Permit 1 ,,,
. ;_t.
A: ' CITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2004 -00238
*wove A. DEVELOPMENT SERVICES DATE ISSUED: 5/4/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S133AD -06600
SITE ADDRESS: 10895 SW SUMMER LAKE DR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 110 JURISDICTION: TIG
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: 1 DOMES. INCIN:
LPG 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Furnace and AC install
Owner: FEES
LANGE, TERRY E Description Date Amount
10895 SW SUMMER LAKE DR [MECH] Permit Fee 5/4/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 5/4/2004 $5.80
Phone: 503 649 - 1271 Total $78.30
Contractor:
BEAVERTON HEATING +A/C INC
5400 SW 170TH AVE
ALOHA, OR 97007 REQUIRED INSPECTIONS
Phone: Heating Unt Insp
hone: 649 - 1271
Cooling Unt Insp
Reg #: LIC 118441 Final Inspection
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.
c
Issued By: Permittee Signature: 7 — •
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
i •
Mechanical " ermit Application FOR OFFICE USE ONLY
lit
R eceived
City of Tigard DateBy: ' `J /n� . Permit Not /16c ��a(, ,,,a a
13125 SW Hall Blvd., Tigard, OR 97223 Plan Re 7 V
Phone: 503.639.4171 Fax: 503.598.1960 /L4n ;\ Date/B Other Permit:
Inspection Line: 503.639.4175 Date/By:
5 .639..us _., Date ed /Met Ready/By: lur Supplemental See Page l Information
Internet:
g Notified/Method:1(� Supplemental [ nformation
E 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: $
dwelling ❑ y ; - RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
and 2-family g ❑ Commercial/industrial Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION - Heat'
Job site address: /D eq§ S to 5 t ,�, y � t/ y l pi (_ .a7I, it conditionin r heat pump
p an showing placement) / 14.00
City/State/ZIP: ( - G„ ()2 mace ,000 BTU ( ducts/vents) / 14.00
"" / F ce 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: 1.6„6- 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
a i 1 0 eic C _ �) C Gas fireplace gas
10.00
(�/ H'tr (13 /tu (O�
� -r Flue vent for water heater or as
e „�cj Zt4 1 _ '7( 1 S ? � Logligh ter (gas) 10.00 10.00
7�.JK.t�IQ �'fC �,� C.l Log lighter J Wood/pellet stove 10.00
Wood fireplace /insert 10.00
D- ROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: Ac ' e _ Environmental exhaust and ventilation
Address: I Q� 5 Su�a Ar L o- l ){ Range hood /other kitchen
equipment 10.00
City/ State/ZIP: ( Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( 503) 5' 7 al 0 4 5S Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:e:LA.)c 4 6_ Fuel piping
Contact name: 'reVZ,I/\ t \ -' i [ Q` � $5.40 for first four; $1.00 for each additional
Address: S .S 11 PnJe Furnace, etc.
Gas heat pump
City/ State/ZIP: ci,,Ljef-1,p -v\ OR 9100 '7 Wall /suspended /unit heater
Phone: (50)) 64, 1 12 71 Fax: : (Sa .g) 64q €446 Water heater
Fireplace
E -mail: i i tA Jo S Range
C T RA TOR • Barbecue
Business name:
Clothes dryer (gas)
Other:
Address: S � � MECHANICAL PERMIT FEES *, -
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 7,2. t
i 8 4�- Plan review (25% of permit fee)
CCB lic.: � State surcharge (8% of permit fee) i O
TOTAL PERMIT FEE -7c( . 3 Q
Authorized signaturs I This permit application expires if a permit is not obtained within 180
( t` days after it has been accepted as complete.
Print name: 00 Jj, o 4A o ti S Date: S/Cf��/, • Fee methodology set by Tri- County Building industry Service Board
\m \
i:\BuildingPeutsMEC- PermitApp.doc 12/03 440 -4617T (1 1 / 2/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.
is\ Building \Permits\MEC- PertnitApp.doc 12/03 2
IH Beaverton Heating & A/C, Inc.
At FULL SERVICE: GAS • A/C • ELECTRIC • HEAT PUMP • CONVERSIONS • ADD -ONS TO EXISTING SYSTEMS
&0j � T - A4£0-d4N1CAL f 5L I GAS L /'Y L GAS Fjizikma_ Fz, / / 4/
OUYDoof P,ivii
6414 CL yJ
5400 S.W. 170th Avenue • Aloha, Oregon 97007 • (503) 649 -1271 • (503) 649 -6446 fax • CCB# 118441
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) R39 -4175 MST
INSPECTION DIVISION Business Line: '503) 639 -4171
it 30 — - - -- / _ _ i B
Received Date Requested S - 1 AEI // `' r' BUP
Location /b 4 <_ 1��1n�Vt�il �� i Suite IVfE' D Y D a,8
Contact Person k a u-c-,ti Ph ( ) 6 K-/a171 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner
Footing ELC
Foundation Access:
Ftg Drain ' e v in S ELR
Crawl Drain �--
Slab Inspection Notes: SIT
Post & Beam /CL/ietiet-C-e
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear J t �® — do 0 - O
°
Framing (� L/
Insulation / (es- , 1 x
Drywall Nailing '
Firewall
Fire Sprinkler t
Fire Alarm ) ) . 6 ` �� G.
R Ceiling 3 0 - Vy
Roof � ,p 7\x
Other: 1
Final C ∎AN
PASS PART FAIL
PLUMBING 3 d Ci---t-,_,C \p-rA--et-k_ eL,(-- 0_..c._.-C
Post & Beam
Under Slab
Rough Service
�� � e
Water Service v
Sanitary Sewer .e S 1--- .' LA 4 / C2.051/4-9 ,
Rain Drains
Catch Basin / Manhole 1 )
Storm Drain
Shower Pan
Other:
Final ./
PASS PART FAIL S
MECHANICAL
Post & Beam g CA
Rou • h -In
Smo e Dampers /YA///
. PART AIL
CTRICAL
S= ice
Rou•
UG /SI .
Lo . tage
F : Alarm
` ' 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspe ion RE: fl 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