Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00757
c � l l i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/18/2004
PARCEL: 2S110BD -00700
SITE ADDRESS: 11870 SW WILDWOOD ST
SUBDIVISION: SHADOW HILLS ZONING: R -2
BLOCK: LOT: 005 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:
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: 1 •
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas fireplace and gas piping.
Owner: FEES
KAREN LINDER Description Date Amount
11870 SW WILDWOOD [MECH] Permit Fee 11/18/20( $72.50 •
TIGARD, OR 97223 [TAX] 8% State Surchari 11/18/20( $5.80
Phone: 503 968 - 2909 Total $78.30
Contractor:
JAY'S GAS PIPING
PO BOX 393
BEAVERCREEK, OR 97004 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 119836 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 dire : - estions to OUNC by calling
(503)24 99.
By: fM� -‘414 Issue B � � � � Permittee Signature: � ., �� � Aipt
Call (503) 639 -4175 by 7:00 P.M. for inspections needed • iness day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: / Rpm" Permit No r - O , . 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review -
Pl
Phone: 503.639.4171 Fax: 503.598.1960 //y ,1\
Date/
By "�I� y Other Permit.
Inspection Line: 503.639.4175 ■ r.T Date Ready/By. Mill ® See Page 2 for
Internet: www.ci.tigard.or.us � - Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction tEl Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all �
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit
6 CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory buildin
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. Ea. Total
JOB SITE INFORMATION AND LOCATIOON Heating/cooling
Job site address: ! / 7 o S W VL (cI(/O c ,g� Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/ State/ZIP: Ti:i /t i4 O y - � Furnace 100,000 BTU (ducts /vents) 14.00
1 ' (�1 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: / i . Obi I J rn FA/ Duct work 14.00
4 99' I J ! i
Residential is hot water system 14.00
Reside boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
/ Q A Flue/vent for any of above 10.00
Subdivision:5kN d / Lot no.:
C „ ` Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
j I / gaA / f `' oga u- '� Gas fireplace
for / 10.00
l Flue vent r water heater or 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 TEf NT Other: 10.00
Name: q , / ///�
/ � ( o r Environmental exhaust and ventilation
Karr4 Range hood /other kitchen
Address: Sa rnt 9 9 /' ( J 3r-] � /J equipment 10.00
City/State/ZIP: f/vJ 6 /J f ` Clothes dryer exhaust 10.00
) 9 / „ � , n o ( ) compartments, Single-duct exhaust (bathrooms,
Phone: 9 (vn p Y Fax: toilet corn n utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
n /1 Other: 10.00
Business name: G r ,� 1 S 6 0 S i p v) q Fuel piping
Contact name: /a +i joit-ri $5.40 for first four; • $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City/State/ZIP: Wall /suspended/unit heater
Phone: (9•) CO `3 a ' <J Fax: • ( ) Water heater
Fireplace / _
E -mail: Range
CONTRACTOR r Barbecue
Business name: \\ A�� Clothes dryer (gas)
B
�Ull.f ( 1 Other:
Address: MECHANICAL PERMIT FEES*
City/ State/ZIP: Subtotal
Minimum permit fee ($72.50) 7,A.5
Phone: ( ) 63 a t %a3 Fax: ( ) Plan review (25% of permit fee)
CCB lic.: 0 / r 3j State surcharge (8% of permit fee) (5'. $0
` 1 TOTAL PERMIT FEE 7g, 30
Authorized s' -lure: This permit application expires If a permit Is not obtained within 180
days after it has been accepted as complete.
Print name: ��/�N �� , Date: , i iFFP ' Fee methodology set by Tri- County Building Industry Service Board
• t\ Building \Permits\MEC- PcimitAppdoc 12/03 440- 4617T(I1 /02/CaM/WEB)
Mechanical Permit Application -'City of Tigard
Page 2 - Supplenierital Information • • • ,• • • •
Commercial Fee Schedule:
$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.
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t.. 7
i:\Building\Permits\MEC-PermitApp.doc 12/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: 03) 639 -4171
1 BUP
Received Date Requested / `r "AM PM BUP
Location J _ ��� �%� = Suite ".' ' MY-6°7,57
Contact Person Ph _ ) PLM
Contractor P , ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: BULL, r^%
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Sheath/Shear . / . T1J �' d
Int Sheath/Shear
Framing i 11
Insulation
Drywall Nailing
Firewall - Sprinkler S - 1; Co ) 0 ; Q S
Fire Alarm
Susp'd Ceiling
Roof
Other:
-
Final
PASS PART FAIL
PLUMBING
Post & Beam
toor
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PAS T FAIL
ECH L
Post &'Beam .
•
Rough -In '(r
Smoke Dampers
( PART FAIL
CTRICAL
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 0 Please call for reinspection RE Unable to inspect - no access
Fire Supply Line
ADA 4 ,
Date Ext
Approach/Sidewalk D a Inspector /_ w
Other:
Final DO NOT REMOVE this Inspection recor Ir the Job site. .
PASS PART FAIL