Permit ■n - w
.�' CITY OF TIGARD
MECHANICAL PERMIT
,> I jA DEVELOPMENT SERVICES PERMIT #: MEC2005 -00168
` � 1 3125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/14/2005
PARCEL: 1S134CD-08900
SITE ADDRESS: 11825 SW SUMMER CREST DR ZONING: R -4.5
SUBDIVISION: BURLWOOD NO.4 LOT: 031 JURISDICTION: TIG
Project Description: Gas stove and outlet.
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:
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:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
WILLIAMS, JUSTIN Description Date Amount
1825 SW SUMMER CREST [MECH] Permit Fee 4/14/200° $72.50
TIGARD, OR 97223 [TAX] 8% State Surchaq 4/14/200: $5.80
Phone: 503 - 577 - 3435 Total $78.30
Contractor:
•
SUBURBAN @ HOME
6014 NE 112TH AVE. REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97220
Phone: 503 257 - 5438
Reg #: LIC 143335
This permit is issued subject to the regulations contained in the Tigai 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: Permittee Signature: %ij i' :/ _/ / _ i _ - A,„,__
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
pity of Tigard RCEIVED Date/By: ` I 14 0 66 Permit No.�1 • .- 001 .S
13125 SW Hall Blvd., Tigard, OR 2 3 Plan Review t Vl
Phone: 503.639.4171 Fax: 503.598.1960 /an, a t t DateBy: Received
Inspection Line: 503.639.4175 � � Other Permit:
P APR 13 2005 1 �I
Date Ready/By: _ _____ _ ___ 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CITYA (cC1RK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
BUI/ TGIPP /I VON Mechanical permit fees* are based on the value of the work
❑ New construction dditlo a eratlo 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: $
- and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
❑ Multi - family ❑Master builder For special information use checklist.
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: \ \C.0 �MO i ^ ' Air conditioning or heat pump
C f > � 1 Jr (requires site plan showing placement) 14.00
City/State/Z11377\ °<Agar2) Fumace 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
DESCRIPTION OF WORK Water heater 10.00
i J �(� � 2Q Gas fireplace k 10.00 1 O.vC
` ` ��C J �\ o ) �� ( .w� 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
ROPERTY OWNER ❑ TENANT Chimney/liner /flue/vent 10.00
Nance: (:)\1/4(-\ �'�‘ \\ \^ 1(�(NG� Other: 10.00
\ 7�J1 , 1i Environmental exhaust and ventilation
Address: \\ ( ( Range hood/other kitchen
\J` equipment 10.00
City/State/ZIP: �ccip CA (D\ Clothes dryer exhaust 10.00
1 � Sing exhaust (bathrooms,
� Phorl � Fax: ( ) toilet t compartments, utility rooms) 6.80
APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
'` � Other: 10.00
Business name' ^t ∎ &_ - ><rv. �Y� l Fu C/ piping
Contact namprel 4caC� $5.40 for first four; $1.00 for each additional
Address: C��''')M 1(' \ \a }ri 1 [ice t!\./7 , Furnace, etc.
um ,e_, Gas heat pump
City/State/ZI �(.\G „ ^C) "" l ' 0( a0C,� Wall /suspended/unit heater
Phone:_§ 5 r'� ' ' '� Fax: : �i X --\b::) Water heater
Fireplace ‘ .
E -mail:
_ Range
CONTRACTOR . Barbecue
Business name: D�'��Y� Clothes dryer (gas)
Other:
�
Address. �� \\a -y( \ Ok;e/V MECHANICAL PERMIT FEES*
City/State/ZIP( CV.0 & C <�� aE Subtotal \ 5 4*{Q
r Minimum permit fee ($72.50) . 0
t J
Phone Q ,�� -\C ) Fax:cijjAl., �lW
Plan review (25% of permit fee)
CCB lic.: \ � ��iE5 State surcharge (8% of permit fee) 5 . %C.
TOTAL PERMIT FEE -*46,, -
Authorized signature. �—. This permit application expires if a permit Is not obtained within 180
days after it has been accepted as complete.
Print narriCS Date:- --1' \\ /06 • Fee methodology set by Tri County Building industry Service Board
Ann nc ,rr n,,mirnunvcos
, CITY OF TLGARD ;
BUILDING DIVISION PERMIT #: MEC2005 -00166
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/2005
Phone: (503) 639 -4171 47 i 4 1 011 il
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/26/2005 TIME: 7:10AM PAGE: 102
SITE ADDRESS: 11625 SW SUMMER CREST DR CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.4 LOT #: 031 TYPE OF USE:
PROJECT NAME: WILLIAMS
DESCRIPTION: Gas stove and outlet.
OWNER: WILLIAMS, JUSTIN, PHONE #: 503 -577 -3435
CONTRACTOR: SUBURBAN @ HOME PHONE #: 503 - 257 -5438
Inspection Request Scheduled For: Date: 4/26/2005 Pour Time:
D
Code # Inspection Description Confirm # Contact # Message' ?...
699 Mechanical final 00533001 503.257 -5438 Y
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orrections /Comments /Instructions: C 4�` 2G0--(Z.
--1 27 - 3 5 55
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Dat 4/ #: (503) 718-