Permit C ITY OF TIGARD MECHANICAL PERMIT
4-4.00 4 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00831
. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/23/2004
PARCEL: 2S103DD -01201
SITE ADDRESS: 13880 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: 1 EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: UNK VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
OIL 3 - 15 HP: COMML.INCIN:
MAX INPUT: - BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> GAS OUTLETS:
10000 cfm:
Remarks: Installation of oil furnace.
Owner: FEES
GRAY, MIKE / PAUL, KRASAUSK Description Date Amount
13880 SW PACIFIC HWY [MECH] Permit Fee 12/23/20( $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 12/23/20( $5.80
Phone: 503 639 - 4100 Total $78.30
Contractor:
AMERICAN EQUIPMENT
89 NE COLUMBIA BLVD
PORTLAND, OR 97211 REQUIRED INSPECTIONS
Phone: 503 - 807 - 1578 Heating Unt Insp
Final Inspection
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. Thos s are set forth i OAR
952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or erect questiwr • U by calling
(503)246 -6699.
Issued By: J.), p , � ,7 Permittee Signature: / ` - %
....-
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechapi,al Permit Application FOR OFFICE USE ONLY
City of Tigard Datly Permit No.. c _ , y , a .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /� A 11l Date Ready/By: Date/By: Juris: Other Permit:
Inspection Line: 503.639.4175
��_�. ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: I( Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ 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 Q'Uther: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling aC ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
o cW P, C I .ric 4 Fw 1
Air conditioning ho or heat pump
Job site address:
( i 3 $ 0 (requires site plan showing placement) 14.00
City/State /ZIP: t r-e 0 {2- / ? Zz3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: k c. 1_5 r Gas heat pump 14.00
Cross street/directions to job site: AA,Q. 00,0 0 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
—Tn.) .511 0 F OIL- �i.t,(2,Y C i 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
❑ PROPERTY OWNER I TENANT Chimney/liner /flue/vent 10.00
Other: 10.00 _
Name: AUL tk. � U2� (c2f3S'A (t Environmental exhaust and ventilation
IMIk
Range hood/other kitchen
Address:
k_;:-.? $7,3$ b c S W •�C l F ! C t..4 equipment 10.00
City/State/ZIP: --� __ (2 ( 1 Z -5 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (....03) 63 4, 4 ( O 0 Fax: (5)3) q(, s- ae+ ? b toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
` , t� Other: 10.00
Business name:
N ELS �., �OVN.�! -g c r - � 1a CA-12-S- Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
n r Furnace, etc.
Address:
1 3 F ao 5 w Pe. t ' `� . Gas heat pump
City/State/ZIP: � , (..j2.— 4 - 7z7_-3 Wall/suspended/unit heater
Phone: b'i 3) t q L., /O C.) Fax: : �� C7& k '., , Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
MQ'✓i�� at tct Other:
Address: N c (91 61. 04,--e-12 MECHANICAL PERMIT FEES*
City/State /ZIP: = Qop____ 9 Zt I Subtotal
p �) g D 7 1 5 7 Ef Fax: ( ) Minimum permit fee ($72.50)
Phone:
Plan review (25% of permit fee)
CCB lic.: ' 'C4.( V� f — r State surcharge (8% of permit fee)
/ TOTAL PERMIT FEE
OIL_ This permit application expires if a permit is not obtained within 180
Authorized signature: . , days after it has been accepted as complete.
Print name: --6„:‘,y�ei J 0 I Date: I 242 011 • Fee methodology set by Tri -County Building Industry Service Board
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:\Building\Pernuts\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2004 -00831
. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/23/2004
Phone: (503) 639 -4171 :i „yIi
I Requests (24 Hrs.): (503) 639 -4175 - `
..
INSPECTION WORKSHEET FOR DATE: 3/25/2006 TIME: 7:07AM PAGE: 123
SITE ADDRESS: 13880 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: NELSEN'S TIRE & SERVICE CENTER
DESCRIPTION: Installation of oil furnace.
OWNER: GRAY, MIKE / PAUL, KRASAUSK, PHONE #: 603- 639-4100
CONTRACTOR: AMERICAN EQUIPMENT PHONE #: 503 -807 -1576
Inspection Request Scheduled For: Date: 3/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 002633 -01 503 -807 -1578 N
Corrections /Comments /Instructions:
Alt/
&NA”
-----14-KR - r (, I i -
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FE S ASSESSED
Inspector: ____ L _ Date: /ig �`J� Phone #: (503) 718-