Permit C ITY OF TIGARD MECHANICAL PERMIT
V 1� DEVELOPMENT SERVICES PERMIT #: MEC2005 -00751
DATE ISSUED: 11/10/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102DC 00510
SITE ADDRESS: 09115 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 013 JURISDICTION: TIG
Project Description: Replace wood stove & flue.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WIO 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES: 1
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
PAUL & LOR LARSEN Description Date Amount
9115 SW EDGEWOOD
TIGARD, OR 97223 [MECH] Permit Fee 11/10/20C $72.50
[TAX] 8% State Surcha 11/10/20C $5.80
Total $78.30
Phone: 503- 639 -6325
Contractor:
STEVEN C SIMMONS CONSTRUCTION
9300 SW EDGEWOOD ST
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Phone: 503 -524 -3488
Reg #: LIC 166899
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.
Issued By: A 1 Permittee Signature: f ~
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.
Mjchanical Permit App NED • . '' ° � _. _FOa OFF 1 cE USE ONLY ' ,.. ', . , . ,
,, City of Tigard Dat J �� Permit No L� -_ ?
t 13125 SW Hall Blvd., Tigard, OR 97223 NOV 1 0 200g Plan Review Other Permit
Phone: 503.639.4171 Fax: 503.598.1960 ilii, i r4 } 1. Date /By:
Inspection Line: 503.639.4175 _yj,l.,61 I :. Date Ready/By NE 0 See Page 2 for
• Internet: www.ci.tigard.or us CITY OF TIGAhi1 Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE *' SCHEDULE USE•CHECKLIST
❑ New construction 2 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
[/} 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description Qty. I Ea I Total
' JOB SI I NFORMATION AND 'LOCATION Heating /cooling
Job site address: C� C . Air conditioning or heat pump
/ ll S l - �J ��oc v'p(,� s f (requires site plan showing placement) 14.00
City /State /ZIP: T a f 6. c.*. 9 7 a a 3 Furnace 100,000 BTU (ducts/vents) 14.00
(� 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
O fr o . b— 4 0 Edq • �.•-., ODa Residential boiler (radiator or
U hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc 10.00
Flue /vent for any of above ( 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
/� Gas fireplace 10.00
R e 1 OlaLerv.a�.�o4 Wood 6 +ove And Foot Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10 00
Wood /pellet stove 1 10.00
Wood fireplace /insert 10.00
' ❑`PROPERTY OWNER ❑ TENAN ' Chimney /liner /flue vent 10.00
Other 10.00
Name: Paul- E Lev; LU 4- S e n Environmental exhaust and ventilation
Address: Range hood/other kitchen
9/IS" L c.) Ce a u90D el equipment 10 00
City /State /ZIP: "'(�t�etUr d 2 !! 0 1`1 7 A 3 Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms,
Phone: (staN) co 39 ^ CD 3 a 5- Fax. ( ) toilet compartments, utility rooms) 6.80
ErA PPLICANT' ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: 6.4e ,e n C Sr p •p, piping
r,^ wn.")0 5 eeoogri..-i -ibA Fue i in
Contact name: C " . 5 i m 0 45- $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: / 300 -C t-%3 (9e wood
Gas heat pump
City /State /ZIP: -ri � o,r a, b 1 . 2 9, 7r, 3 Wall /suspended/unit heater
Phone: ( ) ) ra y _ 39 86 Fax ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
V e C s' 5 Clothes dryer (gas)
Business name 6
>1 r+x rv.C) d 4,_, v Other:
Address: q 3� Sw ,, e w MECHANICAL PERMIT FEES*
City /State /ZIP: { T i ci c .- c' ? ; 3 Subtotal
d Minimum permit fee ($72.50)
Phone: ( ?j5 + sa _ 3.1 f$ Fax: ( ) Plan review (25% of permit fee)
CCB lic.: A6 A L l �k� 1 �- 1 8 ` U q State surcharge (8% of permit fee) 4-72, / TOTAL PERMIT FEE
Authorized i re This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name' y/ Date: / //0/DS ` Fee methodology set by Tn- County Building Industry Service Board
I \BuildingWermits\MEC- PermdApp doe 12/03 440 -4617T (I 1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Co i mercial Fee Schedule:
Tota Valuation: Permit F ee:
$1.00 to '; ,000.00 Minimum fee $72.50
$2,001.00 to '.5,000.00 $72.50 for the first $2 and $2.30
for each additional $ 00.00 or fraction
thereof, to and incluij ing $5,000.00.
$5,001.00 to $10,000.. a $141.50 for the firs. $5,000.00 and
$1.80 for each add' ional $100.00 or
action thereof, to and including
$ : 100.00.
$10,001.00 to $50,000.00 $231. i . r the ' rst $10,000.00 and
$1.35 for ea - : dditional $100.00 or
fraction there. , • id including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for 'he first $50,000.1 i :. d
$1.25 for : ch additional $100.00 or
fraction ereof, to and including
$100,00/.00.
$100,000.01 and up $1,39. 50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
frac' on thereof.
Note: All new commere I buildings require 2 sets of plans,
i.\Bui!dmg\Permits\MEC- PermitApp doc 12/03 2
CITY OF TIGARD �� -- .
BUILDING DIVISION PERMIT #: MEC2005 00751
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 11/10/2005
Phone: (503) 639 -4171 / u�N @�ypiu 1 11
Inspection Requests (24 Hrs.): (503) 639 -4175 =:1.
INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 68
SITE ADDRESS: 09115 SW EDGE - WOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 013 TYPE OF USE:
PROJECT NAME: LARSEN
DESCRIPTION: ce wood stt2vt11u.' `
OWNER: LARSEN, PAUL & LORI 6 PHONE #: 503 -639 -6325
CONTRACTOR: STEVEN C SIMMONS CONSTRUCTION PHONE #: 503-524-3488
Inspection Request Scheduled For: Date: 11/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message /�,�
699 Mechanical final 022010 -01 503 -920 -8813 C
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Corrections /Comments /Instructions:
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PASS 7 PARTIAL APPROVAL El CANCEL H NO ACCESS
I I FAj CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 2--( (� `7 Phone #: (503) 718-
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BUILDING DIVISION PERMIT #: M 0�(�761
13125 SW Ho|| Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2005
Phone: (503) 639-4171 U
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Inspection equoota(24Hnnj:(GU3)83Q-4175 "�
INSPECTION WORKSHEET FOR DATE: 11/18/2005 TIME: 7:17AM PAGE: 91
SITE ADDRESS: 09115 SVyEDGEVV00DBT CLASS OF WORK:
SUBDIVISION: EDGEVK>C`C/ LOT #: 013 TYPE OF USE:
PROJECT NAME: LARSEN
DESCRIPTION: Reo}mmmxvuu�otov��&f|u�. '�
Replace
OWNER: LARSEN, PAUL & LORI PHONE #: 503-639-6325
CONTRACTOR: STEVEN C SIh4KHONS(|ON8TRUCU0N ' PHONE #: 503-524'3488
Inspection Request Scheduled For: Date: 11/18V2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
' 699 Mechanical final 021808-01 503'920-8813 N
Corrections/Comments/Instructions:
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I 1 PASS PARTIAL APPROVAL El CANCEL N N{�ACCESS
X FAIL ` 1K CALL INSPECTION ADO|T|C) ASSESSED
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■ ' `- ' Phone (503) 718- / � y* �� .
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BUILDING DIVISION PERMIT #: K4EC2005-00751
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10V2006
Phone: (503) 639-4171 ,
Inspection Requests (24 Hrs.): (503) 639-4175 s���
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:02Ak4 PAGE: 20
SITE ADDRESS: 09115SWEDGEVV00DST CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 013 TYPE OF USE:
PROJECT NAME: LARSEN
DESCRIPTION: Replace wood stove & flue.
OWNER: LARSEN, PAUL &LORI . PHONE #: 509-639-6325
CONTRACTOR: STEVEN C SIMMONS CONSTRUCTION PHONE #: 503-6243488
Inspection Request Scheduled For: Date: 11/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
616 Mechanical rough-in 021307'01 803-920-8813 N
Corrections/Comments/Instructions:
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PASS ri PARTIAL APPROVAL a ANCEL n NO ACCESS
El FAI H | OALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector. 4 1 Date: 1 / 5 /° -
`/ / 5/ u Phone #: (503) 718-
•
CITY OF TIGARD • t ,.
BUILDING DIVISION
PERMIT #: MEC2005-00761
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 .4.5,.-W 11.
INSPECTION WORKSHEET FOR DATE: 11/14/2005 TIME: 7:12AM PAGE: 58
SITE ADDRESS: 09116 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOD OT #: 013 TYPE OF USE:
PROJECT NAME: LARSEN
DESCRIPTION: Replace wood stove & flue.
OWNER: LARSEN, PAUL & LORI PHONE #: 603-639-6326
CONTRACTOR: STEVEN C SIMMONS CONSTRUCTION PHONE #: 603-52434138
Inspection Request Scheduled For: Date: 11/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
616 Mechanical rough-in 021142-01 603-920-8013 N
Corrections/Comments/Instructions:
I I PASS 0 PARTIAL APPROVAL El CANCEL y\10 ACCESS
K FAIL CALL FOR INSPECTION I] ADDITIONAL FEES ASSESSED
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Inspector: :
""`-..../ Date: ti if 1 7 * -----4 Phone #: (503) 718-
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