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10035 SW HIGHLAND DK
CITY OF TIGA►RD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST --
INSPECTION DIVISION Business Line: (503)639-4171
BUP __.— —
Received 2— c_Date Requests _ AMT—. PM _— _— BLIP _—
Location _ . 1 _ ',1 crc'
7 �U
Contact Person __ C.t-2- Ph(— ) PLM
----
Contractor — _-- _—•-- _ Ph( ) SWR
WILDING Tenant/Owner El C _
Footing ELC
Foundation Access:
Fig Drain ELR
ICrawl Drain --- SIT
Slab Inspection Notes-
Post&Beam
Shear Anchors C C/i/y1(,C( cC, ,,[moi 1 1�U• Cl Ov"1,9 (p -
Ext Sheath/Shear / (/ -- -- ----- -- --
Int Sheath/Shear
Framing —
Insulation --
Drywall Nailing
Firewall _
Fire Sprinkler
Fire Alarm
Susp'd Cei+ing ---_-----
Roof _ — _—
Other' --- -- --
Final —-- -- — -- --
PASS PART FAIL
PLUMBING__ - f - - ------ -- -- — ---��
fust&Beam --
Under Slab -- - ---- -- ---- -- -., -- -------
Rough-In
Water c -rvice ----------
Sanitary Sewer
Rai,,Drams - _ ------__----------- --
Catch Basin/Manhole
Storm Drain - _ --
Shower Pan
Other:
Final
PASS PART FAIL
--
Post& Beam —
Rough-In —— - -
Gas Line
Dampers -_—
Final
FAIL �� -- ---- -
Servic..
Rough-In — ---- --__ ------
UG/Slab /
Low Voltage —�✓L2—_�- �"�- - ---- —---- ------ - r
Fire Alarm
Reinspection fee of$_-._.._ __ _required before next inspection. Pay at City Hall, 13125 SW Hail Blvd
S PART _FA_IL.
SITE - Please call for reinsoection RE:_ ----_____ LJ Unable to inspect-no access
Fire Supply line �(T� e U
ADA / �•� - ins motor� / � �J'Z'`T` Ext-
Approach/Sidewalk Date _ -- p
Other:al DO NOT REMOVE this inspection record 400m the)ob'site.
PASS PART FAIL
i
CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: M 00020
DATE ISSUED: 1115/0415/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S111CC-15600
SITE ADDRESS: 10035 SW HIGHLAND DR
SUBDIVISION: SUMMERFIELD NO.4 ZONING: R-7
BLOCK: LOT: 207 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:
PG _ 3 - 15 HP: COMMI_. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K PTU: I AIR HANDLING UNITS _ OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: IU-place ga:: furnace.
Owner: FEES
CLAUDiA FRANKLIN Description Date _ Amount
10035 SW HIGHLAND IME II] Permit Fee 1/15/04 $72.50
TIGARD, OR 97224 1TAXI `; Si;itc Surchart 1/15/04 $5.80
Total $78.30
Phone: 503-620-8569 ---
Contractor
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
89003W BURNHAM #E1110 REQUIRED INSPECTIONS _.
TIGARD, OR 972.23 Heating Unt Insp
Phone: 503-624-2704 Final Inspection
Reg#: LIC 76359
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 null 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 rales adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952.-001-00
Issu d By: Lki - 4 Permittee Signature:
Call (503) 639-4175 by '7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Received / Mechanical /� �
Date,B Permit No.. Q a(,h
City Of Tigard Planning Ap royal Building
I" Date/By Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 ate Y: Permit No.:
Phone: 503-639-4171 Fax: 503-595-1960 Post-Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us Contact See Page 2 for
24-hour Inspection Request: 503-639-4175 NamelMethod /lilo I Supplemental InN.•mation.
TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
New construction Dentolitior. Mechanical perm:1 fees*are based on the total value of the work
- Addition/alteration/re lacemcnt ❑ Uther: performed. Indicate the value(rounded to the nearest dollar)ofall
CATEGORY OF CONSTRUCTION mechanical material:,equipment,labor,overhead and profit.
1 & 2 Fark-nly dwelling Comrnercial/Industrial Value: S __ ,ec Page 2 for Fee Schedule
f Accessory Budding _ _Multi-Family RESIDENTIAL EQUIPMENT/SYSTEMS FEE*SCHEDULE
Master Builder - Other: Description _ tv Fee ea. Total
Hestin Coolin
JOB SITE INFORMATION and LOCATION Fumace-add-on air conditioning•• 14.00
Job site uddress: nuc t f Gas heat pump 1400
Suite 4 BI_d ./A to 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)
in wall,in-duct,suspended,etc.) _14.00
Flue/vent for any of above _ 10.00
Subdivision: Lot #: Repair units 12.15
Tax map/parcel #; ocher Fuel A trances
Water heater10.00
DESCRIPTION OF WORK _ Ga:;fire lace � 10.00
�`'I J/ ` Flue vent(water heater/gas fire lace) _ 10.00
7 Lug light^r(gas) _ 10.00
— -- --- — Wood/Pellet stove _ 10.00
Wood fireplace/insert 10.00
Chimney/liner,'fluei vent 10.00
PROPERTY OWNER TENANT Other: 10.00
Environmental Exhaust&Ventilation
Name: C/!Ct u dt a i 2 AA/le—! A) Range hood/other kitchen equipment 10.00
Address: 160 J-5- Ss.:
1Q.m Clothes dryer exhaust 10.00
City/State/Zi :
Single duct exhaust
Phone: slzv dO5'4 Fax: _ (bathrooms,toilet compartments,
APPLICANT CONTACT PERSON utility rooms_ 6.80
Name: Attic/crawl space fans _ 10.00
:-
Address ------ ---- Other: 10.00
-- — --- — --- — Fuel Piping
City/State/Zip: •"(55.40 for first 4,$1.00 each addition
Phone: Fax:
Furnace,etc. •'
-- ----- - --- -- Gas heat pump ..
E-mail: _ _ Wall/suspended/unit heater •• _
CONTRACTOR Water heater ••
+.
USIneSS Name: ,,.?�,.� ,l„[�;, Fireplace ++
Address: o �� Range
Z---— B_�_ ++
City/State/Zip: _ Clothes dryer(gas) ••
Phone: -70 Fax: _ Other: _ ••
CCB Lic. Total
Authorized _ Mechanical Permit Fees'
Subtotal. S
Signature: -iyc�' � Dere
Minimum Permit Fee$72.50 $
Plan Review Fee(25 of Permit Fee) S
(Please print name)' State Surcharr a(8110 of Permit Fee) S _
- _ TOTAL PFRVIIT FEE $
�oUcc: 1'hiv permit rpplicauon espires if a permit rs not obtained within •Fee methodology%et'ry Tri-Counh Building Industry Service Board.
191)dad c after it has been accepted as complete. "Site plan requirri for exterl,r A/C units.
1M.,11Crritli I ornu Mc'Pcrnut 1PPdnc ()1 01;
Mechanical Permit Application - Cite of Tigard
Page 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
each additional$100.00 or fraction thereof,to
_ and including$!0,000.00.
$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$11)0,000.00 $771.50 for the first$50,000.00 and$!.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$100,000.000 and
$1.10 for each additional$100.00 or fraction
thereof.
All Ne", Commercial Buildings require 2 sets of plans.
i\Building\Permit Forrns\MecPermitAppPg2 09-01.03 doc