Permit CITY Ti CARD JI MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00400
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/5/2005
PARCEL: 25111 CA -00104
SITE ADDRESS: 09453 SW LAKE SIDE DR ZONING: R -7
SUBDIVISION: ALDERBROOK FARM LOT: 013 JURISDICTION: TIG
Project Description: Add a/c
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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
WARD WILLIAMS Description Date Amount
9453 SW LAKESIDE DRIVE [MECH] Permit Fee 7/5/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchaq 7/5/2005 $5.80
Phone: 503 624 - 7231 Total $78.30
Contractor:
SUPREME COMFORT HEATING
9425 SW COMMERCE CIRCLE #16 REQUIRED ITEMS AND REPORTS
WILSONVILLE, OR 97070
Phone: 503 682 - 1985
Reg #: LIC 21892
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 • - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1 -800 -. 2 -2344.
Issued By: 0 O t j j Permittee Signature: Ar
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.
Mechanical Permit Application FOR OFFICE use ONLY
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Daten3 I ff � Permit No.: _ ��
City of Tigard ' �i1 /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Re view C�J A
Phone: 503.639.4171 Fax: 503.598.1960 /4,,,, li A. � E '', Date/B Other Permit:
Inspection Line: 503.639.4175 � r•� Date Ready/By: Min � ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
. TYPE OF WORK COMMERCIAL FEE* SCHEDULE :- ...USE CHECKLIST
ID New construction - 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: $
-1- and 2- family dwelling ❑ Commercial/industrial RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
❑ Ac cessory building
❑ Multi - family ❑ Master builder For special information use checklist.
❑ Other: Description I Qty. I Ea. I Total
' , - JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: Gi 4-53 5k) l-q, pr Air conditioning or heat pump
(requires site plan showing placement) I 14.00 I 4
City /State /ZIP: �� ! 612_ 7224- 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
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
Attd Ak 4 -0 -O e,( 1 4 h42. la1.4 Flue vent for water heater or gas
c Z ,5J /� fireplace 10.00
J� �� /! Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
(PROPERTY OWNER' • ❑ TENANT Other: 10.00 _
Name: ((J atra - Wt. (,L4 s Environmental exhaust and ventilation
Address: G e . (A) L. a r: Range hood/other kitchen
� � equipment 10.00
City /State /ZIP: it,/ Cl 71. Clothes dryer exhaust 10.00
/- ,l 1 Single -duct exhaust (bathrooms,
Phone: (.5a?,) (0 2 �1L3 / Fax: ( ) toilet compartments, utility rooms) 6.80
, ., ]$APPLICANT . ❑ CONTACT PERSON Attic/crawispace fans _ 10.00
Other: 10.00 _
Business name: (mot. p r CdWI - F - 0 .
Fuel piping
Contact name: 4-2 S , W. t�Qh4 w e,rceCar 7t (C.. $5.40 for first four; $1.00 for each additional
,� 1 '/ ` Furnace, etc.
Address: W t, "',a t) l (e, , rl '70 `j a Gas heat pump
City /State /ZIP: IeIJ (2-- 1-170-is LL Wall/suspended/unit heater
Phone: (607") 6 " ( 5 Fax: : (7 ) 3) GSL . jo l,r Water heater
Fireplace _
E -mail: Range
' CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: . .5 - 4Q 4e r,,//t 641,40-34 Other:
Address: ��'"`''�� MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) F es: ( ) Minimum permit fee ($72.50) 7' q
.3D
— - Plan-review - (25 %.of permit -fee)- ,.4
CCB lic.: s 7 ( L State surcharge (8% of permit fee) V'
' TOTAL PERMIT FEE - 7s , (J
Authorized signature: This permit application expires if a permit is not obtained within 180 • days after it has been accepted as complete.
Print name: & v k (Z -F-- Date: , (. `05 ' Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits\MEC- PermitApp.doc 12/03 440-4617T (11 /02/COM/WPB)
Mechanical Permit Application - City 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.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005-00400
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/5/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/8/2005 TIME: 7:10AM PAGE: 77
SITE ADDRESS: 09453 SW LAKE SIDE DR CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: 013 TYPE OF USE:
PROJECT NAME: WILLIAMS
DESCRIPTION: Add a/c
OWNER: WILLIAMS, WARD PHONE #: 503 -624 -7231
CONTRACTOR: SUPREME COMFORT HEATING PHONE #: 503-682-1985
Inspection Request Scheduled For: Date: 7/8/2005. Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 010929 -01 503 -682 -1985 N
Corrections /Comments / Instructions:
it/E-E0 GA-Z-
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—H -PASS PARTIAL– APPROVAL— - El CANCEL ❑_NO_ACCESS
f l FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Date: 7— Phone #: (503) 718