Permit � CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00601
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/16/2007
PARCEL: 2S102DC -01603
SITE ADDRESS: 09160 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 014 JURISDICTION: TIG
PROJECT: CLARK
Project Description: Installation of gas insert and gas piping.
CLASS OF WORK: ALT 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:
NAT 3 - 15 HP: COMML.
INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
PAUL & BETTY CLARK Description Date Amount
9160 SW EDGEWOOD
TIGARD, OR 97223 [MECH] Permit Fee 10/16/20C $72.50
[TAX] 8% State Surcha 10116120C $5.80
Total $78.30
Phone: 503- 639 -4770
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 692 -5563
FAX 503- 691 -6855
Reg #: LIC 126881
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.
1
Iss d By: , _ C���j � � Permittee Signature:/ c.42,1
Call 503.639.4175 by 7:00 a.m. for inspections tha 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.
Mechanical Permit Application :FoR o.FFICE USE m,y, .' ,
r " '`' « Ci ty of Tigard M Date/By � o �/ Permit No ge "7-0 66
v 1 3125 SW Hall Blvd , Tigard, OR 97223 Plan Review c ��
` - Phone. 503 639 4171 Fax 503 598 1960 DateBy Other Permit
A RD
Inspection Line 503 639 4175
T 1 G Date Ready /By Ju ® See Page 2 for
Internet www tigard -or gov Notified/Method la Supplemental Information
TYPE OF WORK 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 $
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. Ea Total
JOB SITE INFORMATION AND LOCATION , Heating/cooling
1 Air conditioning or heat pump
Job site address:
97 d 0 $ W .D/ye .eeQ d Q St . (requires site plan showing placement) 14 00
i "_-�
City /State /ZIP: d OI / l > Z -. 3 Furnace 100,000 BTU (ducts /vents) 14 00
/ 7'4 r Furnace 100,000+ BTU (ducts /vents) 17 90
Suite/bldg. /apt. no.: Project name: GQ j / 5 +'rt — Gas heat pump 14 00
Cross street/directions to job site: Duct work 10 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 14 00
Subdivision: Lot no.: Flue /vent for any of above 6 80
Other 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10 00
/ Gas fireplace P 10 00
6;3 / h / 17 r X 1 511 Jl F' Z P ,p /4 e e Flue vent for water heater or gas
U 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: Paul C CIO/A Environmental exhaust and ventilation
/ Range hood /other kitchen
Address:
�l 6 0 C S i s fire t' o 6 4 Z equipment 10 00
City /State /ZIP: 7 yv Y di on 7 -7 - - 3 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (, 2 ) 4, 3Y— y 77 d 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 Clothes dryer (gas)
q 1'h i r f Other:
Address: MECHANICAL 'PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72 50) f Ja i
Plan review (25% of permit fee)
CCB lic.: (' C° p l ,2 /o ' / State surcharge (8% of permit fee) 5
1 3 C et + TOTAL PERMIT FEE 7 8);.Z0 T his permit application e
Authorized signature: // L /�(� expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: i-- u / F, (/d r x Date: / 6 //� / 6 7
\mit * Fee methodology set by Tn- County Building Industry Service Board
1 \BuildingPers \ MEC- PermitApp doe 01/19/07 440- 4 (i 1/02 /COM/WER)
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.
I \Buildmg\Permrts \MEC- PenmtApp doc 01/19/07 2
_
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CITY ������K�� '
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BUILDING DIVISION PERMIT #: kXEC2007'00601
13125SVV Hall 8kd, Tigard, OR07223 DATE ISSUED: 10V10'2Q07
Phone: (503) 639-4171 ,
Inspection Requests (24Hmj:(503)G39'4175 .J� 4r *
INSPECTION WORKSHEET FOR DATE: 18y31/200 TIME: 7:00A1v4 PAGE: 88
SITE ADDRESS: 09160 SWEO{][V*]0QST CLASS OF WORK:
SUBDIVISION: EDGEWO()Q LOT #: 014 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: |Au(o||mdnn of gas inswttsVld gas piping.
OWNER: CLARK PAUL & BE| pHONE 503-639-4770
CONTRACTOR: SiAhdBURG HEATING LLC PHONE #: 509-692-5563
Inspection Request Scheduled For: Date: 1O/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
G539 Mechanical final 058692-03 603-839'4770 N
Corrections/Comments/Instructions:
S PARTIAL APPROVAL CANCEL ri NO ACCESS
FAIL | I CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: ^8 / Date: Al 3/~ Phone #: (503) 718- 2
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.
CITY ���� ��Nd��
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BUILDING DIVISION
PERMIT #: 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/16/20g7
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 ak.,W
INSPECTION WORKSHEET FOR DATE: 10131/2007 TIME: 7:00A14 PAGE: 89
SITE ADDRESS: 09160 SyVFDGEWO0QST CLASS OF WORK:
SUBDIVISION: FQG'[l^N]DQ LOT #: 014 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: Installation oJ gas insert and gas piping.
OWNER: CLARK, PAUL & BETTY PHONE #: 5O3-039-4778
CONTRACTOR: SHAk8BURG HEATING lir P HON E#: iSD3
Inspection Request Scheduled For: Date: 10/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
61 6 Mwohani#d O58692-02 503-639-4770 M
Corrections/Comments/Instructions:
| PASS ri PARTIAL APPROVAL CANCEL I I NO ACCESS
FAIL MI CALL FOR INSPECTION EAOD|T|ONALFEESA8SESSED
- �
L ,
CITY OF TIGARD _ ...
BUILDING DIVISION •
PERMIT #: MEC:2007..00601
' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/160.007
Phone: (503) 639-4171
Inspection Requests Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10131/2007 TIME: 7:00AM PAGE: 91
SITE ADDRESS: 09160 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 014 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: Installation or gas insert and gas piping.
OWNER: CLARK, PAUL & BETTY PHONE #: 503-6354770
CONTRACTOR: SHAIVIBURG HEATING LLI. PHONE #: 503,692..5E63
Inspection Request Scheduled For: Date: 10/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 068692-01 503-639-4770 N
Corrections /Comments/ Instructions:
•
PASS
fl PARTIAL APPROVAV- . El CANCEL n NO ACCESS
,.
E FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Date: /0 -- - . ,?/ -0 7 Phone #: (503) 718--"-----------