Permit C ITY OF TIGARD MECHANICAL PERMIT
1A DEVELOPMENT SERVICES PERMIT #: MEC2003 -00675
+L , II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/25/03
PARCEL: 1S133DA-00500
SITE ADDRESS: 11040 SW SUMMER LAKE DR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 027 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: 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace with like kind.
Owner: FEES
VANSICKLE, CHERYL S + Description Date Amount
GERARDS, HUBERT J
11040 SW SUMMER LAKE DR [MECH] Permit Fee 11/25/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 11/25/03 $5.80 .
Phone: Total $78.30
Contractor:
D + R HEATING +AIR COND
PO BOX 1292
27251 S DAVE RD REQUIRED INSPECTIONS
CANBY, OR 97013 ,
Phone: Heating Unt Insp r--
hone: 503 - 266 1229
Final Inspection
Reg #: LIC 84489
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 -00
/� - i.`
4
Issu
cci By: L._ ; 41: .0i____ , iA ►./� Permittee Signature: - ' ; - ',/
Call (50 : 9-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application Received FOR OFFICE USE ONLY
ived Mechanical G�
• Date/B : / A _ i, Permit No.: N td d/3 -a) / 7
Planning Ap• oval Building
City of Tigard Date/B : Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/B : Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
4a> i' IA Date/B : Case No.:
Internet: www.ci.tigard.or.us ,A1:7411 I Contact IIPM ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: affrom Su . lemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
X 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
-
JOB SITE INFORMATION and LOCATION Furnace - . id -on air conditioning ** 1 14.00
Job site address: / /6' , f �' i ' %, e iL Gas he .ump 14.00
Suite #: I Bldg. /Apt. #: ` • work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: I Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
9 /96 iv ,,..9-.5 GA/7e �i / Flue vent (water heater /gas fireplace) 10.00
/ Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
ROPERTY OWNER I ❑ TENANT Other: 10.00
Environmental Exhaust & Ventilation
fi e ' ✓("� ��� Range hoo kitchen equipment 10.00
Address: /k3 6� �(/ #2/ze,f_ /014_ 4 Clothes dryer exhaust 10.00
City /State /Zi 4.e */2.7 Single duct exhaust
Phone: .5 53 Fax: (bathrooms, toilet compartments,
❑ APPLICANT [CONTACT PERSON utility rooms) 6.80
Name: /T/T7� /G1 44,,,..7,0- Attic/crawl space fans 10.00
/ Other: 10.00
Address:
�.9me RS ,�.o� Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Phone: Fax: **
Gas heat pump
E -mail: Wall /suspended/unit heater **
CONTRACTOR Water heater **
Business Name: D 4 (? tieczn n �j A 1e_L�1�Q• Fireplace **
**
Address: t Range
Cit City/State/Zip: C�,bj/ C`� . �' Zo3 BBQ **
y p Clothes dryer (gas) **
Phone :5) ( a'5 I Fax - 5 (L 2_057 Other: *
CCB Lie. #: t34q�>3 Total:
Authoriz Mechanical Permit Fees*
: at . - Date: //, 45 Subtotal: $
Minimum Permit Fee $72.50 $ "79 • 5
v /G/ L 5 Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ 6, W.)
TOTAL PERMIT FEE , !Jj
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industr Tervice Board.
180 days after it has been accepted as complete. •*Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information '
•
•
Commercial Fee Schedule:
•
Total Valuation: Permit Fee: •
$1.00 to $5,000.00 Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52
for each additional $100.00 or fraction
thereof, to and including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and
$1.45 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
•
fraction thereof.
Assumed Valuations Per Appliance: •
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor. 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
•
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
•
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION: •
is \Dsts\Permit Forms \MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspectio ' e: 3) 639 -4175
INSPECTION DIVISION Busines L' . (503) 639 - 4171 MST
�,,� /�f BUP
Received Date Requested X . .> � ' I ` AM PM BUP
Location l I D 4 SA K ✓ /f& h Suite 3 —o 0 676
Contact Person Da d Ph ( ) 78 - 0-5/ 7 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 KIN] O 3 / � , ,P �
Framing "" C l �
Insulation
Drywall Nailing
Firewall ( ‹v t9Pa / l v T 4 BO _ / S
Fire Sprinkler � �E �'Y
Fire Alarm - - /a . — - Gam- / � —
Susp'd Ceiling –
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
FAIL
E
Post & Beam
Rough -In
Gas Line
S oke Dampers
i
PART FAIL
CTRICAL
Service
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: El Unable to inspect – no access
Fire Supply Line
ADA Approach/Sidewalk Date ' I ` Inspector
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL