Permit CITY OF TIGARD
MECHANICAL PERMIT
: ° COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00473
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/31/2007
PARCEL: 2 S 103 C D -02000
SITE ADDRESS: 13770 SW FAIRVIEW CT ZONING: R -4.5
SUBDIVISION: HOLLYTREE LOT: 012 JURISDICTION: TIG
PROJECT: POW ELL
Project Description: Replace gas insert with like kind.
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. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
FLORENCE POWELL Description Date Amount
13770 SW FAIRVIEW CT
TIGARD, OR 97223 [MECH] Permit Fee 7/31 /2007 $72.50
[TAX] 8% State SurcharE 7/31/2007 $5.80
Total $78.30
Phone: 503 639 - 9810
Contractor:
FIRESIDE DIST OF ORE INC
18389 SW BOON ES FERRY RD
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -595 -3726
FAX 503- 620 -5699
Reg #: LIC 40979
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 Not cation 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 OU NC by
calling 503.246.6699 or 1.800.332.2344.
pi,
sued By: A l A tagai t it l ffi ld Permittee Signature: Lti../
Call 503.639.4175 by 7:00 a.m. for inspections that business day. r
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'OFF U ONLY '
Received i
City of Tigard Date /By: 3j Q 7 Permit No.: e . 7 QO 73
11 n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review G
Phone: 503.639.4171 Fax: 503.598.1960 Date/By• Other Permit:
TI G A RD Inspection Linc: 503.639.4175 Date Ready /By: See Page 2 for
Internet: www.tigard - or.gov Notified/Method • Supplemental upplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction Vt. 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
El Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
•
1- and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ A ccessory building
Multi-family Master bui lder For special information use checklist.
❑ y ❑ ❑ O ther: Description _ Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
�,/ Air conditioning or heat pum
)C Job site address: f ' � ‹, /: „-- 4 , '2 ,/ lw, c (requires site plan showing placement) 14.00
City /State /ZIP: / /'ci. /l D /� !/ � 977--.. 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 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
-A• 47 1 Gas fireplace //NICER. 7 / 10.00 /0 t 01)
, 4 /1 41.-e_e et S , ` 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
PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: /`" de' 'V C e � � 1) iWZ Environmental exhaust and ventilation
Address: / -5 77a S 'k/. A— t�J C- 7` Range hood/other kitchen
equipment 10.00
City /State /ZIP: �/f� /Z F - . Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (t� t'v3 y - Fax: ( ) toilet compartments, utility rooms) 6.80
. 0 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
Furnace, etc.
Address: -
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: � /? ._;-/ '02= p ..5 e, ' ci y -DAl
Clothes dryer (gas)
�
//�� Other:
Address: /,. ." F. p v-,tLj s Gfj Bee4v - 7, 1 ne I/ �� MECHANICAL PERMIT FEES*
City /State /ZIP: e t 4a �� f� Z 7 Subtotal . $
Phone: ( 5 6 r5! S - 3 5 Fax: ( i dy C $ D dX B � (,0,7 Minimum permit fee ($72.50) �a , .
Plan review (25% of permit feee)
CCB lie.: 4/6 ? 7 9 State surcharge (8% of permit fee) 5, to
TOTAL PERMIT FEE 2 ( 37, 3,0
X Authorized signature
..../. __ � .. - v'_ 44111f This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
/' Print name: FUti �, "9 - 1 __P Date: 7 ... c� * Fee methodology set by Tri- County Building Industry Service Board
I: \Building\Permits\MEC- PermitApp doe 01/19/07 440 -4617T (I l /02 /COM /WEB)
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.
1:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
CITY OF- TIGARD
BUILDING DIVISION PERMIT #: MEC2007- 00473
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/31/2007
Phone: (503) 639 -4171 �p�pry� ,
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/14/2007 TIME: 7:00AM PAGE: 40
SITE ADDRESS: 13770 SW FAIRVIEW CT CLASS OF WORK:
SUBDIVISION: HOLLYTREE LOT #: 012 TYPE OF USE:
PROJECT NAME: POWELL
DESCRIPTION: Replace gas insert with like land.
OWNER: POWELL, FLORENCE PHONE #: 503-639-9810
CONTRACTOR: FIRESIDE DIST OF ORE INC PHONE #: 503 -505 -3726
Inspection Request Scheduled For: Date: 8/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 053938-01 503-595-3726 Y
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Date: 8 z 4-- a ? Phone #: (503) 718- Z_--g=1