Permit CITY OF TIGARD
MECHANICAL PERMIT
fir ^, DEVELOPMENT SERVICES PERMIT #: MEC2004 -00644
, .� � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/27/2004
PARCEL: 2S 104AA -05600
SITE ADDRESS: 12730 SW WILLS PL
SUBDIVISION: BELLWOOD NO. 2 ZONING: R -4.5
BLOCK: . LOT: 077 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: 0 VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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:
Remarks: Install gas furnace, push/pull, venting for water heater.
Owner: FEES
HUGHES, JUSTIN & TAYLOR Description Date Amount
12730 SW WILLS PL [MECH] Permit Fee 9/27/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 9/27/200 $5.80
Phone: 503 - 425 - 9140 Total $78.30
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone: 503 - 284 - 2173 Heating Unt Insp
Misc. Inspection
Reg #: LIC 222 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 direct questions to OUNC by calling
(503)246 -6699.
Issued By: j Permittee Signature: q Quo
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application • FOR OFFICE USE -ONLY
,h' g Received el Oy — V - ,C .o ZO
Cl of Ti and Rec Permit Nu (` ��C�y
13Ittt5 SW HAI' blvd., Tigard, OR 97223 RECEIV Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 411 f.. ,+ I . ° • Date/By: Other Permit:
l �. •
Inspection Line: 503.639.4175 �'` 1 11. Juris 65 See Page 2 for
t _ t Ready /By:
Internet: www.ci.tigard.or.us SEP Ntui fied/Method: D at e --il (,r- Supplemental Information
TYPE OICW UGP►RD COMMERCIAL FEE' SCHEDULE - USE CHECKLIST
gfilEUitt N
�lVISIO Mechanical permit fees* are based on the value of the work
❑ New construction ( dditio ra ton/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
Q -1✓and 2- family dwelling ❑ Cofnmercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. 1 Ea. 1 Total
JOB SITE 1.1' • RMATION AND LOCATION Heatinp/coolnn
/� 1 C ) C d� ,/ Air conditioning or heat pump
Job site address:
62 / / Q (� � 1 L/ /1 / ` �7'C�L (requires site plan showing placement) 14.00
City/State/ZIP: T d 97 er 3 Furnace 100000 BTU (ducts/vents) 1 14.00 p p{—
.6J t ,_ Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt no.: Project name a lgal Yl�-S Gas heat pump 14.00
Cross street/directions to job site: Duct work 1400
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit beaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue/vent for any of above i 10.00 l Q
Subdivision: Lot no.: Other 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION *OF WORK Water heater 10.00
S w Gas fireplace 10.00
< r Flue vent for water heater or gas L' - � — ��� � / fireplace 10.00
.�/ Lid a e_ YQ./!t >r' CJ � (/ /� W � Log fighter (gas) 10.00
�J Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 1 10.00 LC JD
OrCROPERTY OWNER I 0 TENANT Other. 10.00
Name: T r _Q ! iti l Environmental exhaust and ventilation v L�(O 4re Range hood/other kitchen
Address: I g...'7 O 5w L a k equipment 10.00
City/ State/ZIP: � 3 Clothes dryer exhaust 10.00
I i Single -duct exhaust (bathrooms,
Phone: 653) 9 I go Fax: ( ) 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
Furnace, etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
ax :: Water heater
Phone: ( ) Fax: ( ) Fireplace
E-mail: Range
CONTRACTOR Barbecue
/ � f (/ A� melt'
. Clothes dryer (gas)
Business name: n f - Other
Address: 4 4 /.1 r7 E 1 K 7 Ali/ef j MECHANICAL PERMIT FEES'
City/State•/ZIP: 7 A Subtotal 3y�
(� ~- _/ G � Minimum permit fee ($72.50) � ,71
Phone: (53) map I Fax: ( 3bp 28/ 153e Plan review (25% of permit fee)
CCB lie.: Q� State surcharge (8% of permit fee)
"'��'" — TOTAL PERMIT FEE /15. t
This permit application expires if a permit is not obtained within HO
Authorized signature: after it has been accepted as complete.
I Print name: � _ I Date: Q [ /A a ,,� I • Fee methodology set by Tri•County Building Industry Service Board
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/-1/ BUP
Received Date Requested ! AM PM BU
Location W41 Ica Suite ME �O (/ '<e (°
Contact Person 2ervYLC-e- Ph ( ) 2 ?4-/- `a 73 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC t■I
Footing
Foundation ELC
Ft A ccess: 6
9 Drain f • . ELR
Crawl Drain i '
Slab Inspecti • / otes. � V ' SIT
Post & Beam ��
Shear Anchors i A /l� •
Ext Sheath/Shear v"
Int Sheath/Shear
Framing
Insulation /
I 1 , Q _ � C/\ 7/
Drywall Nailing l �� / j®
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam � " ,d/./ _
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PAS FAIL
CHypll AL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
CTRICAL •
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El 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 / / J Vb
ADA v
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL