Permit rte' w.
'CITY O TIGARD MECHANICAL PERMIT
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� DEVELOPMENT SERVICES PERMIT #: MEC2003 -00581
'-' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
PARCEL: 2S111 BC -03700
SITE ADDRESS: 10420 SW VIEW TERR
SUBDIVISION: DOUGLAS HEIGHTS ZONING: R -3.5
BLOCK: LOT: 004 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: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 0
> 10000 cfm: GAS OUTLETS: 1
Remarks: Gas line to cooktop and exhaust. (downdraft).
Owner: FEES
FAIRLEY, RONALD S + KAREN S Description Date Amount
10420 SW VIEW TERRACE
TIGARD, OR 97224 [MECH] Permit Fee 9/30/03 $72.50
[TAX] 8% StateTax 9/30/03 $5.80
Phone: 503 639 - 6344 Total $78.30
Contractor:
VALLEY RENOVATION
1055 NE 25TH AVE
HILLSBORO, OR 97124 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 144427 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 -00
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Issued By: w t. Permittee Signature: k` 0 V
1 ^
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
N.
Mechanical Permit Application FOR OFFICE USE ONLY
Received ,\ Mechanical �i
Date/By /v ,3 61 Permit No/((LGC�003 "'r7()5 0 4
C1 of Ti aC I ® Planning Apprs al Building
`J g Date/By Permit No :
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223SEP 3 0 a�( l3 Date/By Permit No.
Phone: 503- 639 -4171 Fax: 503-598-1960 1960 Post - Review Land Use
ul � Date/By. Case No :
Internet: wvvw.ci.tig T . I I Contact J ns.: ® See Page 2 for
24 -hour Inspection gtR IVGyMi i 75 Name/Method / /Cj _ Supplemental 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 matenals, equipment, labor, overhead and profit.
❑ 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 - add -on air conditioning ** 14.00
Job site address: 1/5 ) 'lf'eft,J - etr - Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: Vvke 4-0 (for radiator or hydronic system) 14.00
I D3 * Udw d'Ctl.L'e- - Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units - 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
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
❑ PROPERTY OWNER I 0 TENANT Other: 10.00
Name:l>h t ac`t~.� Fq\ C'�,e Environmental Exhaust & Ventilation
� �� y Range hood/other kitchen equipment % 10.00
Address: S Ile, z {t iLe--
City /State /Zip: T-t &c. 7-2-4 Single dryer exhaust 10.00
Single duct exhaust
Phone: 6 631 3144 Fax: (bathrooms, toilet compartments,
❑ APPLICANT CONTACT PERSON utility rooms) 6.80
Name$ c ifY .‘,1\_. Attic /crawl space fans 10.00
Address: I DS'S f Other 10.00
Fuel Piping
City /State /Zip: �t b ®(a -c-t_ 17 t a& * *($5.40 for first 4, $1.00 each additional)
Phone:,5 643 .i-j Fax: Furnace, etc. **
Gas heat pump **
E -mail: Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name: v .p ,, Fireplace **
Address: /05-5— 0_ (k.V.4.- Range 1 **
City /State /Zip: +(-cLL. Clothes dryer (gas) **
Phone: i V 3 - 61.7 3 -7;s 1'l _ Fax: Other: **
CCB Lic. #: 1 I t Lk 24 6 - a I —C2 <o Total:
Authonzed ,A Mechanical Permit Fees*
Signature. I ` Date e).3 Subtotal: S
p 1 Minimum Permit Fee $72.50 $ - 7.- -
q t�� v 'i . k Plan Review Fee (25% of Permit Fee) $
(Please punt name) State Surcharge (8% of Permit Fee) $ S
TOTAL PERMIT FEE $ 7k. e
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i \Dsts\Pernit Forms\MecPemiitApp doc 01/03
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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and
$1.10 for each additional $100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of plans.
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i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
7 !/.76 /
Received Date Requested l Z PM BUP
Location /0 c � coL? \JQ Suite el 3 -00 SF/
Contact Person Ph ( ) r7. q3 -' 2 3? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler 0111/5„
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
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers •
Final
PART FAIL
TRICAL
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: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Date /
Approach /Sidewalk � / Inspector 1 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL