Permit •
C1TY TIGARD MECHANICAL PERMIT
r� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00221
•
. .� j- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/28/04
PARCEL: 1 S133CD - 06000
SITE ADDRESS: 11763 SW SWENDON LP
SUBDIVISION: COTSWALD MEADOWS ZONING: R -25
BLOCK: LOT: 058 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:
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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of a/c unit.
Owner: FEES
TRYON, LANCE F + SUZIE K Description Date Amount
11763 SW SWENDON LP [MECH] Permit Fee 4/28/04 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 4/28/04 $5.80
Phone: Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223
Phone: 503 - 624 -2704 Cooling Unt Insp
Final Inspection
Reg #: LIC 76359
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 - �
O. You may obtain copies of these rules or direct questions to OUNC by calling
(5 -6699. • I
sued By: �� i - Permittee Signature: x
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mech nical Permit Application FOR OFFICE USE ONLY
City of Tigard Received AMIE DaDate/By: M Permit No.: ii 1 / ��v / �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 /i . p ..:q, \ D ate /B y: Other Permit:
Inspection Line: 503.639.4175 , .0' Y_I Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: - 1 L a, Supplemental Information
TYPE OF WORK COMMERCIAL FEE *. SCHEDULE _. USE CHECKLIST
El New construction ddition /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: $
and 2 -famil dwellin RESIDENTIAL EQUIPMENT /_SYSTEMS FEES*
For special information use checklist.
y g ❑ Commercial/industrial ❑ Accessory building
R stf ulti -famil
Multi-family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION ''� .: Heating/cooling
Air conditioning or heat pump
Job site address:
/ /'7A 5 i t<!tJ te zt../ r , C.Q (requires site plan showing placement) / 14.00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17.90
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
M 0 0 e f}-C. 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 • 4ROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00
/r Other: 10.00
Name: Lei /lice T . g Environmental exhaust and ventilation
/ Range hood/other kitchen
Address:
b 3 s 5 ea/ Cn op equipment 10.00
City/State/ZIP: ��/ Clothes dryer exhaust 10.00
Q Fax: Single -duct exhaust (bathrooms,
Phone:
( s0) S Alt 9 / ( ) toilet compartments, utility rooms) 6.80
. ❑ APPLICANT - ❑ CONTACT PERSON ' 1 - Attic /crawlspace fans 10.00
Business name: Other: 10.00
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
Clothes dryer (gas)
Business name: Ce //c," ,G 1 6..D v /, r ,/ 9 Other:
Address: f d 6 O X (-PO, 73 7 M ECHANICAL PERMIT FEES*
city/state/ZIP: �/ '' c, ci 0/- 97/ 3 Subtotal
r / Minimum permit fee ($72.50)
Phone: (�j �) � atL 2...--2 i T Fax: ( 5p3 ) 5 7 6 n A. 77 Plan review (25% of permit fee)
CCB lic.: CJ !7 3 5 , State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: fl4 e t d e / Dom. .Z , y ! ate: .y� �/ ' Fee methodology set by Tri- County Building Industry Service Board
is\ Building \Pemtits\MEC- PemtitApp.doc 12/03 440-4617T (I 1 /02/CMM/
OWE B)
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
i .
HEATING & COOLING, INC.
8900 S.W. BURN:HAM ROAD, SUITE E110
TIGARD, OR 97223
(503) 624 -2704
FAX (503) 59 8-0270
( 51 \
•
JOB ADDRESS: / 7 3 S' SW-e tioe,e -h 6c.2
SITE PLAN FOR AC OUTDOOR UNIT LOCATION
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested
(61„c BUP
PM BUP s 0
5 4) ite
Location I V 7 co 5 5 O 0 ) 1
Contact Person V OLe. Ph _ — c'7 Q 4- PLM
Contractor `. / ......... a.: Ph ( ) SWR
BUILDING Tenant/Owner 1 1 O V\ ELC Al'e
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ` SIT
Post & Beam A ( C1
Shear Anchors
Ext Sheath/Shear ,� Q
Int Sheath/Shear 6 —e_-
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
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
• - - PART FAIL
r ECHANICAL
. Post & Beam
Rough -In \C/ Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
• ice
Roug'
UG/Slab
Low • tage
•
F : Alarm
inal ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ��
Approach/Sidewalk Date �8 /i./ Inspector Ext
Other: / / /27 7.....
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL