Permit --A CITY OF TIGARD MECHANICAL PERMIT
i i DEVELOPMENT SERVICES PERMIT #: MEC2004 -00129
L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 ------ DATE ISSUED: 3/19/04
PARCEL: 2 S 102 D B - 06400
SITE ADDRESS: 09107 SW HILL ST
SUBDIVISION: CHELSEA HILL NO.2 ZONING: R - 4.5
BLOCK: LOT: 041 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Fireplace and gas line
Owner: FEES
COOLEY, ERIC J + RUTH A Description Date Amount
9107 SW HILL ST
TIGARD, OR 97223 [MECH] Permit Fee 3/19/04 $72.50
[TAX] 8% State Surchaq 3/19/04 $5.80
Phone: 503- 639 -9427 Total $78.30
Contractor:
JEFF BENNETT CONSTRUCTION
602 HOLLY DRIVE
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone: 971-235-0493 Gas Line Insp
Mechanical Insp
Reg #: LIC 143825
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR
952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: / Permittee Signature: ,A,A
Call (5 ) 639 -4175 by 7:00 P.M. for inspections needed the ne b ' siness day
Mar 19 04 06:53a Jeffrey Bennett 503- 537 -5463 p.2
RECEIVED
MAR 19 2004
02/27/2004 13:01 FAX 5035981960 CITY OF TIGARD IJ001
CITY OF TIGARD
Mechanical Permit Application)ILDING D VISION FOR OFFICE 1_ ONLI - '
City of i t Doure % Permit No 9 X' -(SD ate -
13125 SW Nall Blvd.. .. Tigard, OR 97223
linen Review
Phone: 593.639.4171 Fax: 503.598.1960 i � : D„�y OC1, , Permit:
Inspection Line: 503.639.41 25 Date Ready/Br Auk: 0 Sec P 2 far
lntrntet, www,ci.tigt,rd.or 11s Not RedIMetbodc SWple:mental taformatten
.0 3.4.s .":F- : ;t? tilig-1 �µ,�1��;i1. - ; y. ". t ? ;'c ;: _.;�.;�)t.;,ij; •` 'r �j6 t ' l t t:2 SCfIk1DIi ' = •'(i1S$CJ3ECl
' :'5 ,:1 11 1.. ; . 1.0 .n.,l•il• =
ft�i.; i �!h _ �.;f.._• .. .. •.:7.r....... S� ��...
❑ New construction pdd on aeeal
itlonfaltcrati/replt 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. equipmcnj labor, overhead. and profit.
- ilt•I;:.p.,.1a;:( x'il0 rl Y, Sim, -1` .1 •Ini,( Value:S
:1;b# ••. .,., If7ti:�?�.a'c�r..'�i���� - ,��t!"fb�;:b �: -' ?• r;
l�T %�51 /SF1�1 � 7 5 £ EFS
I- and 2- family dwelling 1:1 commercial/industrial ❑ Accessory building '�l# E•• " RE83D;EIVT)kA Q
For special information use checklist
❑ Multi- family s,. t� �ryl� ' ❑ �v4 -M ( a ') stterrb � uiillder 0 �a Other " Description Qty. I �• I roil
Y L. ,1_ ^'. I.t F'. i' p .f•. {I ^.L'•=.-�`: { `�Qp AJ• - ... • � I Reatlagicaoling
..
- A i r con or heat pump
Job site address: G 1
'
I ( V SL'.; ��c� ` �� ( m i ni. site plan sho ptsument) 14.00
City/State/ZIP: , l ' Furnace t 00.000 BN (ducts/vonta) 14.00
Furnace 100,000+ BTU (ducts/vernal 17.90
Suite/bldg. /apt. no.: I Projestname: Gras hcat pump 14.00
Cross street/directions to job site: ; C Gj. G)....-k Cl ‘ ( . -Jct.) 0/7 -tc` Duct work • 14.00
Hydronic hot water sys 14.00
�[) 1" l� C Residcatial boiler (radiator or
hydranic) 14.00 ,
- Unit heaters (fuel - type, not electric),
in - wall, in -duet, suspended, etc. 10.00
Subdivision: I Lot no.: Flue/vent for any of above 10.00
Other. 10.00
Tax map/parcel no.: other fad SLtpltanoes
1- ''- - t a •I vfi Ik[t r. _ �•7 li•• �'•. Water heater 10.00
�i ;i €i .::••:. _ii :f(`.i: �: •.. : Q1�q ..`ri� ;: - a ` t : °f.( ,
:.. :1•. e ': s::_.._, t, . al - 1 10,00 [ 0
"''. ' . � r � Gas f ireplace
r(O V).12. - -� ■J,Z T L 47 Lcs, c- L Flue vent far water heater or gas 10.00 ,
\ 1 .. fireplace
•
A t .� �� ( �i `7 G: S c Log lighter (gas) 10
C) i .. S C -� �..E 1' J ' Wood/pellet stove 10.00
Wood fireplace/insert 10.00
i a{�y . . , Chimney/liner /flue/vent 10.00
tiaE:�t.".�t1�`ijti =r.:2 . „„,,,, _ "�_ :�� f ) S' • - i �iL { : o, _ 10.00 _
1 i VS;!! . f.(.: ,LF .. .0 1 ! 1 ..' : .•5
Name: L t ` ` 2 w'l �. cocz, , / Environmental =haunt and ventilation
�F Range hood/other kitchen
Address: cl (-D'1 :mow 4 : t t S•k . cquiemrnt 10.00
U ` ` Clothes dryer exhaust 10.00
City/State/ZIP: ) t �[ •Z Z Single -duct exhaust (bathrooms,
Phone: (S-p- 4 � f f 1 Fax: ( ) toilet compartments. utility rooms) • 0 -80
J " •-;jn:= ` .lily,• ":_e :, -:-" - '_ ,...' .. ..:•:1_,K.-1; .1{q..` Tf...... S .... : ttieiaawtspecefans 10.00 • as <" 1z t :.:. . : _ : . 1 .. .11 Other: 10.00
~ Business aalne: S . mow CU k) c_\__‘ • Fuel piping -
Contact name: `- 1 ,. ' -• , N - S5.40 for first four; $1.00 fee each additional
i- � 7( --f--
n Pomace, etc.
Address: ( '? Ho f f �x- ' r <<. Gas heat pump .
City/State/ZIP: l` ) „.�i'-R << (yr _ GI -it ? 7 Wall /wspende beater
(. water heater
Pbonc : K ? �3 - X44, _ Fax::(SD 5' - 5 1-t Fireplace - 5. .
E-mail: Range
aa i e 'i . 1 -. s r L i y,. .�, , �I't`�":s'i"� •. 't i 5 ]� ?fasbecue •
.. _ . t��:� =:: . f•`�f:i •.: - S FI t: ��"' �' r${. .n_�,,t,:�.6fi•n•I-ii:f�l:l��i{ �;i+���y - • 1
: ^ :jd:`
�/ Clothes dryer (gas)
Business name: ,��i.1_•.L S . :m C [�, - G oJ, j : Other.
Address: t„cC> Z - ( 5 4 ' . : d` ; lVi>;C$ki[[_i>;1: PP fi l7tlfEFS a •
City/State/ZIP: A jC,•,JS (.. ) 6 /j.• -it '? 2 Subtotal
Minimum permit fez ($72.50)
Phone: ( e - r 1 ( ) 2 - 1 s 4c- 7 I fax ( v') - S' . 1 S' 3 Plan review (25%ofpermit fee) -
CCH lie.: 1 F2.
_ • state surcharge (B% of permit fee)
run R......_____-..--"---14.--- TOTAL PERMIT FEE 7 . � �( )
�'a .1:3(:) Ttti permit app of t hies (apiece if a Fermis Is complete.
within 100
da
Authorized si cure: ri aver it t.wt been aeaptcd ea eomp4rr.
Print name: 'T r,, ,, ,, t 7 - I Date: • _e , 4 - 1 - Fec methodology set by Tri -County Building tnm say Service Beard
Case Activity Listing 12/3/2004
��� 10:33:18AM
TIDEMARK Case #: MEC2004 -00129
COMPUTER SYSTEMS, INC.
��. ,„. Via: v.., „r• „''- str. ;m.;:: ,.� , ;,'s,: : a ��i+y, >. ; >,y.� ..
�q 3�
Date:,; ,� a "�. ii ' � .
k i
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�',.:.: �r .y�4 f�S:
}y p
,,- N�,,�� ,,_,�s�a.z��i�,:..,,, „> � ,,,,,; <', , rz/eP•• „' ,,,, „v,...,Ws�r. .� ;.f,., ., <ryu,F:�Y-..... ,,,,,, ,. <..a�a; A �....��.:��- .,,,,.� ,� -,. � .k..,,,,, •: <irs,a� , .�^d,., .,G'r msZ•' �t,^:.; f:�� „ «:.,.��'.e�;s:�E- ::: ° g " ,
MECA007 Application received 3/19/2004 None DONE FAX 3/19/2004
JMT
MECA008 Create Permit 3/19/2004 None DONE JMT 3/19/2004
JMT
MECA705 Gas Line Insp None 3/19/2004
JMT
MECA715 Mechanical Insp 3/24/2004 None PASS MRS 3/24/2004
MRS
MECA060 (F) Issue permit 3/19/2004 None DONE JMT 3/19/2004
RCP
MECA800 Case Finaled 3/24/2004 None PASS MRS 3/24/2004
MRS
Page 1 of 1 CaseActivity..rpt