Permit CITY TIGARD MECHANICAL PERMIT
4 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00504
6.6.1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/18/03
PARCEL: 2S 109 BA -04900
1 SITE ADDRESS: 14119 SW WAGONER PL
r SUBDIVISION: HILLSHIRE SUMMIT NO. 2 ZONING: R -7
` a BLOCK: LOT: 031 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:
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:
> 10000 cfm: GAS OUTLETS: 1
Remarks: 1 l Oft. underground gas line to pool heater (1) outlet.
Owner: FEES
KAELIN, GREGORY A + SUSAN T Description Date Amount
14119 SW WAGONER PL
TIGARD, OR 97224 [MECH] Permit Fee 8/18/03 $72.50
[TAX] 8% StateTax 8/18/03 $5.80
Phone: Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Gas Line Insp
Heating Unt lnsp
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 -00
Issued B Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next • siness day
Mechanical Permit Ap lication FOR OFFICE USE ONLY
R eceived lli Me
R EC E IV DateBy: �// $/03 .)1') Permit No. -C. , ? 3 - ,r �0
City of Tigard Planning A pra al Building
Date/By: Permit No.:
13125 SW Hall Blvd. AUG 18 2003 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
+ Phone: 503- 639 -4171 Fax: 503 - 598 -1960 ��a Post - Review Land Use
Internet: www.ci.tigardno�Prt'��tt� Y OF TIGAR nN c .� I I Date/By.
Contact ontact Case No.:
Juns : ® See Page 2 for
• 24 - hour Inspection Regllt l P5 Name/Method. 1 I Os 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 materials, equipment, labor, overhead and profit.
® I & 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 p Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: pi//5 Sw ,..,,,g4a,x0._ ,00/Ar_4 / 776,9,f...D 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: (for radiator or hydronic system) 14.00
6- L /VI c wpvvw — /6/-4.-5.74/24-. Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
/W i Z.Co 4 L kGe.t�ci2 P64 ca 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
ND ' ,..ti - d,'`ti G,z•a..•■•A C 45 L./,u C: ,C2 Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
/-4U5.cS "AS-rt_ 7 /4 3o , ./E G•owuJ /Lc_ Wood/Pellet stove 10.00
A410._ Wood fireplace/insert 10.00
Chimney/liner /flue /vent 10.00
0 PROPERTY OWNER I ❑ TENANT Other: 10.00
Name: �it �y K,t`L�.� Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: lyll9 5; -....> wc440,+,e =/1- Ab Clothes dryer exhaust 10.00
City /State /Zip: 7 4 az 02 5'7Z2 -f Single duct exhaust
Phone: 6 524 'Nei/ I'Fax: (bathrooms, toilet compartments,
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Other: 10.00
Address: Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Phone: Fax: Gas heat pump **
E -mail: WalUsuspended/unit heater **
CONTRACTOR Water heater t / **
Business Name: t (`) 1,0 i\re °� Fireplace **
Address: Range ** BBQ **
City /State /Zip: Clothes dryer (gas) **
'Q(J
Phone: Fax: Other: 4._ /46/4 f **
CCB Lic. #: Total:
Mechanical Permit Fees*
Authorized Subtotal: $ "7-... .5
Signature: Date: $ (8"` 03 Minimum Permit Fee $72.50 $
Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ 5" irG
TOTAL PERMIT FEE $ -y S1, ?,( )
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\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
10I k 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 Inspection Lin
INSPECTION DIVISION Business Line: " "MST
I BUP
Received Date Requested / 7 AM PM BUP
Location /L/// q fp Suite MEC c 60, 3 - 0 o5?J f
Contact Person P Ph ( ) Sa -'-) ' 7 PLM
Contractor V Ph ( ) SWR
BUILDING Tenant/Owner ELC (Ponca - 6d51
Footing
ELC
Foundation Drain Access: C- o �,,n 66 ELR
Ft Drain / J J
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear •
Int Sheath/Shear
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
Other:
Final
PASS - FAIL
Rough -In
Gas Line
Smoke Dampers
'L. W PART FAIL
Service _
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SS • ART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line Date
ADA .8 / 2 �7 Inspector Ext
A pproach /Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from tsite.
PASS PART FAIL