Permit CITY TIGARD MECHANICAL PERMIT
im I • DEVELOPMENT SERVICES PERMIT #: MEC2004 -00175
l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/7/04
PARCEL: 2S1 04CA -02000
SITE ADDRESS: 13711 SW LAUREN LN
SUBDIVISION: HILLSHIRE ZONING: R -7
BLOCK: LOT: 020 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
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: 1
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Gas piping and outlet for dryer, fireplace insert, has existing piping /outler.
Owner: FEES
MARCH, HENRY Description Date Amount
13711 SW LAUREN LN
TIGARD, OR 97223 [MECH] Permit Fee 4/7/04 $72.50
[TAX] 8% State Surchar 4/7/04 $5.80
Phone: 503 - 590 - 5987 Total $78.30
Contractor:
HOLMES INSTALLATION SERVICE
RAYMOND FLANDERS
33535 NW VADIS ROAD REQUIRED INSPECTIONS
CORNELIUS, OR 97113
Phone: 647 Gas Line Insp
Misc. Inspection
Reg #: LIC 102473 Final Inspection
i
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
Issued By: Permittee Signature: /.14 f / 71 ,4 40/41 -i
Call (503) 639 -4175 by 7:00 P.M. for inspections needed tK next business day
Mechanical Permit Application FOR OFFIICE°USE ONLY
CI Oiri and Received
`J g DateBy:// 7/ V 26 Permit No. �i L -2W)/1 e rv/7'5
13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev,e . `
Phone: 503.639.4171 Fax: 503.598.1960 //�wgiiio r � ,t Date/By:
Other Permit:
Inspection Ins Line: 503.639.4175 i I D ate Ready /By: Juris: Ei See Page 2 for
P
Internet: www.ci.tigard.or.us Notified/Method: 77t, Supplemental Information
ire. , ? h .i 3. .� - a .,r .. .;n= �� � ��'i '' e�." f +':, "`�'�- " ".:: .: �; ,�
r, .�y,�:; >' ; . a ; -. "?, , r � , ;" „iaVdlik . 14 - . 0 r e dk v ' IERCI FEE *. - SCHED USEtCHECKLIS .
❑ New construction
1 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.
rats °' W i m oC ,TEGORY OF CONSTRUCTION ` `rgc Value: $
-, RESIDENTIAL /EQUIPMENT /SYSTEMS FEES*
r't 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea, Total
E > ; ERI JOB„ SITE lNF®RMATION A ND L ” .,,.. =� Heating/cooling
Job site address: 3 -- 7 ( � S ioJ 1,- ' y tea / ). N �J Air conditio or heap ump )
L' re uires site lan showing lacement 14.00
City/State /ZIP: — k Gi j e :) ) y" 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
r' r r sp4- 04- q na' 4a a .., ,rs�°r ' - c
u ki it..'Mktia s 6 DESCRIPTION OFi��WORK� at 1,$! Water heater 10.0
\ „ �t /� Gas fireplace 10.00
�._�j (\ ( C € - S t9 ,, t M /Tim A- 6 ' i + f Flue vent for water heater or gas
Lk � �� ---e/..11 ! J 1 � � �J fireplace 10.00
-I-T "� 1 t. P-' V 7 0-3' I ` t 7 tG --- --4 tale k
Log lighter (gas) 10.00
Wood /pellet stove 10,00
Wood fireplace /insert 10.00
t N,,,:,,,,;,,W , , > - r v ,,,; 4 Chimney /liner /flue /vent 10.00
P R OPE RTY4 z
TE ' . > y
„ � a,,.. .� - arOW�, > =�Rs,^�"J; w �.i>li'���^'��>s< :�,. v��� -... , . . a� a« Other:�T hv✓i.tn 1 0.00
Name: 4 >v� r -_' rc fl Environmental exhaust and ventilation
` ] Range hood /other kitchen
Address:
3 7 ( S — t"/ ,. L a v V n' 1--/J equipment 10.00
City/State /ZIP: ) ,5 Cu v () 6 y'P / 7 Li 3 Clothes dryer exhaust / 10.00
['/ � 1 Single -duct exhaust (bathrooms, •
.$ Phone: ) S '' Fax: ( ) toilet compartments, utility rooms) 6.80
": ,., 4 ::. _;,,' , ._,: > , v_ •:,:. ace fans 10.00
' l l V i ® P1V , ," "; . . " , i CONTACT PERSON x ^- Attic/crawls p
Other: 10.00
Business name: 1
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 (^ 1
E -mail: Range
n
`# : " s A `CONTRAC �� R Barbecue
Business name: /.-,O %(/y+ CS' 1 1' ( R112—..., Clothes dryer (gas)
Other:
Address: 3 35- 5- ict / i (-'3 \ S v' h`< : 1VIEGHAN:IGAL'PERMIT EIEES *q
City/State /ZIP:C Q R A e (, v 5 -0 l 7( ei Subtotal
e Minimum permit fee ($72.50) --7V., _ Phone: 9 )3 ) _24, _ _ _Fax,(_ __) Plan Teview (25% of permit f
CCB lie.: / p 2 %,i 7 3 State surcharge (8% of permit fee) ` 5
�
TOTAL PERMIT FEE d
.�// This permit application expires if a permit is not obtained within 180
Authorized signature: /[ - .�` days after it has been accepted as complete.
Print name: l e,_.... ( fY/ rte G P.�-J� Date: i t) � 0 y * Fee methodology set by Tri- County Building Industry Service Board
i'\ Building \Pernvts \MEC- PermitApp.doc 12/03 440 -4617T (I I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 = Supplemental Information
Commercial Fee Schedule:
:.«Totalaluat><on e q Pernut 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:\Building\Permits\MEC- PermitApp.doc 12/03 2 •
•
CITY OF TIGARD 24 -Hour
BUILDING , __, Inspection Line:' (503) 639- 4175 '
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 7 / Date Reque ted 4 AM PM BUP
r
Location / �3 < /f Suite MEC C
Contact Person f : GvL Ph ( ) U — A'7LM
Contractor Ph ( ) SWR _
BUILDING Tenant/Owner ELE it
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam ( /
Shear Anchors calf
Ext Sheath /Shear
Int Sheath /Shear
Framing
Dry
Insulation ��� � s4.i �,
Drywall Nailing � � �� /44T C4t/L/L�� f`"ia-Ce■:-/ �
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
PASS PAT FAIL /
,CHANICgI - t/
Posf&Weam
Rough -In
as Line
mo a ers
ART 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 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line - _ —
ADA
Approach/Sidewalk Date 4 r - Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL