industrial ❑ Accessory building
l ; RESIDENTIAL EQUIPMENT' / >SXSTENIS - FEES*
❑ Other:
❑ Multi - family ❑ Master builder For special information use checklist.
Description Qty. Ea. Total
:..r. , K - JO
u, „ ATION N :L 1 `' ;, "
a� r < �M.,. A° D OCATIO ��`�� %' � ..,�� He ating cooling
i
/ Z 5 � � t t 0 r 7 / - C:71-, Air conditioning or heat pump
Job site address: 7TJ7
(requires site plan showing placement) 14.00
City/State /ZIP: it p r /, 0 , 2 _ 9' 7ZZ j Fumace 100,000 BTU (ducts /vents) 1 14.00
v " / Fumace 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
c h f/r A1,-/-/ 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 1 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
4, . _ ,, $I � Cd ,,',. Z a: ' � " 2 Water heater 10.00
t, a l .DE O „
�"€`�: �� - `. act'. �h: �3�.r: - � : ��. ��t ti ,_
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
' - i QPik finWNER `� '` „ "r its TENANT � l , t - Chimney /liner /flue /vent 10.00
r )'''''' .. _. ,. �. ., , . _ ; 1,14 .1 +" .. ; Other: 10.00
Name: hl %4a ,i.e /Se", if f Environmental exhaust and ventilation
Address: /2,45 5'.41 .. � l�l� Range hood /other kitchen
Gd equipment 10.00
City/State /ZIP: -- / -- it-a"-z) C/e_ 4 7 'Zz 3 Clothes dryer exhaust 10.00
/ Single -duct exhaust (bathrooms,
Phone: (5Z1 S 2 0 - Zy- 3 Fax: ( ) toilet compartments, utility rooms) 6.80
; :,;ia ;';t 5,: ° -. *; .r,,.�:,:;� - °• : x:;,;, ° .,fi,,..'.��;..;< ".., cue:.: ee...�.ua,,`..::u. -;
r ;; CON' 1 ERSON �" Attic /crawlspace fans 10.00
Other:
Fuel piping 10.00
Business name: � � 'i -eJ Al- .
Contact name: ,G , - Gic-c' E B 2-7 $5.40 for first four; $1.00 for each additional
Address: . � 22 W Furnace, etc.
Gas heat pump
City/State /ZIP: `, CL / 1,0e_.. 7/74.S Wall /suspended /unit heater
Phone: (�� Fax: Water heater
(573) ��� 7 �� � ( )
Fireplace
E -mail:
Range
i V E I'� , N ' CONI`RACTOR 'r, : ' $,'- i • & �. .m , .. Barbecue
Business name: a - 1 - - It). Clothes dryer (gas)
Address. •�� �_ -- - '- 1? p, h / zz OAL P ERMIT FEES*
City/State /ZIP: - . elite /�- D2- 9' 7Gf� Subtotal
( .5 �) , b 7 Fax: (S 3) Z 3S = 7) 7V Minimum permit fee ($72.50) � TO
Phone:
3S 7.1 Plan review (25% of permit fee)
CCB lie.: / D b S5- ,,/(0 State surcharge (8% of permit fee) 0 i gd
I C I TOTAL PERMIT FEE 7g t 0
-"7 _ i
Authorized signature: /, .f ,, y .6• This permit application expires if a permit is not obtained within 180
l/ V At
l days after it has been accepted as complete.
Print name: y�y� WAS L� i Date: )2 -�-�� * Fee methodology set by Tr -County Building Industry Service Board
i:\Building\Pemuts \MEC- PernutApp doe t2/03 440 -4617T (11/02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total a no n P er mi 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.
$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 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: 4503) 4171 MST
BUP
Received Date Requested / Z- -3 PM BUP 77�
Location / c- R a ( Suite MEC �`e/o el i
Contact Person /R-, 0 �,5 - Ph ) • 7 9 c'7 / 3 PLM
Contractor ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: S�Na u:s " �=-�y 5 ve� �'c c"? ] �.c �x
Ftg Drain
ELR
Crawl Drain =
Plat Inspec r4,JVotes: yII �� pa x SIT
Post & Beam J .! . / I I
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear " /�^ � i��
Framing V ` L✓
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING r :. ` : °.::
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin / Manhole
Storm Drain •
Shower Pan
Other:
Final
PASS _ AktT FAIL
ECHANIC L
Pos "& B eam
Rough -In 1
Gas Line •/.I
Smoke Dampers
PART FAIL
ELECTRICAL,
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 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 r
ADA
Approach/Sidewalk Date /� Inspector L� Ext
Other: k
Oth qihk
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL