Permit CITY TIGARD MECHANICAL PERMIT
, DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00798
` It'll ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/7/2004
PARCEL: 1 S 125DA -01400
SITE ADDRESS: 06700 SW TAYLORS FERRY RD
SUBDIVISION: ZONING: R - 4.5
BLOCK: LOT: 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:
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: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas water heater.
Owner: FEES
GEIGER, DARLENE Description Date Amount
6700 SW TAYLORS FERRY RD [MECH] Permit Fee 12/6/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 12/6/200 $5.80
Phone: 503- 245 -0674 Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Gas Line Insp
Misc. Inspection
Reg #: 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.
f ti
Issued By: Permittee Sig .ture: ;0. , ' . � � ( ��
• 7
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next bu-iness d
Mechanical Permit A lication , . y ' FOR OFFICE USE ONLY ;
' R eceived
City of T7,P'ilI (� � `' � � Date/By: Permit No. , \- . jzt �I
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review [/v ■
Phone: 503.639.4171 Fax 503.598.1960 DEC ((�� rj //raN�,� I DateBy: Other Permit:
Inspection Line: 503.639.4175 D 0 / ," /11
Date Ready/By: EN H See Page 2 for
Internet: www.ci.ti ard. or.us `
g Notified/Method: Supplemental Information
,:. . m . ,.; „��
CITY OF T
', .. ,., t t' - . u : z... t f .W, i �, T Prv 3I .c - ` CO , DZMERC I AT-r` FEE *SC HED UL E * US E:C HECKLIST
❑ New construction Ad dition/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.
r, - - , 7 . . , 3 . g asa r .- :47r`. Value: $
:' ` _ '� x . i' . CATg EG OF CONS,T ,u 't ';``1 ;, o 4 , ; 4.i&i as ; , RE lYT S*
1- and 2-family dwelling C /industrial r SIDE IAL EQUIEMENT lSYSTENIS F.EE
y g ❑ ❑Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea Total
Iii - • JOB SITEj 'FORMATIO %IY, D- LQC 4TIQNt Heatin
Job site address: Lol S \N ) �al F fs ?� Air conditioning or heat
(requires site plan showino o placement) 14.00
City/State /ZIP 3 Furnace 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
j
� ( o /�f� Hydronic hot water system 14.00
SA,) '6 y — /6Y'S /"'Z/I / 6 ()7IJV Residential boiler (radiator or
I 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
I . €: :; -':, ;:£ :. - - :� T ure :E- ; r t ,.. .::$,., ,. .. 10.00
id k .. .,itr DESCRIP =TJ$ F jg» RI i,1pL 3 '� Water heater
$s'��.1<; ^':' „��'3 � , z „„p ..afi .� �'�.�Pa�u�'�,�,��f#s"'>, r�. � •.Y .. �,�.�' � � ,,. T:;
Gas fireplace 10.00
-) t . t tt 1 L /�% ' to / a / / .,/, ' 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
p er ` .. ,.. P R .a .... 4, 4 i ° 4 ` *. 0 . t A N T ` i : f ... Chimney /liner /flue /vent 10.00
R pEERTY OWNE
Other: 10.00
Name: \ l a Q Environmental exhaust and ventilation
FFFF Range hood /other kitchen
Address: t n Gil (--
/ O equipment 10.00
City/State /ZIP: On Cj� / ` 9122 I Clothes dryer exhaust 10.00
1 Single -duct exhaust (bathrooms,
Phone:SCG � $ d (6 7 Fax: ( ) toilet compartments, utility rooms) 6.80
.' ,, .;ri; ,i i; =Ez r. =. grip c /crawl ace fans
C . „ . ,APPLICANT lit ' - Y .. ., �... z'A' . ,., CON ACT PER ., q, 1 At s 10.00 Other: 10.00
Business name:
Fuel piping
Contact name:, Q $5.40 for first four; $1.00 for each additional
Address:
(7
7J1 F urnace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E - mail:
Range
c 'A J ) ff GONTRA�TOR e � 't it Barbecue
_s.u,�.� „�.. � . � . at..��..�, sx• n -� ..., „Ke;,.. - .4.:.w_ � � �.�. ,_ _ . l- -.2. ....ft' - emu
Business name: Clothes dryer (gas)
Other:
Address: ,1/y� Q -s•g.; . ..�I , y , A . y ,
'I ” `��—' „�� ;,ECHANIGAL"PERMTT FEES *:, -'
City/State /ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE 7 b
Authorized signature: ,.. 4, This permit application expires if a permit is not obtained within 130
days after it has been accepted as complete.
Print name: 1 AV' {Q l ( Q,L Q t Date: )17.0 * Fee methodology set by Tri- County Building Industry Service Board
1:\Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (I I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard F
Page 2 - Supplemental Information
Commercial Fee Schedule:
"VtalValuatron,. r°PermrttFee, + .. n ;
$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:\BuildingWermits\MEC-PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Rece i / �"-0 Date ested r �� �` � AM PM BUP
Location ( 100 S 6 ( ) I ' /A6 Suite MEC 00 4 - 00 7`71f
Contact Person , �h ! . � 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
Framing
Insulation
Drywall Nailing '
Firewall `• A �MVI. /1_ Orr
Fire Sprinkler
Fire Alarm
Susp'd Ceiling •
Roof i
Other: (DE ' M Final ` v \w
PASS PART FAIL
PLUMBING
Post & Beam • �-1 1
Under Slab _ —
Rough -In « if 1. f ;
Water Service
Sanitary Sewer •
• Rain Drains
Catch Basin / Manhole
Storm Drain ��f
I
Shower Pan `� I
Other: �
Final surrafttn, �
PAS T FAIL , " 1
CHANIC •
Post &Beam
Rough -In
Gas Line
•.,•:sa - mpers
l%
PART FAIL
- - ' RICAL
Service
Rough -In .
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE u Please call r reinspection RE: n Unable to inspect - no access
„ otcrio
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final • DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL