Permit CITY TIGARD MECHANICAL PERMIT
'I� DEVELOPMENT SERVICES PERMIT #: MEC2005 -00639
I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/7/2005
PARCEL: 1S125DD-07900
SITE ADDRESS: 09695 SW VENTURA CT ZONING: R -4.5
SUBDIVISION: WASHINGTON SQUARE ESTATES NO.3 LOT: 087 JURISDICTION: TIG
Project Description: Permit for final inspection of existing furnace.
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
HERBER, JOSEPH A Description Date Amount
9695 SW VENTURA CT [MECH] PernutFee 10/7/200: $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/7/200f. $5.80
Phone: 503 245 - 1791 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
Reg #:
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 -00 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 50 ;-246-6699
or 1- 800 - 332 -2344.
Issued By: Z /7( /. Permittee Signature: L• „ ' !,`j./
Call 503 - 639 -4175 by 7:00 a.m. for inspections t at business day.I
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.
Media q cal Per g elication FOR OFFICE USE ONLY . .
City of Tigard E1V® Received � I 05 Permit N �/ , y'i
13125 SW Hall Blvd., Tigard, OR 97223 �1 r J
Plan Revie
Phone: 503.639.4171 Fax: 503 . al 60 ,, Other Permit
;,, `\ Date/By
Inspection Line: 503.639.4175 f ? 0 7 2005 _ . .j�. -� _�_ L Date Ready/By: N El See Page 2 for
Internet: www.ci.tigard.or us Notified/Method Supplemental Information
CITY OF TIGARD
BUIL ®rdtS1t1RK 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 RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2-family g ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family 0 Master builder
❑ Other: Description I Qty I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address:9 C CV , e�� M. tt • p conditioning or heat p pump
1 v (requires plan showing placement) 14.00
City /State /ZIP A oveck 90 - °� Furnace 100,000 BTU (ducts/vents) ( 14.00
J 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
Flue /vent for any of above 10.00
Subdivision: I Lot no.: Other: 10.00
Tax map /parcel no.. Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
• Gas fireplace 10.00 •
r (,/ TAD t r S LI aye Flue vent for water heater or gas
fireplace , 10.00
Log lighter (gas) 10 00
Wood/pellet stove 1 0.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER ❑ TENANT
Chimney/liner/flue/vent 10.00
l O S other: lo.00
e V Nam f 'Q'r \ v ' Environmental exhaust and ventilation
Address: 6 Range hood/other kitchen
e� � I U r0✓ equipment 10.00
City /State /ZIP: >l 0 q 7 1L Clothes dryer exhaust 10.00
Single duct exhaust (bathrooms,
Phone:.a _ ! v OS) ' i i (951 ) 3 13" toilet compartments, utility rooms) 6.80
❑ APPLICANT - ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
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 ( ) I Fax:: ( ) Water heater
Fireplace
E -mail:
Range
C Barbecue
c Clothes dryer (gas)
\��...JJJ
Business name: 0 Kt-11112,1— • /4 OWr Oth
YVI
Address: MECHANICAL PERMIT'FEES* •
City /State/ZIP: Subtotal
• Minimum permit fee ($72.50) 7g y0
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee) 0 j. $'d
TOTAL PERMIT FEE .7fr, 30
Authorized signa . -' • ■ A i This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Q t► , 1� a i Date: o a • Fee methodology set by Tn- County Building Industry Service Board
i\ Buildmg\PernitatMEC- PermiW.pdoc 12/03 440 4617T(11 • 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.
i:\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD
444 t) h J � iy 7 y'� 1/14444-4,4 d j
O
BUILDIN DIVISION PERMIT #: MEC2005-00639
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/7/2005
Phone: (503) 639 -4171 , 1 �'
Inspection Requests (24 Hrs.): (503) 639 -4175 �'!+� "II
INSPECTION WORKSHEET FOR DATE: 11/1/2005 TIME: 7:06AM PAGE: 11
SITE ADDRESS: 09695 SW VENTURA CT CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE ESTATES NO.:: LOT #: 087 TYPE OF USE:
PROJECT NAME: HERBER
DESCRIPTION: Permit for final inspection of existing furnace .
OWNER: . HERBER, JOSEPH A, PHONE #: 503 -245 -1791
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 020018 -01 503. 730.0244 Y Va 0 -to 12:60
' 0/001 kW 6c%
Corrections /Comments /Instructions:
•
•
.!-� PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
\ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 91//Xt.: Date: !!'`� i Phone #: (503) 718-