Permit C ITY OF TIGARD MECHANICAL PERMIT
vj DEVELOPMENT SERVICES PERMIT #: MEC2004 -00786
--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/3/2004
PARCEL: 2S1 11 AD -06800
SITE ADDRESS: 08875 SW SCHECKLA DR
SUBDIVISION: SCHECKLA PARK ESTATES • ZONING: R -4.5
BLOCK: LOT: 022 JURISDICTION: TIG
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:
ELE 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:
Remarks: Installation of a/c unit.
Owner: FEES
DAVID TURZILLO Description Date Amount
8875 SW SCHEKLA DR [MECH] Permit Fee 12/3/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchari 12/3/200 $5.80
Phone: 503 624 - 2661 Total $78.30
Contractor:
REQUIRED INSPECTIONS
Phone: Cooling 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. 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 -669 .
< 1
Issued B • !'J /� .I �. Permittee Signature: k
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next btr‘iness day
Mechanical Permit Application FOR OFFICE USE ONLY
Received
City of p ig ar d Date/By: / /Q(,, ell -0 Permit No.:tifH./O^ /l,_lL,�
7s /,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Y�JT �f
Phone: 503.639.4171 Fax: 503.598.1960 /�s.,�.6gi u\ DateBy: Other Permit:
Inspection Line: 503.639.4175 _ ■ J,. : :Tl � Date Ready/By: ! See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 6, 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 ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1:1 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
L Air conditioning or heat pump
Job site address:
$87 5 s w s cat ec kt A- D R (requires site plan showing placement) / 14.00
City/State /ZIP: 'TI a,_A O Z ' 9 a.3 Furnace 100,000 BTU (ducts/vents) 14.00
1 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
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
El OWNER I ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: -.:DA v i a. TV IZ ZI Lt,0 Environmental exhaust and ventilation
Address: 8 27 SW sche_.k‘ A D R Range hood/other kitchen /
equipment 10.00
City/ State/ZIP: - ./ 0 k c a -w-/' Clothes dryer exhaust 10.00
,, Single - duct exhaust (bathrooms,
Phone: ( 553) > q - a 6 b/ Fax: ( ) 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 additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: OU.) 10 q Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 72 • sD
Plan review (25% of permit fee) �.��
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE " '6e)
Authorized signature: a — _ � This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: - I 4 v id S. Tu Kt t LLD Date: m? 'a /3/ o'I. • 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\Permits\MEC- PermitApp.doc 12/03 2
L._ .
5 , 0 5 E 2_ a Ltar
CITY OF TIGARD 24 -Hour
BUILDING Inspection f&tne: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 63 4171 MST
BUP
Received Date Requested /--)- — AM - PM BUP
Location G . _ �. _ _ i Suite . "d d ��
Contact Person �.L-r j Ph ( ) 2 ( - Z 406/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner LG Oc y 76?
Footing
Foundation ELC
Access:
C4->-y) Ftg Drain L3� � ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath/Shear '61(Q ��� �� ��
Framing '\ Aikek
Insulation
Drywall Nailing
Firewall Fire Sprinkler /c 0\1 I1 4-X P �G
Fire Alarm
Susp'd Ceiling _
Roof s � S C b
Q
o
tit �lC� LC-
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole =11L=i1W
Storm Drain
Shower Pan
Other:
Final
PASS TWIT FAIL
eEtrl AL
Post & Beam
Rough -In
Gas Line
Sm • - Dampers
in_-
n 'ART FAIL
L
Service
Rough -In
UG/Slab
Low Voltage
Fir: larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• PART FAIL
SITE Please call for reinspection R : / C ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record the job site.
PASS PART FAIL