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CITY O F T I G A R® MFS ;iANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00611
LA 13125 SW Hall Blvd., Tigfira, OR 97223 (503) 639-4171 D.QTE ISSUED: 10/21/03
PARCEL: 2S111 BA-02103
SITE ADDRESS: 09925 SW INEZ ST
SUBDIVISION: INGEBRAND HEIGHTS ZONING: R-3.5
FLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: AL T FLOOR FURN: EVAP COOLERS:
T"PE OF USE: SF LINT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS WIO APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES _ 0 - 3 HP: DOMES. INCIN.
3 - 15 HP: COMML. INCIN:
MAX INPUT: R'r, 15 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES'
GAS PRES;URE: 50 + HP:
CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
OTHER UNITS:
URN >=100K BTU: <= 10000 cfm: -�
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>
GAS OUTLETS:
10000 cfm:
Remarks: Replace furnace&flue/vent
Owner: _ FEES
WARREN, JACK R Description Date Amount
SHARON I. 10121/03 $12.50
9925 SW INEZ ST [MECHJ Permit I rr
TIGARD, OR 97224 [TAX]R" Statc]a\ _ 10/2.1/03 $5.80
Phone: 503-6.39-3494 _ Teal $78.30
Contractor:
BEAVERTON HEATIN 7 + A/C INC
5400 SW 170TH AVE
ALOHA, OR 97007 REQUIRED INSPECTIONS
Phone: .t I Duct Inspection
Final Inspection
Reg#: I_IC 118441
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable law:. All work will be done in accordance with approved plans. This permit will expire if wo,R 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: --L _ ) - �I� _ Perrnittee Signature
r
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application Received Mechanical
Date/By:16 Permit No. -DD(1_/
CityLit O11 jl and PlanningApprova Building
DateiBy: Permit No.:
13125 SW Hall Blvd. Plan Review Other --"
Tigard,Oregon 97223 Date/9y: Permit No.:
Phone: 503-639-4171 Fax: 503-59'3-1960 Post-Review Land Use
Date/By: Case No.:
Internet: www.ci.rigard.or.us Contact — Juns.. Sec?age?G.r
24-hour Inspection Request: 503-639-4175 Name/Method: Sulemcntal Information.
TYPE OF WORK COMMERCL41,FEE*SCHEDULE-USE CHECKLIST
New constructi n_ _ D Demolition Mechanical perms rtes"aye based on the total value of the work
j [Q'Addition/alteration/replacemen_t_ Other: performed. Indicate tic• lue(rounced to the nearest dollar)of all
f CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit.
1 & 2-Family dwellin Cornin:!rcial/IndUstrial� Value: S See Page 2 for Fee Schedule
Accessory Buildin 'Multi-Famil; RESIDENTIAL EQUIPMENT/SYSTEMS FEE*SCHEDrJLE
--- Description ty. Fee ea. 7 ct«i
Master Builder LJ Other: Hestin Conlin
JOB SITE INFORMATWN and LOCATION Furnac •add-on air conditionin •• 14.00
Job site address: f •w s r as cat pump 14.00
Suite#: BIL3./Apt.#: _ Duct work 14.00
Project Name: H dronic hot waters stem 14.00
Residential boiler
Cross street/Directions to job site: - (for radiator or hydropic system) 14.00
Unit heaters(fuel,not electric)
'g in wall,in-dust,suspended,etc.) 14.00
L <-v C'L. Flue/vent for any of above 10.00
Subdivision: Lot#: Re air units 12.15
Tax map/parcel #: Water heater Other Fuel Ap Ilaeces 10.00
DESCRIPTION OF 1%,)RKGas fireplace 10.00
dtT.✓aC� /�LP4 Ai r�+nt v_� Flue vent iwater heater/ as fireplace) 10.00
Log lighter gas 10.00
Wood/Pellet stove _ 10.00
Wood fire lace,'insert 10.00 _
Chimney/liner/flue/vent Y 10.00 _
PROPERTY OWNER _ TENANT Other: 10.00
Name: Environmental Exhaust&Vertiladoc _
Range hood/other kitchen equipment !0.00
Address_4yy?,2 S!s'r✓ O�c s ---
-- Clothes dryer exhaust 10.00
Cit /State/Zi
p: /"«"! Single duct exhaust
Phone:yv'.. e Fax: (bathrooms,toilet compartments,
APPLICANT I Ll CONTACT PERSON_ utility rooms 6.80
Name: �'t'd�.•to/ spac
_ Attic/crawl e fans _ 10.00
Sr��d ,,, 7O*'�q✓ Other: —_ 10.00
Address:
Fuel Piping _
Cit /State/Zi :,t0'e.n,61"W e'/L 9-7ao 7 "*($5.40 for first 4,$1.00 each additional
-- Furnace,etc. •�
Phone:-r,,3 rz 7� Fax: ey y 6'%y Gas heat pump _ — _ — ••
E-mail: Wall/suspended/unit heater_ _ •• _
CONTRACTOR Water heater _ ••
Business Name: eKr:4,1or ," 7_1_ ,q Fireplace _ ••
Address: 7e•`'1 ,g�/ Range ••
BBQ
Cit /State/Zi :,Ae- 'W 2 97ro '7 - Clothes dryer(gas)
Phone:_i->J--e _/z Fax: 6ySf e _ Other: ••
CCB Lic. Total:
-- _ Mechanical
Authorized � Permit Fees*
Subtotal: $
Signature: 1I ..�, � Date:/CJ ?_/ `� Mirimum Permit Fee 572.50 S ,
_�j xv,,� Aly/ {Z Plan Review E ec 125°a of Permit Fee S
(Please print name) State Surcharge 8110 of Permit Fee) SQL
To'rAL PER�11T
Notice: This permit application expires If a permit Is not ohiained Hithin *Fee methodology set by Tri-County Building Industry Sersice Roard.
180 days after It has been accepted as complete. "Site plan required for exterior A/C units.
is\Dsts'Termit FormsMeePermitApp doc 01,03
Mechanical Permit Application - Cite of Tigard
Pale 2 - Supplemental Information
Commercial Fee Schedule:
TOTAL VALUATION: PERMIT FEE:
$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
Path 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.
$100,001.00 and up $1,396.50 for the first S 100,000.000 and
$1.10 for each additional$100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets )f plans.
i16uilding\Permit Forms\MecPermilAppPg2 09-01-03.doc
CITY OF TI%'.'X"A►IRD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPEC710N DIVISION Business Line: (503)639-4171 MST
( U �?3 BUP ---- --
Received z. -Date Requested_ L'zq AM PM_ BUP _
Location S Z :5-( ----Suite---- �C)
Contact Person ___,p. CB�� _ Ph( ) 6 ��� PLM —
Contractor Y
— Pti( _) __ SWR —_—�—
BUILDING Tenant/Owner _ —� _ BLG
Footing - ---
Foundation Access: ELG _-
Fig Drain
ELR --
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors -
Ext Sheath/Shear
Irrt Sheath/Shear ---
Framinr -,�.!1 �L�2.iCJ1L uc oiZ .aLafG
Insulation
Drywall Nailing
Firewall -
Fire Sprinkler
Fire Alarm —
Susp'd Ceiling -- —
Roof
Other:
Final
PASS PART FAIL ---
PLUMBING
Post& Ream — -- -- — -
Under Slab
Rough-In -
Water Service
Sanitary Sewer
Rain Drains — ---_ —
Catch Basin/Manhole
Storm Drain - —
Shower Pan
Other• — - -- ---- _
Finst ------ ------
PASS PART FAIL -- —� —
MECHANICAL a_
Post& Bea F- --
Rough-In gf�-1L
Gas Line
peke Dampers
H
irai
-
6a
FAIL ----- —
IC.t,L
service
Rough-In _
UG/Slab ^�— —
Low Voltage
Fire Alarm --
Final El Reinspection fee of$— required before next Inspection. Nay at City Hall, 13125 SW Hall Blvd.
PASS _PART FAIL
31TE _ `_ [-] Please call for reinspe 1lon RE: _+ Unable to inspect-no access
Fire Supply Lin 9___
ADA
Approach/Sidewalk Date Inspector _ — Ext ^—
Other:
Final DO NOT REMOVE this Inspection record from the Job slits.
PASS PART rAIL