Permit F r �� CITY OF TIGARD MECHANICAL PERMIT
higtve Ai' DEVELOPMENT SERVICES PERMIT #: MEC2004 -00324
' � II 13125 SW Hall Blvd., Tigard, O R 97223 (50 639 -4171 DATE ISSUED: 6/3/2004
PARCEL: 1 S125DB -10100
SITE ADDRESS: 09600 SW SHADY PL
SUBDIVISION: THE RAZBERRY PATCH ZONING: R -4.5
BLOCK: LOT: 021 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: AC install.
Owner: FEES
POWERS, GLENN SAND Description Date Amount
MARILYN J [MECH] Permit Fee 6/1/2004 $72.50
9600 SW SHADY PL [TAX] 8% State Surchart 6/1/2004 $5.80
TIGARD, OR 97223
Phone: 503 244 - 2951 Total $78.30
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 503 - 692 - 5563 Cooling Unt Insp
Final Inspection
Reg #: LIC' 126881
•
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. Q
Issued By: Permittee Signature: �.��'" ca .
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Q igatii Date/By: lj / 6t. 1 l/ Permit No.m 2.4D, Y / - .6 �f
13125 SW Hall Blvd., Tigard, OR 97223 t� �'"�
Phone: 503.639.4171 Fax: 503.598.1960 �u ii Date/By: Review
k I Other Permit:
Inspection Line: 503.639.4175 ■ rr l i Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL_FEE *, SCHEDULE USE.CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction [21 Addition/alteration/replacement
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*
51 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job `` h h Air conditioning or heat pump
ob site address: 9 b c 0 3 ^
V) S c�� L. P ( (requires site plan showing placement) / 14.00
City/State/ZIP: 7, Cc CU r ,� Cj 7 a_ Z -- Furnace 100,000 BTU (ducts/vents) / 14.00
Furnace 100,000+ BTU (ducts/vents) I 17.90
Suite/bldg. /apt. no.: J Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
` Hydronic hot water system 14.00
O F T c4- y 1 n r' 5 t e r r y h 'lam 7 Residential boiler (radiator or
t ,� 0 v 1 . r A S . 1 --a-we �kr V a r" hydronic) 14.00
l.u-� v. ^ 3 r Unit heaters (fuel -type, not electric),
S P� ...C.. t' 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
V'< e v (azc ..e___ ..e___ 9 GLS P UL , r �ec-C , E , ' , E , ' J ■ vvS 1'�l 1 Flue vent for water heater or gas
9 fireplace 10.00
Gv r e —o'rcSt lN‘orvt.r Gl rc \e_c_v \H.`r
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
(a-PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 10.00
Other: 10.00
Name: G_.1 E n PO a (qcx r ; h ?Owe CS Environmental exhaust and ventilation
Range hood/other kitchen
Address: n
L 0 U S W S ot-,cIl� ? ke c e equipment 10.00
City/State/ZIP: T -t �r CO t , 9 -j '- z 3 Clothes dryer exhaust 10.00
v Single -duct exhaust (bathrooms,
Phone: (G t . - 4 4 a.q &-- I 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: WalUsuspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
•
CONTRACTOR Barbecue
Business name: M 6(,t a_e) /i n , Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) %A.
Plan review (25% of permit fee) 6
CCB lic.: / t61 State surcharge (8% of permit fee) � .C
TOTAL PERMIT FEE 7R. , O
y Authorized signature: D_ J ^ This permit application expires if a permit is not obtained within 180
i t days after It has been accepted as complete.
Print name: G- 1 _ h n S . P (� S Date: (, j 1 / 04 • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits\MEC- PermitApp.doc 12/03 4404617T(11/02/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 12/03 2
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Vir
GLENN S. PO Walt.
qwo S. w. SHAD PL
TI G�1'D o►'e, x (7223
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTIO'I DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received , Date Requested 6 / AM PM BUP
Location � (7/ !�ai�� . � �` ' Suite MEC -�`�v�
Contact Person A /irc.2 Ph ( ) v d'9.S7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
zei
Finar: SigfanliMERSVIIMIP
PASS PART FAIL , is — '
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service 1111PAL
Sanitary Sewer
Mig P) 111 �RI 'ak 71 '
Rain Drains ��� �• —
Catch Basin / Manhole � I � dir
Storm Drain
Shower Pan
Other:
Final
T FAIL
MECHANIC
Rough -In
Gas Line
Smoke Dampers
Fii
t� PART FAIL
ce
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 Please call for reinspection RE: 111 Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL