Permit t
,'
4 CITY OF1]GARD MECHANICAL PERMIT
A,, �n DEVELOPMENT SERVICES PERMIT #: MEC2004 -00626
41 P
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4 DATE IAR ECEL: : 1513 004
ARL 1 S133D6 -04400
SITE ADDRESS 11381 SW WINTERLAKE DR
SUBDIVISION BRITTANY SQUARE NO. 4 ZONING: R -12
BLOCK LOT: 072 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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: < =10000 cfm:
> GAS OUTLETS:
10000 cfm:
Remarks: Replace gas furnace with like kind.
Owner: FEES
MICHELLE CARLTON Description Date Amount
11381 SW WINTERLAKE DR [MECH] Permit Fee 9/17/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 9/17/200 $5.80
Phone: 503 -579 -4540 Total $78.30
Contractor:
VALLEY HEATING AND AIR
2584 BULLOCK RD
MEDFORD, OR 97504 REQUIRED INSPECTIONS
Phone: 541 - 944 -8397 Heating Unt Insp
Final Inspection
Reg #: LIC 22457
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
952-0 1- 00.1- 0- thtough OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(5 246 -6699.
Is ed By: ,_,g ..4 ^ ia � / ■ t • Permittee Signature: 0 -4 a---
T Call (5.3) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Meckan cal Permit Application FOR OFFICE USE ONLY
w City of Tigard Re c eived 9 1 7 y Permit No.: / ( .. 0 6,90,
13125 SW Hall Blvd., Tigard, OR 97223
Date/ Plan
Review
Phone: 503.639 4171 Fax: 503.598.1960 Other Permit
Ak47. - 80g..•, ii\ Date/By.
Inspection Line: 503.639 4175 , A I I Date Ready/By. �iury/� 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 ❑ Addition/alteration/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: $
RESIDENTIAL EQUH'MENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ CommerciaVindustrial ❑ Accessory building
For special information use checklist
❑ Multi-family ❑ M builder 0 Other: Descnption I Qt I Ea. Total
' JOB SITE INFORMATION AND LOCATION . Heating/cooling
Job site address: // 3 f� W/ 4 , 7-a.,-L, 7-a.,-L, ce� f Air conditioning or heat pump
a40
- /CGIi� (requires site plan showing placement) 14.00
City/State/ZIP: -7-/4 ,(_,0 r D 9 6 02e2-Z, Furnace 100,000 BTU (ducts/vents) 1 14.00
Furnace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Q- 4- iC/ Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electnc),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
. DESCRIPTION OF WORK. ' . Water heater 10 00
n Gas fireplace 10.00
i -/G L t_z .e.) a if 6-` ' /Z / 6-- Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent (0.00
.- Other 10 00
Name: / Q��L _ a---,-,,6 , Environmental exhaust and ventilation
Address: _ / e j bo 1,0 N / L Q_ - i �� - Range hood /other kitchen
/ �-�/✓ 'L a- equipment 10.00
City/State/ZIP: - T - / ,,,*--*---/e._40 B 9 7� �'3 Clothes dryer exhaust 10.00
�/,, Single -duct exhaust (bathrooms,
Phone: (�7� % �f 9 c45-14) Fax: ( ) toilet compartments, utility rooms) 6.80
' , APPLICANT - .❑ CONTACT_ PERSON Attic/crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: K4.--LL Y -eye -,- ),, "-t., Clothes dryer (gas)
Other -
Address: e2 Ste' -Z [_[_ 6 �J�L - MECHANICAL PERMIT FEES* '
City/State/ZIP: 4, /z_, ,e...,3 4 g 9 7 S2) V Subtotal
Phone: (6 - 9 ( _ $7 7 Fax: („Mr 79— 9 5-/l Minimum permit fee ($72.50) g„
ax
Plan review (25% of permit fee) l
CCB lic.: 0 2,2_ 0 2,2_ G / O C) � `7 State surcharge (8% of permit fee) 7 g
TOTAL PERMIT FEE
Authorized SlgnatWe: � This permit application expires if a permit is not obtained within 180
w/ days after it has been accepted as complete.
Print name: //�t..- 2-4-20_.,C_7 - 11 0 ') Date: 9h774 • Fee methodology set by Tri- County Building Industry Service Board
i \Buidding\PemiitsC- PennitApp doc 12/03 440 -4617T (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
YrailiAltAitiarXN
$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.
•
•-
u\BuildingTermits\MEC-PermitApp doc 12/03 2
CITY OF TIGARD 244Iour
BUILDING Inspection - : (503) 639 -4175
INSPECTION DIVISION - Business e: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location 3 r _ _ ,.1.: . Suite ME D O - 'D ex 4,
Contact Person Ph ( ) PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner 1L - > / - 4 _ �, ELC 1 0 N
Footing o 7 4 / 1 1 — 23 '1 6 ') 1-54,0-44-3:333 ELC
Foundation Access:`' C
Ftg Drain ELR
Crawl Drain
Slab Insp Ion Notes: C 8 e SIT
Post & Beam
Shear Anchors / 6 , 11
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation / �L W/A-- Dryw Drywall Nailing 4
Firewall I / / ' , 4 • /
Fire Sprinkler J � ��� - �� ��� 411:
Fire Alarm ki 1.1o loo
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 u ���„�,(�
Rough-In �.[
Gas Line L /
Smoke Dampers
i a PART FAIL
E RICAL
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 1=l Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2g aX Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL