Permit CITY TIGARD MECHANICAL PERMIT
AT DEVELOPMENT SERVICES PERMIT #: MEC2003 -00694
'�'I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/5/03
PARCEL: 2S 103 D D -00200
SITE ADDRESS: 13530 SW WATKINS AVE
SUBDIVISION: MELROSE ZONING: R -3.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: Install fireplace insert
Owner: FEES
CEARLEY, DARRELL A + Description Date Amount
ANGELA M
13530 SW WATKINS AVE [MECH] Permit Fee 12/5/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 12/5/03 $5.80
Phone: 503 620 - 3803 Total $78.30
Contractor:
DENNIS STOREY CONSTRUCTION
37432 NE CLARA SMITH RD
CORBETT, OR 97019 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 67267
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 By: �Pjyy( Permittee Signature: (QUA Q
Call ( 03) 639 -4175 by 7:00 P.M. for inspections needed the next business d
t - ,
FOR 01: FICE 1 ONLY
Mechanical Permit Application Received
D i 0 3 9fig- — mpcnnicch.",:aofili,c"" 0746v3 ove, e/i/
C
Planning 'Approval Building
ity of Tigard Date./By. Perrrut No..
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Dote/By Permit No.
Phone: 503-639-4171 Fax: 503-598-1960 ,: , ,., Post-Review Land Use
"• I .‘ , 11:1113 - Cue No.:
Internet: www.ci.tigard.or.us 41. -;i I Contact Juns.: S See Page 2 for
24-hour Inspection Request: 503-639-4175 '''—' "" Name/Method: Supplemental Information.
''... ' '.',?••:.: ‘'' i: ',, '....: ', -TYPE OFIWORK":1:',. '.;.:';'.:....]-`, , - ;.::...-...,, .:;,:-.,:'. „i '''' FEE•SCHEDULE 41ISE CHECKLIST 'c",, ,.-"-', '','
0 New construction El Demolition Mechanic pe . iI fee . b. , • o the tot: value ojthe work
D Addinon/alteration/replacement 111 Other: perform •. • , te . e va. (rounsed • e e: -t d 11 all
` ..L . ..' mccham , mat a , equi . ent, I.. • , over .. and p it
1 & 2-Family dwelling D Commercial/Industrial , value: See Page 2 fur Fee Schedule
Accessog Building
\I\ 4
Master Builder D Multi-Family
El Other: ..;," RESIDENTIAL
Deseripdon I OtY I
Reatlag/Coollog Fee(ea.) I Total
;IJORSITEINFORMATIONsad:LOCATIOIC :: ' -1, Furnace - add-on air conditioning' 14.00
Job site address: 1 50 "3o.i-kirts Gas heat pump , 14.00
Suite #: I BItts./Apt.#: Duct work 14 00
Project Name. Hydronic hot water system 14.00
Residential boiler
Cross strecVDirections to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
in wall, in suspended, etc.) _ 14.00
Flue/vent (for any of above) ltiTKT1
S d" . si : I Repair units
- -
Other Fuel Appliances 12.15
T pa I • , _
Water heater 10.00
;;;;DESCRIPTION:OEWORIC:;'::.. , .1.;..•:,. Gas fireplace 10 00
t nfyirdi .3?.-.t-e. Owe, Flue vent (w let heater/gas fireplace) 1(1.00 -
?I\ 1 Y_(_--*_ Log lighter (gas) 10 00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
. , Chimney/liner/Oue/vent 10.00
O . PROPERTY - OWNER:f i :. 3 / : .1' . . el .TWANT.I.4: 11:A.:.,„' , r•'r. Other: 10,00j _
ame:
Address: to 1? 1/4)..) ' , irre ‘ C e(LIrtf,_1-1 A . n Environmental Exhaust & Ventilation .
Range hood/other kitchen equipment 10.00
) 530 5 .
Clothes dryer exhaust 10.00
City/State/Zip: -- Tiack_jrd 012 cria.„3.3
Single duct exhaust
Phone:50319?0-13 Fax: (bathrooms, toilet compartments,
' FIAPPLICANC.': `.'.•:.. ' ; .f: utility rooms) ii 80 ,
' Name: Attic/crawl space fans 111.00 .
Other 10.00
Address: Fuel Piping
,. .
City/State/Zip: ($5.40 for first 4, 51.00 each additional)
,, F etc.
Phone: i Gas heat pump
Fax: F
' ••
E-mail: ..
Wall/suspendecVunit heater
''. - :CONTRACTOR:: 7. .:,' .. , .: .' Water heater •• .
Business Name: bc,ririfs si-O r e, u ( Cora Fireplace .4,
Address: "3 ivs Ict-ra shilzoi pAckd Range ••
BBQ ' ••
City/State/Zip: C_Orbe-i / el P._ 0,70 n . Clothes dryer (gas) •• '
.Phone: 603 [ Fax: so3-h4s-5a7 Other: . •• —
CCB Lic. #: (0-7?-42-7 Total
Authorized
Mechanical Permit Fees'
Signature: Date:/ z - 5 3 Subtotal. S
Minimum Permit Fee $72 50 $
?( T) - 0
i (" ire/ i ee_A-/ley , Plan Review Fee (25 of Permit Fee) S
(P e lrin n r4
State Surcharge (8% of Permit Fee) S
TOTAL PERMIT FEE $
• 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 ForinsNecPervnitApp.doc 01/03
TOO Z C1111/9I.I. AO AID 096196C0 S XVd ST:OT COOZ/170/ZT
TY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
// �� �� ASOX/ BUP
Received / 272-2) ,
? ( late Requested z4,�q' /�j AM PM BUP
Location / 3 S3 0 �, Suite 3 - DC) (09 4Z
r
Contact Person .� i 1.. ' � •
.:1 6 ' Ph ( 5O) h 2- O 3 ?d 2 ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
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
P FAIL
ECHANICAL
Rough -In
Gas Line
Smoke
F r.'
S PART FAIL
ECTRICAL
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 I 0 6 ,
Approach/Sidewalk Date ` Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL