9145 SW NORTH DAKOTA STREET-1 IS VIO)lVG HIHON MS SM
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9145 SW NORTH DAKOTA St
- CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2004-00817
13125 SW rials Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 12/16/2004
PARCEL: 1 S135DB-08100
SITE ADDRESS: 09145 SW NORTH DAKOTA ST
SUBDIVISION: ASHBROOK FARM ZONING: R-4.5
BLOCK: LOT: 025 JURISDICTION: TIG
!CLASS OF WORK: OTR FLOOR TURN: 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:
3 - 15 HP: CCMML. INCIN:
MAX INPUT: P,rU 15-30 HP: RF.PAIR UNITS:
FIRE DAMPERS?: 30-50 HP: VVOODSTOVES:
GAS PRESSURE: 50+ HP: CLO DRYERS:
FURN < Innv nr'—' 1 AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remar�s: Replace gas furnace.
Owner: FEES _
KIRKPATRICK, KELLEY Description Date Amount
9145 SW N DAKOTA ST IMECH)Permit Fee 12/16120( $72.50
TIGARD, OR 97223 [TAX] 8%)State Surchari 12/16/20( $5.80
Total $78.30
Phone: -- -------- —
Contractor:
OREGON HEATING + A/C INC
BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
DU _
Heating Unt Insp
Phone: 538-2953 Final Inspection
Reg#: LIC 125815
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all othrr applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not starteJ within 180 days of issuance, or if work is suspe,.ded for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Noti;ication 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: � 41� Permittee Sig nt.FttrEr.
Call (503)639-4175 by 7:00 P.M. for Inspections needed th buslness day
Mechanical Permit Applicatidn
City of Tigard Rcccived PerrtdtNo.
DawAy ���C.cfG"V 7 U
1 x175 SW hall Blvd,Tigard,OR 97223 Plan Review
Phone: 503 639.4171 Fax: 503.598.1960 Uate/By. Other Permit:
Inspection Line: 503.639.4173
Date Ready/By 3uru ® gee Page 2 for
Internet: www.ci.tigard.or.us NotiftedRdethod I(r Supplcmentallnrormatton—
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er; iit!t i c'�lLCnV6f019 - USPCHECKL[ST
❑New construction �[30'Addition/alteration/replacement Mechanical permit fees*are based on the value of the wotk
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical rnatenals,equipment,labor,overhead,and profit.
Value S
N'I1AI
1-and 2-13urtily dwelling ❑Commercial/industrial ❑ EQUIPMENT/SYSTEMS FEES*
Accessory building --
❑ hl-Camp
For special information use checklist
Mu
y []Master builder ❑Other: Description Qty Ea. Total
W-V 160 RM
Heating/cooling
Job site address: (� �� / e / y Air conditioning or heat pump
.l�� •_L7t1e' (require site plan showin 4cemmt 14.00
City/State/ZIP: �`�, ect name: Furnace 100,000 BTU d( uctstventii14.00
Suite/bldg./apt.no.:
"- Furnace 100,000+BTU(ducwvents� 17.90
Proj --
Gas heat pump 14.00
Cross street/directions to job site: Duct work 1400
Hydron�c hot water system _ 14.00
_ Residential boiler(radiator or
h dronic 14.00
- -- Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 10.00
Subdivision: Lot no.: Flue/vent for an of above 10.00
Other: _ _ 10.00
Tax map/parcel no.: Other fuel appliance _
Water heater 10.00
Gas fireplace 10.00
_ Flue vent for water heater or gas
fi Ilr�are _ 10.00
----
Log lighter _ 10.00
Wood/ ellet stove 10.00 _
Wood fireplace/insert 10.00 ^
F* Chitrmey/liner/flue/vent 10.00
'eft Other: _ 10.00
Environmental exhaust and ventilation
Address: Range hood/other kitchen
e upmmtent — 10.O0 _
City/State/ZIP: Clothes dryer exhaust 10.00 —___
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( ) toilet compartments,utility rooms) 6.80
1f i, i t Attic/crawls ace fans 10.00 _
Business name: Other: 10.00
, — _
_ Fuel piping
Contact name: - '� $5.40 for 11rat four;$1.00 for each additions!
4' �6 � Furnace,etc.
Address:
Gas heat pump
N City/State/ZIP: Wall/suspended/unit heater
Phone:( ) l !'�l Fax::( ) Water heater
Fi lace
E-mail:
Range
Barbecue —
u�,
W Business name: Clothes dryer ash_
"O Other:
Address:
City/State/ZIP: Subtotal
_ Minimum permit fee($72.50)
Phone:( ) _ �15 Fax:( ) = Plan review(25%of permit fee)
CCB lic.: /+����.!� — State surcharge(89.6 of permit fee)
TOTAL PERMIT FEE
Authorized signature. This permit application expires Ira permit is not obtained within 180
Olt
of
_ days after It has been accepted as complete.
Print name: [.rete: • Fee methodology set by Tri-County Building Industry Service Board
i lBuiidinauPermits\MBC-PermitApp doc :2103 440-461 IT(I IM2/cowwa9)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
S 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$2.30
for each additional$I00.00 or fraction
the_reof,to and including$5,000.00.
$5,001.00 to S 10,000.00 $141.50 for the first$5,000.00 and
$1.80 for each additional$100.00 or
fraction thereof,to and uiciuding
_ $10,000.00.
S 10,001.00 to$50,01)0.00 $231.50 for the first$10,000.00 and
$1.35 for each additional$109.00 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
$1.10 for each additional S 100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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i:\Building\renTdts\MEC-Pe"nitApp.doc 12/03 2
CITY OF TIGARD 24-Hour
BUILDING 0 0 Inspection Line: (603)6369-4�175
INSPECTION DIVISION Business Lim (50 639--4171 T -- �`---
BUP -- —_—.—�-
Received ___ _Date Req ested_ 3 P OUP —
Location -----C' !�� uite MEC �4)0 CQXx`7
Contact Person Ph _) 3 q s�. PLM
Contractor— P (— ) _ SWR _
BUILDING _ Tenant/Owner _ _ ELC --
Footing
Foundation ELC --. --
Ftg Drain AC�eSS: ELF#
Crawl Drain
Slab Inspection Notes: �, L j_- A-!f Snve- SIT
Post&Beam _
Shear Anchors QCT '7`/M(:- f-v C'C., --
Ext Sheath/Shear _
Int Sheath/Shear
Framing _—
Insulation
Drywall Nailing
Firewall
Fire Sprinkler — - -- -----
Fire Alarm
Susp'd Ceiling
Roof
Other: —
Final
PASS PART FAIL --
PLUMBING _
Post&Beam
Under Slab
Rough-In
W^ter Service
Sa atary Sewer
Rain Drains — ---
Catch Basin/Manhole
Storm Drain — ---
Shower Pan
Other: ---
Final
PASS PART FAIL --
MECHANICAL _ _ --
Post&Beam
Rough-In
Gas line
CIL S mpers
CO) PASS/ ART FAIL -- - _ -- —
ICAL
.,t Service
m Rough-In
F3 UG/Slab
W Low Voltage
J Fire Alarm - — �__--__---- —,_-•
Final F] Reinspecticn fee of$— required before next inspection. Pay at City Hall, '.1125 SW Hall Blvd.
PASS PART FAIL
SITE F] Please call for reinspection RE: Unable to inspect-no amass
Fire Supply Line _
ADA /
DMO ates v, ___ In#poCto►
Other:
Final DO NOT REMOVE this Inspnsttan rmmrd •job alto.
PASS PART FAIL