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Permit • C ITY OF TIGARD MECHANICAL PERMIT r�,�4 l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00696 �,�It 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/21/2004 PARCEL: 2S102CD -01700 SITE ADDRESS: 09875 SW GARRETT ST SUBDIVISION: ZONING: BLOCK: LOT: 016 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: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: WOD 3 - 15 HP: COMML.INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1 > 10000 cfm: GAS OUTLETS: Remarks: Installation of wood fireplace. Owner: FEES DOUG PHILIPS Description Date Amount 9875 SW GARRETT ST [MECH] Permit Fee 10/21/20( $72.50 TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/21/20( $5.80 Phone: 503 670 - 4777 Total $78.30 Contractor: WEST COAST CONSTRUCTION INC PO BOX 2313 WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone: 503 Misc. Inspection Final Inspection Reg #: LIC 151931 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 -00 I through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)24 ; -6699. Issue. : ` . / y.i , t Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next n se s -day Mechanical Permit Application ., . . F O R OF ONLY M / .; City of Ttgare ,,. Date/By 0 o d 111111 Perm t No.: r v ( Gig Gv 6 Fa 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review Phone 503.639.4171 Fax. 503 598.1960 *ONO( i p Date/By Other Permit. Inspection Line 503.639 4175 . l ... Date Read B ® See Pa e 2 for Internet www.citigard.or.us v ' y y g g Notified/Method fSupplemental 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* /` I -- 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 Job site address: 61817 S S : F 3- ( ,� Air conditioning or heat pump (requires site plan showin g placement) 14.00 City/State /ZIP: 7 (A. r� O 2 q � 7 2 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. /_/14,7 q7 Duct work 14 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. 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 � / Gas fireplace 10.00 ! / re j%/ P 1 PI'S 4 (( Flue vent for water heater or gas fireplace 10.00 Log tighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert / 10.00 ❑ PROPERTY OWNER Chimney /liner /flue /vent 10.00 ❑ T ENANT Other: 10 00 Name: p oeL c i p ; )I i ,p S r Environmental exhaust and ventilation Address: I / Range hood /other kitchen (f0. f� ��- equipment 10 00 City/State /ZIP: Q /Z `7 72 2 3 Clothes dryer exhaust 10.00 �j Single -duct exhaust (bathrooms, Phone: (5o3) 67 - 1-rit7 !_ Fax: ( ) toilet compartments, utility rooms) 6.80 [APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10 00 Other: 10.00 Business name: 5 /`. Fuel i in P g 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 - 1 _ 64- Clothes dryer (gas) Business name: P S G J Other Address: 0 - Y__ 2 * '.2 MECHANICAL PERMIT FEES* City /State /ZIP. K to I) yo r ,„ i ' 1 ( p t) ( q 7 ©77 D Subtotal Phone ( 3) 521711 Minimum permit fee ($72 50) 7 ..5O a Q ) Fax 5C ) t'f� — Plan review (25% of permit fee) CCB lie : l 6 \ C ( . 3/ � /A[1/°4' State surcharge (8% of permit fee) 51I0 / " TOTAL PERMIT FEE . 7 g . 30 Authorized signature: / I T his permit application expires if a permit is not obtained within 180 Z____ _ days after it has been accepted as complete. Print name: i Date: /-()—Z ` —c) * Fee methodology set by Tn -County Building Industry Service Board 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 12/03 2 CITY OF TIGARD 24 -Hour r ;_ BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION ,Business Line: (503) 639 -4171 MST BUP Received Date Requested // T3 AM BUP Location 7 S Suite e' Contact Person Ph ( ) R — 16 / 3 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: d_ / i r Q _ SIT Post & Beam Shear Anchors • Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL 'PLUMBING •�, Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final SS— AAtT FAIL �VIECHA AL .: Post & Beam Rough -In � Gas Line Sm a Dampers in ASS.• -PART FAIL ECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ' . s Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line ADA Date /4 Inspector Ext Approach /Sidewalk Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL