Permit C ITY ®1 TIGARD MECHANICAL PERMIT
*-404 DEVELOPMENT SERVICES PERMIT #: MEC2006 -00507
° °T' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/20/2006
PARCEL: 1 S133DA -04000
SITE ADDRESS: 12530 SW GLACIER LILY CIR ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT: 062 JURISDICTION: TIG
Project Description: Replace woodstove.
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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: 1
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
PAUL BLOOM Description Date Amount
12530 SW GLACIER LILY CR
TIGARD, OR 97223 [MECH] Permit Fee 10/20/20C $72.50
[TAX] 8% State Surcha 10/20/20C $5.80
Total $78.30
Phone: 503 -524 -6126
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
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: , I 7 .6 - Permittee Signature: ,`/ °‹
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.
.
a
Meihanical Permit A Heatio�n' jr _ '
,,.i F012 OFI ICI 11SL,0 \LY
ii R eceived
City of Tigard — 1 Permit No _ d 6"
13125 SW Hall Blvd., Tigard, OR 97223 '' u '
®"' Phone: 503.639.4171 Fax: 503.598.1960
OCT li g
n Review
1 yC� l (; Date/By. 2006 Date/By Other Permit:
T l + +G A K'D' Inspection Line: 503.639.4175 Ii ! V U Date Ready /By IIN H See Page 2 for
Internet: www.tigard- or.gov . , Notified/Method: Supplemental Information
4�.iY'Uk -fEIu �i.
x l/ " 4 Tic.' `i- .
. TYPE OF' 4 ,• d
COMMERCIAL FEE* ,SCHEDULE - USE CHECKLIST '
❑ New construction [ R. 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: $
and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
I j 1 -
_ y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. I Ea. Total
JOB SITE, INFORMATION AND LOCATION Heating /cooling
Job site address: / C) S� 6- C,t9ei -e/' /1/i C� Air conditioning ho or heat l a em
(requires site plan showing placement) 14.00
City /State /ZIP: -( , Z Z. 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
(14 t `, Hydronic hot water system 14.00
S t ✓N�+�- Residential boiler (radiator or
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
/le(1 CAt `/ Sbyl t✓-'/W- 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
OPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
! /!! Other 10.00
Name: /14k( 'COG * Environmental exhaust and ventilation
r @ ��� C114.
Range hood/other kitchen
Address:
2iJ 5 ✓` ✓ equipment 10 00
City /State /ZIP: 4-1' 5 Pill> ' 7 Z-z----/i Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) j s ---2-Li 6 / Fax: ( ) toilet compartments, utility rooms) 6 80
❑ APPLICANT , , ❑ CONTACT "PERSON" P 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: Clothes dryer (gas)
Other:
Address. MECHANICAL PERMIT FEES* ` . -
City /State /ZIP: Subtotal
Phone ( ) Fax' ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE 7 , 3 Q
Authorized signature: This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ( (61/ta- . Date: / (7 A:4 • Fee methodology set by Tri- County Building Industry Service Board
I \ Building \Permns\MEC- PenwApp doc 04 /06/06 440 -46I7T (I1 /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.
I:\ Budding \Permits\MEC- PermitApp.doc 12/30/05 2
CITY OF:,TI-GARD
BUILDING DIVISION PERMIT #: MEC2006-00507
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2006
Phone: (503) 639 -4171 ivoltviAel
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/15 TIME: 7 :Q7AM PAGE: 49
SITE ADDRESS: 12530 SW GLACIER LILY CIF; CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 062 TYPE OF USE:
PROJECT NAME: BLOOM
DESCRIPTION: Replace woodstove.
OWNER: BLOOM, PAUL PHONE #: 503.524 -6116
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/15/2006 Pour Time:
' Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 039770 -01 503 -524 -6126 Y
Corrections /Comments/ Instructions:
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edzvwer
PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 Date: i /.--/ Phone #: (503) 718- 2_