Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 00405
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
DATE ISSUED: 7/6/2005
PARCEL: 1S134AC-02620
SITE ADDRESS: 11215 SW COTTONWOOD LN ZONING: R - 4.5
SUBDIVISION: ENGLEWOOD NO.3 LOT: 177 JURISDICTION: TIG
Project Description: Installation of A/C & furnace.
•
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:
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:
Owner: FEES
ZWINGLI, WALTER SCOTT + SUSAN GR Description Date Amount
11215 SW COTTONWOOD LN
TIGARD, OR 97223 [MECH] Permit Fee 7/6/2005 $72.50
[TAX] 8% State Surcha 7/6/2005 $5.80
Total $78.30
Phone: 503 - 579 -9058
Contractor:
PIONEER GAS FURNACE
3615 NE BROADWAY
PORTLAND, OR 97232 REQUIRED ITEMS AND REPORTS
Phone: 503- 249 -5000
Reg #: LIC 36102
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: Permittee Signature: 52 e F\c,
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.
' .Mechanical Permit � y Applica'tion, 11/R til f 1( 1.: I.1 t,.l.)
City of Tigard a ®� ! � DateBy: �h (� Permit No.\ C. C COQ e) Ili'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
- Phone: 503.639.4171 Fax: 503.598.1960 I /�dr, : d µ „ �,.' Date/By: Other Permit.
. Inspection Line: 503.639.4175 d 5 2005 � . ' •I � Date Ready/By: lini ® See Page 2 for
• ' Int www.ci.tigard.or.us CITY OF TIGARL' Notified/Method: Supplemental Information
Rl Ill nINIP, nIVISION
3-, ", } a•,, TYPE OF WORK COMMERCIAL ;FEE *.;SCHEDUL;Ek USECI G7C:LST "
❑ New construction RI 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.
;; ' :r ` ` :` .:&' '' OF CONSTRUCTION Value: $
i m
: and 2- family dwelling ❑ Comercial /industrial ❑ Accessory buildingmEALsEQUIPMENTy /SY3TEM9fFEES` ;,`^
For special information use checklist.
• ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
u =,` " t i .JOBI <SITE INFORMATION AND LOCATION Heating/cooling
c' \� Air conditioning or heat pump
kit' site address:
( a ( s ' ' (J c 1 �' 1j n • (requires site plan showing placement) I 14.00 I
City/ State/ZIP: q 1 Fumace 100,000 BTU (ductsivents) I 14.00 I
0 Fumace 100,000+ BTU (ductslvents) 17.90
Suite/bldg./apt. no.: P roject name: Gas heat pump 14.00
'Cross street/directions to job site: Duct work 14.00 r
Hydronic hot water system 14.00
j - 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
"''� „_.r . . Gas fireplace 1 0.00
'1 & ` om [,n e, p^`+ek__. - 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
t% ,, " r 1 1 ❑ TENANT • Chimney/liner /flue/vent 10.00
Other: 10.00
- - Name: r O � 't I� Environmental exhaust and ventilation
� . C ` 1, Range hood/other kitchen
Address: - ep U Q & aS� Won equipment 10.00 .
City/State/ZIP: / Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
` ' Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
N E l APPLICANT • . ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: , 10.00 , .
Business name:
• Fuel piping
Contact name: Sm-Q_ ICJ- x_-Co $5.40 for first four; $1.00 for each additional
Address: Fumace, etc.
Gas heat pump
' City/ State/ZIP: Wall /suspended/unit heater
'Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail Range ��‘ti�
: ;? p F ", ..- '` , .'' ' ?CONTRACTOR e Barbecue
Business name: - /0//,) e e� 5 Ft c /-/?a2' a Clothes dryer (gas)
� Other:
�
/V�
Address : S road ''MECHANICAL PE RM I T }FE FS, ! ��;' . ' iA � ',:"
s City/ State/ZIP: a k _ 7 L-/ an d OR 9 z Subtotal OS
( 505 2� 5D� f Minimum permit f�( '.f 1a
Phone: Fax: (503 2 49 T 8 26t
•
Plan review (25% of
. CCB lie.: 36 / Z State surcharge (8% of permit fee) 5 /$0
TOTAL PERMIT FEE 30
-. Authorized signature: �(� Q � ` n n .b U ID This permit application expires if a permit is not obtained is 180
• �[.�c A.. c pifD V,LXJW l days after it has been accepted as complete.
/ ' I. Print. name: �Y�A� Q- `tl'"r �� D(� I Date: — i f1 I " Fee methodology set by Tri -County Building Industry Service Board
•
:Mechanical Permit Application - City of Tigard
'Page 2 - Supplemental Information
• °. Commercial Fee Schedule:
'' , Tofal�altion: Permit • Fee: • .
It. • '= $1 $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:U 3uilding \Pennits\MEC- PermitApp.doc 12/03 2
1
. a ;
1 f ur n ace
_ • _ •.•
•
y _-. 3_
a..
NC Silo Han fui lho addiuss of:
•
Customer Name and Phone #:
`bC0 � �c.�,.n Z� r\ 1 ��3 51 `i q-8-
J
y4: ebo
:j�r,•;s ` ~fir � I � ,
r�F n k 1 1
fl;
HOUSE
•
•
•
Wv
STRrrT
•
•
•
PHONE 503 249 5000 • FAX 503 249 8260 • OREGON CCB 1136102
3615 NORTHEAST BROADWAY • PORTL AND, OREGON 97232
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005-00405
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2005
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/17/2005 TIME: 7:05AM PAGE: 99
SITE ADDRESS: 11215 SW COTTONWOOD LW CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO LOT #: 177 TYPE OF USE:,
PROJECT NAME: DM NGLI
DESCRIPTION: Installation of NC & furnace.
OWNER: ZWNGLI, WALTER SCOTT + SUSAN GR, PHONE #: 503 - 579 -9058
CONTRACTOR: PIONEER GAS FURNACE PHONE #: 503 -249 -5000
Inspection Request Scheduled For: Date: 8/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 013573.01 503-249 -5000 Y
Corrections /Comments / Instructions: A ,
V
•
// -11
•
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /riV Date:g 7 Phone #: (503) 718-