Permit A l i CITY OF TIGARD MECHANICAL PERMIT
'ireii DEVELOPMENT SERVICES PERMIT #: MEC2006 -00211
' L. ��J I DATE ISSUED: 5/17/2006
1 3125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 136AD -04200
SITE ADDRESS: 06808 SW PINE ST ZONING: C -G
SUBDIVISION: VILLA RIDGE LOT: 001 JURISDICTION: TIG
Project Description: Convert furnace from oil to gas.
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:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
MARY CORNISH Description Date Amount
6721 SW PINE ST
TIGARD, OR 97223 [MECH] Permit Fee 5/17/200€ $72.50
[TAX] 8% State Surcha 5/17/200E $5.80
Total $78.30
Phone: 971 227 - 0218
Contractor:
C D JOHNSON FURNACE SERVICE INC
9440 SW EDGEWOOD ST
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 620 - 3636
Reg #: LIC 81133
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 or 1- 800 - 332 -2344.
Issued By: - .. 2 .L. fica „i„ dtrt Permittee Signature: -.4_ I ..../ e.—..../ -4
Call 503 - 639 -4175 by 7:00 a.m. for inspections that b . • ss day.
This permit card shall be kept in a conspicuous place on the job site , completion of the project.
Approved plans are required on the job site at the time o ach inspection.
Mechanical Permit Application l:olz orrlcl. t sE oNi.)
City of Tigard ECE�VED — 9 R Permit No. � G , • — ,o. I)
13125 SW Hall Blvd., Tigard, OR 97 Plan Review
'� R Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit:
T I G n K D Inspection Line: 503.639.4175 V 1 ' / 2006
Date Ready/By: tuns: MI See Page 2 for
Internet: www.tigard - or.gov Notified/Method y / Supplemental Information
• CITY OF TIG;ARD
TYPE OF 14ING D IVISION 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 Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
u 1- and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family 0 Master builder
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 4, 6 e� S w Air conditioning or heat pump
At Z (requires site plan showing placement) 14.00
City /State/Z1P: 11 I q 77.--z-7 Furnace 100,000 BTU ( ducts/vents) t 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
l e)5' Gas fve e 10.00
t m Flue vent t for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/i 10.00
l,$ PROPERTY OWNER ❑TENANT Chimney/liner /flue/vent 10.00
Other: 10.00
Name: �A a Enviro exhaust and ventilation
V! 4^, � r h ! --• Range hood/other kitchen
Address: / , - / c W At 4 ,G equipment 10.00
City /State/ZIP: / Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( Fax:
�' 2 , y 7 t� 2 � ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: Fuel piping
Contact name: $5.40 for first four; $1.00 for each a dditional
Address: Furnace, etc. ty(>
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail:
Range
CONTRICTOR Barbecue
Business name: t
Clothes dryer (gas)
t % Other:
Address: 9 e f K c E a,/ -- 14-, ew �o I S MECHANICAL PERMIT FEES*
City /State/ZIP: ! .1— ""1T g ! cc ( 9 72 Z 3 Subtotal
Phone: ( ) ,2 0 .3& F. ' ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 9'i t 3 3 State surcharge (8% of permit fee)
TOTAL PERMIT FEE - /
War This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: 61 D it , tr I Date: ,S` 1 O � • Fee methodology set by Tri- County Building Industry Service Board
lor
1:\ BuildingWPerm its C- PermitApp.doc . •/06/06 O 4 617T(II/ COM/WEB)
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 \Permits\MEC- PermitApp.doc 12/30/05 2
•
CITY OF TI -
BUILDING DIVISION PERMIT #: MEC2(1OC, 002'f 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/17/200.
Phone: (503) 639- 4171 ,7I�I
Inspection Requests (24 Hrs.): (503) 639 -4175 ":_..
INSPECTION WORKSHEET FOR DATE: 6/23/2006 TIME: 7:03AM PAGE: 97
SITE ADDRESS: 06808 SW PINE ST CLASS OF WORK:
SUBDIVISION: VILLA RIDGE LOT #: 001 TYPE OF USE:
PROJECT NAME: CORNISH
DESCRIPTION: Convert furnace from oil to gas.
OWNER: CORNISH, MARY PHONE #: 971 -227- 0218
CONTRACTOR: C C) JOHNSON FURNACE SERVICE INC: PHONE #: 503 620 - 3E06
Inspection Request Scheduled For: Date: 5/23/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 030364 -01 _ 971- 227 -0218 N
f!O/U C/1-g 4rAdo
Corrections /Comments /Instructions:
#, 6(.6 (»L Akti lam h - At S 74 5d - 2Cc,i- ---
7,e---' i =.. -4e •ae5
►% PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: �. Date: 5= = 23. -ef Phone #: (503) 718-