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Permit ' CITY OF TIGARD MECHANICAL PERMIT • i DEVELOPMENT SERVICES PERMIT #: MEC2004-00097 �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/4/04 PARCEL: 1S133DA-05300 SITE ADDRESS: 12790 SW GLACIER LILY CIR SUBDIVISION: AMART SUMMERLAKE ZONING: R -7 BLOCK: LOT: 075 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: LPG 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: AIR HANDLING UNITS CLO DRYERS: • FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: 2 Remarks: Installation of gas piping for gas range and future appliance. Owner: FEES POULSEN, LAWRENCE L AND Description Date Amount CHRISTINE L 12790 SW GLACIER LILLY [MECH] Permit Fee 3/4/04 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 3/4/04 $5.80 Phone: Total $78.30 Contractor: HOLMES INSTALLATION SERVICE RAYMOND FLANDERS 33535 NW VADIS ROAD REQUIRED INSPECTIONS CORNELIUS, OR 97113 • Phone: 647 Gas Line Insp Final Inspection Reg #: LIC 102473 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 " 4),LL, Iss ed By: ; I.!,p� / �i,� Permittee Signature:X" Call (503 . • 9 -4175 by 7:00 P.M. for inspections needed the next business day . . . . , Mechanig Application . FOR OFFICE USE ONLY City of Tigard A 13125 SW Hall Blvd Tigard, OR 97223 ate/By: Received D ew 47 44 i Plan Revi Permit No.: Other Permit: , ,,,, - ei00 F 7 ., Phone: 503.639.4171 Fax: 503.598.1960 iary4 i t\ Date/By: Inspection Line: 503.639.4175 ,,,41.‘1, lir 1 I Date Ready/By: Mall El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information PeWTOMMIM''' ';5:=4,igAr ' l' '' '' ' 4'Pt "TAS I MEMOI trOblgrAingf i6k1 V itt.4,INICIPloilt , ated=1, - -4&t .,' " '-' ,. - -., , ,45 ,, , ,- i., - , , , ,44 , ,,..*Mana c • .. 4 . 1'.,-1 :4t - ANIltt. , : ,,,, : ',.,,, ,-- '. ,.---- ' , • :„, ,,I - ''`' '4 ` ' • - -.' ' ' ' New construction .Addition/alteration/replacement Mechanical permit fees* are based on the value of the work 0 performed. Indicate the value (rounded to the nearest dollar) of all 0 Demolition Other: mechanical materials, equipment, labor, overhead, and profit. MiliWitij' 6RIB p,SS111 Value: $ -,-t-ki, ,, ;, , d. s ,, ,.<0 ' t4. - ',q.t.= , ...4,, , ,,, ,, ,S.,, , ,a.u&s==.4.til.,, , ,Qtr ■-...nadA. .-!,, ,,,, . ' <,-,w ,.!, -,,,,,, rAtlaVISOVA..004 ii§i :Et t s , I - and 2-family dwelling El Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi 0 Master builder 0 Other: Description Qty. Ea. Total i1 NF ,, ..._.•i ...- - zc - .L,Fi..:zt7z;•LT. , . - MOIISAMP; ASiCilit S1 ott-oDI: '''',a'V '"R ' - ' , "'Z'''''' Heating/cooling ;.u...41 ..,--. Z;FL',P'4;`.^ ,' ' '- `11:A=o,,V4 Job site address: I 2 7 ¶"0 5 01/4./ C ( a cce_4_ L, LL C (4., Air conditi ite oning or heat pump (requires s plan showing placement) 14.00 r---.. City/State/ZIP: - j • ....5 64-4.- , 0 VQ-- 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 - 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 Flue/vent for any of above 10.00 Subdivision: I Lot no.: Other: 10.00 Tax map/parcel no.: Other fuel appliances ,II1Whilijr1VeZ:Fdit;:*44.4 Water heater 10.00 * .,s,..74,„ ,, ,4fs Gas fireplace 10.00 & ) / 1 14.- 14 6 't2 icry 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 tr,,x,,,i, , ,,...4 4 4 K , Az4.4 . : N76 , iv ,--- l w ajz ,. :*: 4:, , m mix sa Chimney/liner/fille/vent 10.00 aMinm, , t„ othe, 10.00 Name: L--0ry poul /0 Environmental exhaust and ventilation Address: 1 2 /1 0 . 5' V.! C. ( c c i Range hood/other kitchen t° R_ Z., a y c f 4.- equipment 10.00 City/State/ZIP: k ,9 O- -0 0-17--Q Clothes dryer exhaust 10.00 Single-duct exhaust (bathrooms, Phone: (S03) 4 3 7 1 .---0 2$0 Fax: ( ) toilet compartments, utility rooms) 6.80 kyoc.z•rosgxm-a•o4:ftFr tikv Ail..0.1AfrcliiiiiiigtKiarMI1 Attic/crawl sp ace fans 10.00 Aw.p --:: Ki.4..,t,z:A4,:..;„:• ,qm4. ,s , ,, ,,%2.!„e„5".A.., Business name: Other: uel pi 10.00 Fuel ping 1 3 5 '-. Contact name: $5.40 for first four; $1.00 for each additional Furnace, etc. Address: Gas heat pump City/State/ZIP: Walllsuspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E-mail: Range / "piggsw#1740:,, zit.' Val5MT:itiirolinetalW*SianINVII Barbecue , A4,141114bwrat• -, :::.1. - •• .,. 4'M ': ,,2,,,,,c.N.,1 , Clothes dryer (gas) Business name: 1_40 \ k e t 1-- -_i_ frs et_ Address: 1 isl 5 N't,,../ kf 54 11)) ZIAlti' MaiNiefiiiiMiiiigin =' : ' • '' City/State/ZIP: Co in_v e... k k ./ 0 v--e..._ 9 7( < 3 Subtotal Minimum permit fee ($72.50) 70:1 5?-) Phone: (s 6 L(7 --q ? 20 Fax: ( ) Plan review (25% of permit fee) , _ - CCB lic.: 1 0 L. <( -? 3 State surcharge (8% of permit fee) ,P • go TOTAL PERMIT FEE -78., 50 This permit application expires if a permit is not obtainh within 180 Authorized signature: 1 ....c._ 4 e. days after it has been accepted as complete. Print name: P.o. \--,-.3)-r-A--5- Date: 7/1(( * Fee methodology set by Tri-County Building Industry Service Board i: \ Building \ Permits \ MEC-PemitApp doe 12/03 440-46I 7T (11/02/COM/WEB) Mechanical Permit Application - City of Tigard a•, Page 2 - Supplemental Information Commercial Fee Schedule: __ otal aluat>< _: AlermitEgebto.kovzievNa4A $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:\Building\Permits\MEC- PermitApp.doc 12/03 • 2 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: ,(503) 639 -4175 INSPECTION DIVISION Business Line: (56) 639 - 4171 MST BUP Received ,-3' 6 � Date Requested © AM X PM BUP Location c3 0 Q c I Suite MEC 0 POP C 7 Contact Person L- Ph (Cr )_c q r C PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing )"-/-1 Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof � � � , � / 1 , , 6 J�� Rv 1cq,J� I���I �' 1 Other: ffff Final PASS PART FAIL � ' I PLUMBING _ , 7 1 4 1 ) Post & Beam Under Slab Rough -In Water Service �� �,�,, Sanitary Sewer i�} 1" '''� Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Smoke Dampers Final PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA - L.5 Approach/Sidewalk Date Inspe ' Ext Other: Final DO NOT REMOVE this inspection record fr m the ob site. PASS PART FAIL